Ethiopian Pediatric Society Quality Improvement Initiative: a pragmatic approach to facility-based quality improvement in low-resource settings

Abstract

ObjectivesTo describe critical features of the Ethiopian Pediatric Society (EPS) Quality Improvement (QI) Initiative and to present formative research on mentor models.SettingGeneral and referral hospitals in the Addis Ababa area of Ethiopia.ParticipantsEighteen hospitals selected for proximity to the EPS headquarters, prior participation in a recent newborn care training cascade and minimal experience with QI.InterventionsEducation in QI in a 2-hour workshop setting followed by implementation of a facility-based QI project with the support of virtual mentorship or in-person mentorship.Primary and secondary outcome measuresPrimary outcome—QI progress, measured using an adapted Institute for Healthcare Improvement Scale; secondary outcome—contextual factors affecting QI success as measured by the Model for Understanding Success in Quality.ResultsThe dose and nature of mentoring encounters differed based on a virtual versus in-person mentoring approach. All QI teams conducted at least one large-scale change. Education of staff was the most common change implemented in both groups. We did not identify contextual factors that predicted greater QI progress.ConclusionsThe EPS QI Initiative demonstrates that education in QI paired with external mentorship can support implementation of QI in low-resource settings. This pragmatic approach to facility-based QI may be a scalable strategy for improving newborn care and outcomes. Further research is needed on the most appropriate instruments for measuring contextual factors in low/middle-income country settings.

Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review

“…QI tools could be applied to a wide variety of disciplines, and the teams benefitted from building QI capacity and learning techniques rather than focusing solely on one improvement project [ 36 , 47 , 69 , 77 , 94 , 99 , 122 – 124 ]. Many authors described the benefits of having coaches or external experts to teach QI methods, provide mentoring support, and motivate perseverance in the face of obstacles [ 51 , 58 , 63 , 92 , 93 , 124 ].…”

“…Run charts were one common tool used for data visualization, and teams felt motivated by seeing their improvements displayed using a run chart [ 49 , 63 , 92 ]. Data dashboards also helped identify bottlenecks, set priorities, and focus QI leadership attention when a change was needed [ 12 , 36 , 87 , 93 , 120 ]. Collecting and analyzing data was also described as important for studying a pilot version of an improvement project before scaling up [ 33 , 68 , 137 ].…”

“…There were additional challenges regarding data interpretation and effective data visualization. Many programs were challenged with capacity and resources to collect and analyze data [ 13 , 35 , 93 , 126 , 141 ]. There were concerns about the reliability of data and a need to create better data collection systems [ 15 , 37 , 44 , 55 , 77 , 81 , 88 , 94 ].…”

Quality Improvement in Public-Private Partnerships in Low- and Middle-Income Countries: A Systematic Review

“…Run charts were one common tool for data visualization, and teams felt motivated by seeing their improvements displayed using a run chart (47,61,91). Data dashboards also helped identify bottlenecks, set priorities, and focus QI leadership attention when a change was needed (12,33,86,92,119). Collecting and analyzing data was also described as important for studying a pilot version of an improvement project before scaling up (30,66,136).…”

“…There were additional challenges regarding data interpretation and effective data visualization. Many programs were challenged with capacity and resources to collect and analyze data (13,32,92,125,140). There were concerns about the reliability of data and a need to create better data collection systems (15,34,42,53,76,80,87,93).…”