Factors influencing national rollout of quality improvement approaches to public hospitals in Tanzania

Abstract

Purpose – The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries. Design/methodology/approach – The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score). Findings – Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant. Research limitations/implications – This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries. Originality/value – The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.

The current status of nurses–doctors collaboration in clinical decision and its outcome in Tanzania

“…Additionally, the same principle requires MDs to collaborate with other health workers in the interest of providing the best possible holistic healthcare services (MAT, 1995). Inarguably, teamwork is more significant than skills and knowledge in the provision of quality healthcare services (Ishijima, Eliakimu, Takahashi, & Miyamoto, 2014).…”

Applicability of the 5S management method for quality improvement in health-care facilities: a review

“…5S was applied to primary health-care facilities [ 28 , 33 , 34 ] and different locations or sectors of hospitals, including a pharmacy [ 24 ]; an emergency department [ 25 ]; an operating room [ 26 ]; multiple departments (central supply, histology laboratory, ICU, medical-surgical inpatient care unit, and infusion center) of several hospitals [ 27 ]; a laboratory [ 29 ]; a surgical clinic [ 31 ]; multiple locations of hospitals (or without specific information about target locations) [ 32 , 35 – 38 ]; and central warehouses [ 30 ]. Of the 15 studies, six were conducted in the USA [ 26 , 27 , 29 – 31 ], one in the UK [ 35 ], and eight in low- and middle-income countries, namely Brazil, India, Jordan, Senegal, Sri Lanka, and Tanzania [ 24 , 25 , 28 , 32 – 34 , 37 , 38 ].…”

“…Ten of the 15 empirical studies involved the application of 5S only [ 27 , 28 , 30 , 32 – 38 ], whereas the other five studies combined several tools and methods including 5S [ 24 – 26 , 29 , 31 ]. In addition, 5S was regarded as a method under the framework of lean health-care by authors in ten studies [ 24 – 27 , 29 – 31 , 33 , 35 , 36 ] and toward better quality management (or total quality management (TQM)) in three studies [ 32 , 37 , 38 ].…”

“…Of the 15 research articles reviewed, five involved empirical 5S application as part of government initiatives, and these five studies were all concentrated in low- and middle-income countries. In these studies, the 5S application was initiated as part of the local governments’ programs in India [ 28 , 34 ] and national strategies for health-care quality improvement spearheaded by health ministries in Senegal, Sri Lanka, and Tanzania [ 32 , 33 , 37 ].…”

“…TQM was also considered as an approach interchangeable with continuous quality improvement (CQI) [ 20 ]. In contrast, some empirical studies considered 5S as a step toward TQM [ 32 , 37 ]. In some context, the 5S approach toward TQM was represented as “5S-KAIZEN-TQM,” which was also interchangeably referred to as “5S-CQI-TQM” [ 45 ].…”