The structure-process-outcome is one of the tools used in quality improvement. Structure refers to the particular organization responsible for providing care. It is characterized by elements such as “staffing patterns, programs, finances, facilities, and size of the organization.” A process, on the other hand, entails “examining what must happen when, by whom, and in what sequence.” The processes for QI include activities such as planning, implementing, assessing, and revising the necessary changes. Outcomes are the end products of structure and processes. Outcomes of any QI project should be measurable.
Although better health outcomes may be the goal of any QI effort, measuring health outcomes is not an effective substitute for structure and process measures. This is because measuring health outcomes only gives the end results, but it does not entirely inform us on where the problem is and what can be done to improve the health outcomes. An example to illustrate this is the issue of oral morphine in managing pain in terminally ill patients. The health outcome can be measured by the number of terminally ill patients who have (or lack) access to the drug. If the outcome is a high number of patients who lack access to the drug, this measure does not tell us anything more. So, in order to find out where the problem of accessibility to the drug is, we need to measure the structure and processes involved in administering the drug. These two latter measures will highlight where the real problem is.