The PSF category represents conditions or factors thatmay impact on healthcare outcomes. This category iscomposed by the following three aspects: structure, pro-cess and culture/climate. Donabedian’s framework coveredthe first two aspects. However, there have been no orfew frameworks that explicitly described “PSF” or relateddimensions. It is well known that organizational culture– or a related concept, organizational climate, which isreferred to as its surface manifestation – is correlatedwith various indices of organizational performance [25].Taking the safety aspect as an outcome property, forinstance, it has been well acknowledged that safety per-formance is affected not only by structural and processfactors, but also by employee attitudes to and perceptionsof their job roles and safety related issues, their orga-nization and management, i.e., safety culture (e.g., [26]).Therefore, the framework proposed in this paper might be