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Trinity qualtitatis: strucure - process - outcome
In memoriam Avedis Donabedian Dieter Bo rger

Avedis Donabedian Professor at the School of Public Health at the University of Michigan, Ann Arbor, whose name and work are inextricably connected with the concerns of the quality of medical care , died on 9 November 2000 of cancer, which his body had pressed for thirty years. Structure - Process - Result: this trinity insignificant words like exegesis, he has done over bulky books
(Donabedian 1980.1982 .1985), made him famous in the world. Almost all the time in his career spent it in a small study room in the Thomas Francis Building, School of Public Health at the University of Michigan, Ann Arbor Nathan Sinai Distinguished Professor of Public Health (Emeritus since 1989).
Ann Arbor is one of the Big Ten universities and the University Hospital is one of the leading U.S.;. A place at Oxford imprint in the remote hills of Michigan on Huron River, which are by Cooper's Leatherstocking so familiar was born Avedis Donabedian. on June 7, 1919 in Beirut, the son of a physician. He studied medicine, was first practicing physician in Jerusalem and then later to attend Harvard University to be
Public Health study. His family was a Victims det Armenian Holocaust, the survivors scattered these little people all over the world.

His scientific habitus consistent with its cultural tradition, a scribe who writes books and gathers his disciples around him. Although the paper flood averse to modern science, but he wrote a Citation - classic, published in 1966 in the Milbank Memorial Fund Quarterly, entitled: Evaluating the quality of medical care (Donabedian 1966). This topic has never left him and he was successful evangelist of a message conveyed in the 80's also reached Germany and who gave this journal its name.
The Donabedlian paradigm
structure process results experienced ni s
organizational diagnosis clinically
building therapy functional
technology interaction by patients
Expertise Management Healthier Life

The history of medical quality assurance is of course as old as medicine itself, but only the time after 1960 brings a systematic and Begiffsapparat academisation, leading to a practical field with its own identity. That this work was done by a former practitioner is almost surprising, but perhaps an academic role for a first residents only geek in this field - a fate that also affected many Jewish refugees from Germany.
The motive and the legitimacy of the author of this obituary is in the randomness of the individual life course, which took him on the advice of Manfred planting in the mid 70s to the School of Public Health to Ann Arbor. There has taught Avedis Donabedian and Axelrod Salomon as a prophet of a publicly responsible and organized health care. the American reality, however, increasingly
should counteract. The "hidden agenda" of teaching, research and rhetoric was to finally make it in the U.S., which had lead by example Bismark and Beveridge in Europe: medical care as a public good. The Kennedy-Johnson era had to an expansion of Medicare (1965) performed as well as a Health Planning and HMO legislation. The still coming from the Roosevelt era lines appeared again to allow a health care reform.
Donabedian was not a practitioner of quality assurance, as reflected in Auditing - systems, quality circles, statistical quality assurance procedures and total quality management today, certification etc. expressed. but he was the stellar academic and systematization of realities that contradicted their formalities its general claims to the nature of the medical commission of times. In a personal interview
in 2000, he has work experience in dealing with his own Disease it this run (Mullan 2001):

"The perception of quality that prevails at the hospital (he means specifically, which belongs to the 10 leading hospitals of the nation University Hospital in Ann Abor) is reduced to technical competence and first since recently focused on more superficial interpersonal communication, are as nice to the patient, remember his name and so on. The idea that the patient should co-decide his treatment is not handled in a responsible manner. Today we talk about patient autonomy, but this is seen as a legitimation for patient neglect. I think the hospital corridors are a disaster. I think the commercialization of medical care is poured out error. Health care is a mission. It is a moral and scientific enterprise, we do not sell products.
We have all this shadow apparatus of quality assurance that is not working. The clinicians are either uninterested or unable to make himself understood. "
And in regard to the future of American health care, he said,
" The doctors distrusted always the governments you rejected any reform of American health care. The national health insurance under Truman, Medicare, under Johnson, and recently the reform work under Bill Clinton . Now the market has taken control and the capital and the medical profession is on all sides exploited by corporations. The doctors lose public esteem and maintain a status as a technician. A positive element of the current situation is the general chaos that leads to greater dissatisfaction. Sooner or later we will have to develop a national health plan. "
Donabedian's Seven Pillars of quality
Efficacy
Effectiveness
Efficiency
Acceptability
Optimality
Equity
Legitimacy

The intellectual historical roots of this in the 80 years, increased only academic dreams were in America the New Deal and the American labor movement. Avedis Donabedian had had no part in this story. He met with the America of the 50s in the Roosevelt New Deal was already in retreat. Donabedian teacher at Harvard, was Franz Goldmann, an emigrant from Berlin and students Grotjahn (Antoni 1997). This was published in 1947 a book titled "Public medical care,
and a lectureship in medical care administration from Harvard University will receive. But as was gleichgestzt public medical care with socialized medicine, had this option begin their historic resignation and ended complained in the corporate medicine, the Donabedian. The quality problems began for Donabedian with the issue of access to medical services (accessability of medical care). The inequality in the U.S. is still the largest and growing Qualtitätsproblem. For in the Christian tradition, social repealed scholar, Donabedian was his
harsh but realistic comments are not unusual words. because the prophet is not known in their own country. The existing publications in Donabedian formal academic style and appearance was also a resource in a real world, which went the opposite way to its central message. This formalism has also led to the fact that the core of his message of quality personal services in bureaucratic Devices could communicate (Scherer 1998). His legacy as a scholar, physician, and wise is the health policy is health as a cultural system with a mission to equip, which will meet its Christian heritage - beyond commercial and bureaucratic formalities in the can, the quality issue bogged down easily.

literature
Antoni, Christine
Social Hygiene and Public Health, Franz Goldmann (1895-1970)
essays on the history of medicine and science
Mathiessen, Husum 1997
Donabedian, A
Evaluating the quality of medical care
Milbank Memorial Fund Q 1966, 44 :166-206
Donabedian, Avedis 1980 : Explorations in Quality Assessment and Monitoring . Vol . 1 : The Definition of
Quality and Approaches to its Assessment . Ann Arbor, MI : Health Administration Press
Donabedian . Avedis 1982 : Explorations in Quality Assessment and Monitoring . Vol . 2 : The Criteria and
Standards of Quality. Ann Arbor, MI : Health Administration Press
Donabedian, Avedis 1985 : Explorations in Quality Assessment and Monitoring . Vol . 3 : The Methods and
Findings of Quality Assessment and Monitoring . Ann Arbor, Ml : Health Administration Press
Mullan, Fitzhugh
Interview mit Avedis 'Gonabedian
Health Affairs . 20, 137-141, 2001
Scherer, Hanfried, Sahler, Irmgard (I-Irsg .) : Einstürzende
welfare states. Arguments against welfare cuts, Wiesbaden 1998