Donabedian’s model of components of quality in health care

The seven components of quality in health care, as listed by Donabedian in the figure above, can be easily linked with the five key lines of enquiry put forward by the Care Quality Commission as part of their revised pattern of inspection s. As a result of the events at Mid Staffordshire Trust and Winterbourne View Hospital, and following through with the recommendations made by the Francis report, the Care Quality Commission has revised its methodology and guidelines for inspections, with a new inspection pattern being put into practice as of November 2014. The new guidelines for inspections are structured around five key questions which constitute just as many lines of enquiry and assessment of a care service:




Care Quality Commission Key Line of Enquiry What it means


Is the service safe? People who use the service must be safe from abuse and avoidable harm. Appropriate systems should be in place to safeguard people from harm and to promote their safety.


Is the service effective? The care, treatment and support provided should achieve good outcomes while helping people to maintain good quality of life.


Is the service caring? People who use the service are being cared for by staff who treat them with compassion, dignity, respect and kindness.


Is the service responsive to people’s needs? The care services provided are structured in such a way that they respect people’s preferences and meet their needs accordingly.


Is the service well-led? The care provider is able to show evidence of good leadership, management and governance to ensure high-quality care which is based around people’s individual preferences and needs.


Table 1. Care Quality Commission Key Lines of Enquiry


By asking the questions listed above, inspectors are able to assess the level of quality care provided by the service which is being evaluated. With no straightforward definition for quality care available on the Care Quality Commission website, one can use the key lines of enquiry listed in the table above as reference points to describe what quality care means within the current health and social care context in England, and to outline the main components which contribute to a comprehensive yet at times very much elusive definition of quality care.

So thinking forward, will you discuss your findings in relation to this schematic? Otherwise, why include it?