title: Using the Donabedian framework to examine the quality and safety of nursing service innovation.
abstract: OBJECTIVE
  To evaluate the safety and quality of nurse practitioner service using the audit framework of Structure, Process and Outcome.
  
  
  BACKGROUND
  Health service and workforce reform are on the agenda of governments and other service providers seeking to contain healthcare costs whilst providing safe and effective health care to communities. The nurse practitioner service is one health workforce innovation that has been adopted globally to improve timely access to clinical care, but there is scant literature reporting evaluation of the quality of this service innovation.
  
  
  METHODS
  A mixed-methods design within the Donabedian evaluation framework was used.
  
  
  METHODS
  The Donabedian framework was used to evaluate the Structure, Process and Outcome of nurse practitioner service. A range of data collection approaches was used, including stakeholder survey (n = 36), in-depth interviews (11 patients and 13 nurse practitioners) and health records data on service processes.
  
  
  RESULTS
  The study identified that adequate and detailed preparation of Structure and Process is essential for the successful implementation of a service innovation. The multidisciplinary team was accepting of the addition of nurse practitioner service, and nurse practitioner clinical care was shown to be effective, satisfactory and safe from the perspective of the clinician stakeholders and patients.
  
  
  CONCLUSIONS
  This study demonstrated that the Donabedian framework of Structure, Process and Outcome evaluation is a valuable and validated approach to examine the safety and quality of a service innovation. Furthermore, in this study, specific Structure elements were shown to influence the quality of service processes further validating the framework and the interdependence of the Structure, Process and Outcome components.
  
  
  CONCLUSIONS
  Understanding the Structure and Process requirements for establishing nursing service innovation lays the foundation for safe, effective and patient-centred clinical care.
authors.affiliation: School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Qld, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardner
authors.forename: Anne
authors.initials: A
authors.lastname: Gardner
authors.forename: Jane
authors.initials: J
authors.lastname: O'Connell
mesh_terms: D006801:Humans; D016294:Models, Nursing; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D009936:Organizational Innovation; D010348:Patient Care Team; D061214:Patient Safety; D017060:Patient Satisfaction; D011787:Quality of Health Care
keywords: audit; health service innovation; health services research; nurse practitioner