Fig. 2

Pathways for operationalising Donabedian’s theory in the ICDM model of care in South Africa. a Unidirectional path: Good structure should promote good process and good process in turn should promote good outcome. b Mediation path: Good structure directly promotes good outcome, good structure promotes good process and good process in turn promotes good outcome. c Non-recursive (reciprocal) path: Good stucture promotes good process, good process promotes good outcome and good outcome in turn promotes good process