This book is not for experts in quality assurance—in fact it was written with the “student of the subject in my native Armenia” in mind, although not priced with them in mind at a hefty £27.50. It is a conversational and readable book that many beginners everywhere will find to be a comparatively painless introduction to one approach to quality improvement. Donabedian was one of the first and the most well known of proponents of quality assurance. His “structure, process and outcome” model is part of healthcare language, used beyond those working in the quality field.¹ Two strengths of the book are that it is easy to understand and provides useful practical advice to practitioners and others in both the west and developing countries. Although Donabedian is right that “fundamentals do not often change” and that “the new is …mostly a continuation of the old”, there are more recent ideas that are missing in this book that would be useful to its readership: particularly the simple improvement models now in common use in the west,² as well as discussion of theories and examples of how to get change—one of the most important issues in quality improvement, but only covered in one chapter of the book.

The book defines quality and quality assurance in health care, and describes the components of quality assurance. The main strength of the book is a practical exposition of how to do and use monitoring of quality and performance, covering page 29–page 122, about 80% of the book, with appendices to help. Simple does not mean simplistic and Donabedian has not avoided tackling difficult subjects in this book. One example of this is his clear short presentation of statistical process control—a subject baffling for many beginners, and others. Like many other difficult ideas, it can only be presented well by an expert who has taught it many times yet still understands the difficulties of the beginner.

Readers across the world and especially those needing an easy and practical introduction to the subject will find this an invaluable book. Many experts would also enjoy the read and find in it lessons about how to communicate in an unpretentious way. A fitting posthumous publication from a master in the subject, showing the relevance of quality assurance to all types of health care. A way must be found to publish a version at one third of the price.