Quality and safety are ultimately determined by the degree to which health care improves important patient outcomes. However, documenting variations in morbidity and mortality is labor intensive. In this first volume, Donabedian develops the framework for measuring quality by assessing elements of structure or process with proven connections to key outcomes of interest. This framework may seem straightforward now, but only because Donabedian’s approach has become the paradigm for quality measurement in health care. Despite the wide dissemination of the structure-process-outcome triad, Donabedian’s original work remains worth reading. Those who wish to sample a briefer introduction can look at a review article by Donabedian in the Journal of the American Medical Association (The quality of care: how can it be assessed? JAMA. 1988;260:1743-1748).