Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia

Human Resources for Health

Young Mi Kim¹  Joyce Monica Chongo Mulilo²  Hildah Shasulwe³  Stephanie Reinhardt¹  Webby Kanjipite³  Joseph Banda³  Supriya Sarkar¹  Eva Bazant¹ 

[1] Jhpiego/Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA;Zambia National Service, PO Box 32251, Church road, Lusaka, Zambia;Jhpiego Zambia, 8 Ngumbo Road, Long Acres, PO Box 36873, Lusaka, Zambia

关键词: Zambia;    Quality of care;    Quality improvement;    Prevention of mother-to-child transmission of HIV;    HIV;    Health personnel;    Health facilities/standards;    Delivery of health care;   

Others  :  1135931
DOI  :  10.1186/1478-4491-12-73

 received in 2014-02-24, accepted in 2014-12-08,  发布年份 2014

【 摘 要 】

Background

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers’ work environment and perceived quality of HIV-related care were assessed to complement data of provider performance.

Methods

The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups.

Results

In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.

In the multivariate analysis, the intervention group’s improvement and the comparison group’s decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item “provider lacks confidence in some clinical skills” declined in the intervention group but increased in the comparison group (P = –0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care.

Conclusions

The performance and quality improvement intervention implemented at Zambian Defence Forces’ health facilities was associated with improvements in providers’ perceptions of work environment consistent with the intervention’s focus on commodities, skills acquisition, and receipt of constructive feedback.

【 授权许可】

   
2014 Bazant et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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