Designing and Evaluating Quality Improvement Projects
The Institute for Healthcare Improvement’s (IHI) Senior Vice-President, Professor Pierre Barker, conducted a workshop at UKZN’s Innovation Centre Auditorium on Designing and Evaluating Quality Improvement (QI) Projects.
Barker, a QI International Expert based at the University of North Carolina in the United States, was invited by UKZN’s Centre for Rural Health and the 20 000 Plus Project to give a seminar on the design and evaluation of QI research.
QI is the method by which health systems are improved in a specific context to implement generalisable medical evidence. According to Barker, learning is a key activity to bring about improvement and it requires social change with interventions needing to be amended to local settings.
‘Concepts rather than fixed protocols are a good starting point for people to test and learn how improvement interventions can be amended to their setting,’ he said.
QI aims to bridge the gap between what professionals know and do and Barker said health professionals’ knowledge differed from their actions. ‘The primary role of QI is closing the knowledge-versus-action gap using evidence-based knowledge.’
His presentation focused on narrowing that gap and enabling health practitioners to improve their services through systems improvement.
Barker shared a programme experience Project Fives Alive! which was conducted in Ghana. The project focused on the potential of front-line health workers to develop, test and implement strategies to overcome systems failures that lead to preventable deaths in children under the age of five years in Ghana.
It aimed to reduce the mortality rate by 66 percent, from 110 per 1 000 live births in 1990 to less than 40 per 1 000 live births by 2015 through the application of QI methods.
It was implemented in four successive waves over five years in the north of Ghana and eventually spread to all health facilities across the country, to cover an estimated 3.3 million children under the age of five.
The project staff assisted health providers and their managers to improve the coverage, quality, reliability and patient-centredness of health services for pregnant women and children under five.
This was done by training, coaching and mentoring clinic, hospital, district and regional health staff on acquiring and applying quality improvement knowledge and skills to achieve goals over a 12 to 18-month period. The project made significant progress in antenatal, perinatal and neonatal care and in spreading the QI process across Ghana.
Centre for Rural Health Director, Dr Bernhard Gaede found Barker’s presentation stimulating. ‘It moved beyond the assumption of what works in a theoretical way or in a particular context can simply be provided in the health care system. Rather the approach asks the question of how we can implement complex interventions. Many good ideas fail because the way they are not implemented in a structured and coherent manner. Pierre’s presentation gave a glimpse to what can be done, particularly in low resource settings.’
Gaede said the presentation was particularly relevant to rural health which was comparatively resource poor. ‘Pierre’s demonstrated convincingly how innovation and improvement in the health care system can be led from peripheral settings.’
- Nombuso Dlamini