For many years, hospital accreditation bodies assumed that if the structural criteria were met, that is, that the physical plant, the qualifications of the staff, and the necessary equipment were in place, the quality of the services would automatically be acceptable. Subsequently, accreditation groups decided that they had also better look at the medical records to see how the services were being provided. They assumed that, if the necessary structure was in place, and the required services were delivered as prescribed, the quality of care would be acceptable. Now, these same accrediting groups find it necessary to look at the outcomes of care as well.

• Describe “structure, process, and outcome” in the assessment of the quality of medical care, and provide examples of each dimension.
• How are the three dimensions related?
• Can these relationships be trusted to assure the quality of care in the complex, high-tech world of modern medicine? If not, why?

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