How to prioritise in quality improvement? Targeted implementation as a key for quality improvement in Kenyan health facilities

BMJ Open Quality

article

Christine Nitschke¹  Maureen Nafula²  Marc Brodowski³  Irmgard Marx⁴  Charles Kandie⁵  Irene Omogi⁶  Friederike Paul-Fariborz⁴  Joachim Szecsenyi³  Lucia Brugnara⁴  Michael Marx¹ 

[1] Heidelberg Institute of Global Health , University of Heidelberg;Institute of Health Policy, Management and Research;Institute for Applied Quality Improvement & Research in Health Care;Evaplan at the University Hospital;Department of Health Standards, Quality Assurance and Regulations , Ministry of Health;Health Programme , Deutsche Gesellschaft für Internationale Zusammenarbeit

关键词: decision making;    quality improvement;    qualitative research;    quality measurement;   

DOI  :  10.1136/bmjoq-2020-001139

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Background Data from national surveys of low- and middle income countries indicates that there is still a need to improve the quality of healthcare in resource-poor settings. This study aims to understand the benefit of an integral, facility-driven, indicator-based approach used as a decision-making tool to define effective quality improvement interventions in Kenya.Objective The aim of the study is to understand whether the integral approach developed leads to effective interventions.Methods Categorical data is collected from ten health facilities covered by the Integrated Quality Management System (IQMS) project in Kenya. First the information on concrete improvement interventions implemented within the facilities is collected and merged into five different intervention topics. Second, groups of facilities with similar quality improvement interventions are selected to compare between the first and second quality assessment rounds. Those IQMS indicators matching the content of the intervention topic are extracted from the software VISOTOOL. In a third step, the data is summarised using means and SD. A one sample T-test is applied on the mean changes and SD. Frequency counts and percentages were used for the presentation of categorical data.Results All improvement interventions resulted in positive and higher change values (T2-T1). Four of five intervention topics, show statistically significant improvements including neonatal mortality (42%; p<0.0001), waiting time (39%; p=0.0490), infection prevention control (28%; p=0.0007) and with shortages of staffing and transport in remote areas (32%; p=0.0194).Conclusions In all facilities the interventions selected have a positive impact, some of which markedly improved. It demonstrates that this integral quality improvement approach in Kenya can serve as an effective decision-making tool for identification and prioritisation of interventions. Those targeted interventions, being performed under institutionalisation in form of coaching and tutoring, effectively contribute to improving the quality of care in resource poor settings.

【 授权许可】

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