Nurse-Led, Equity-Driven Quality Improvement: An Adaptation of the Donabedian Model

Equity and justice have long been positioned as moral imperatives in nursing, yet operational models of quality improvement seldom integrate these values at a theoretical level. This concept development adapts the Donabedian model to align structural competence, social mission, and equitable outcomes, offering a mid-range theory to guide nurse-led quality improvement, education, and policy: the Equity-Driven Quality Framework. This equity-driven reconfiguration relies on the familiar structure-process-outcome triad, then extends it to intentionally incorporate health equity as a defining criterion of quality. The framework advances nursing’s moral and scientific commitments to justice within contemporary health system reform.

Duke Scholars

Author Michael Paul Cary School of Nursing