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Interview

A Founder of Quality Assessment Encounters A Troubled System Firsthand

INTRODUCTION:Avedis Donabedian, physician, scholar, and poet, died on 9 November 2000 at age eighty-one, a month after this conversation with Fitzhugh Mullan. Known fondly by his students as "Mr. Structure-Process-Outcome" and internationally for his "Seven Pillars of Quality," Donabedian through his research and writing created much of the conceptual underpinnings for quality assessment in health systems used today. Born in Beirut of Armenian parents who had fled persecution in central Turkey, he grew up in an Arab village north of Jerusalem, where his father worked as a general practitioner. Donabedian studied medicine at the American University in Beirut, the starting point for his academic career. In 1953 he came to the United States to study public health at Harvard and in 1961 joined the faculty of the School of Public Health at the University of Michigan, where he spent the balance of his career. His work was framed by a simple question that he asked often: "How can you tell if you have good-quality health care?" His books include the classics, Aspects of Medical Care Administration (1973), Benefits of Medical Care Programs (1976), and the three-volume Explorations in Quality Assessment and Monitoring (1980–1985). Today many of his students are leaders in health care and public health around the world. His name, Avedis, means "good news" in Armenian—a comment on his life and work with which his colleagues, students, and the public at large would surely agree.

Being A Patient

 
Mullan: For a person who has taught and written so much about health care, it must seem odd to find yourself a patient. Tell me about your illness.

Donabedian: My current illness began in 1972 with symptoms of urinary infection. A subsequent exam and biopsy revealed that I had cancer of the prostate that had spread a little. I had a prostatectomy and cobalt therapy and, for many years, was in pretty good shape. I actually did much of the work for which I am known after the cancer manifested itself. Then, about fifteen years ago, my PSA (prostate specific antigen) began . . . [Full Text of this Article]

Mullan:Donabedian:Mullan:Donabedian:

Judging Quality

 
Mullan:Donabedian:Mullan:Donabedian:

Confidence Amid Errors

 
Mullan:Donabedian:Mullan:Donabedian:Mullan:Donabedian:

Commercialization Of Care

 
Mullan:Donabedian:Mullan:Donabedian:Mullan:Donabedian:

A Scholar And A Poet

 
Mullan:Donabedian:

Daisies In Winter

 

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