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Tibeihaho, Hector, Nkolo, Charles, Anguyo, Robert, Ayebare, Florence and Henriksson, Dorcus Kiwanuka (2021) 'Continuous quality improvement as a tool to implement evidence-informed problem solving: experiences from the district and health facility level in Uganda'. BMC Health Services Research, Vol 21, Issue 83.
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s12913-021-06061-8-1.pdf - Published Version Available under License Creative Commons Attribution. Download (2MB) | Preview |
Abstract
Background: Continuous quality improvement processes in health care were developed for use at health facility level, and that is where they have been used the most, often addressing defined care processes. However, in different settings different factors have been important to support institutionalization. This study explores how
continuous quality improvement processes were institutionalized at the district level and at the health facility level in Uganda.
Methods: This qualitative study was carried out in seven districts in Uganda. Semi-structured interviews with key informants from the district health management teams and document review were conducted. Thematic analysis was used to analyze the data.
Results: All districts that participated in the study formed Continuous Quality Improvement (CQI) teams both at the
district level and at the health facilities. The district CQI teams comprised of members from different departments within the district health office. District level CQI teams were mandated to take the lead in addressing management gaps and follow up CQI activities at the health facility level. Acceptability of quality improvement processes by the district leadership was identified across districts as supporting the successful implementation of CQI. However, high
turnover of staff at health facility level was also reported as a detrimental to the successful implementation of quality improvement processes. Also the district health management teams did not engage much in addressing their own roles using continuous quality improvement. Conclusion: The leadership and management provided by the district health management team was an important
factor for the use of Continuous Quality Improvement principles within the district. The key roles of the district health team revolved around the institutionalisation of CQI at different levels of the health system, monitoring results of continuous quality improvement implementation, mobilising resources and health care delivery hence
promoting the culture of quality, direct implementation of CQI, and creating an enabling environment for the lower-level health facilities to engage in CQI. High turnover of staff at health facility level was also reported as one of the challenges to the successful implementation of continuous quality improvement. The DHT did not engage much in addressing gaps in their own roles using continuous quality improvement.
Keywords: Continuous quality improvement, District health management team, Quality improvement, Uganda,
Health facility
| Item Type: | Article |
|---|---|
| Subjects: | W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84.4 Quality of Health Care QS Anatomy > QS 4 General works. Classify here works on regional anatomy WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1186/s12913-021-06061-8 |
| Depositing User: | Rachel Dominguez |
| Date Deposited: | 27 Jan 2021 11:17 |
| Last Modified: | 27 Jan 2021 11:17 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/16779 |
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