Developing consensus for improvement competencies

Esther Karamagi

Chief of Party, Uganda, USAID ASSIST Project/URC

Kim Ethier Stover

Senior Improvement Advisor, USAID ASSIST Project/URC

Over the past couple of years, a wide range of stakeholders in East Africa have been involved in developing a framework of core competencies for quality improvement. This process was facilitated by the Regional Centre for Quality of HealthCare and the USAID ASSIST project.  An initial group of stakeholders from Ministries of Health in Kenya, Tanzania, and Burundi, nursing councils in Kenya, Uganda, Rwanda, and Tanzania, and medical and public health training institutions form Kenya, Tanzania, and Uganda gathered to brainstorm core competencies that were needed by health care worker to continuously improve the care they provide. Following the initial development, the framework went through two rounds of Delphi review by experts in quality improvement from the USAID ASSIST project, ICAP/Columbia University, WHO, Path International and the Ministry of Health in Uganda.

The competency framework defines the knowledge, skills, attitudes and behaviours required by QI teams to perform specific tasks in improvement. It is designed for use by trainers to help assess competencies and design trainings to help health workers develop the lacking competencies.  The framework is designed to outline the needs of frontline health care workers and improvement teams working to improve care. 

The three major domains covered by the framework are: 

  1. Basic principles and concepts of improvement science
  2. Designing, planning and managing the quality improvement process
  3. Leadership and support for the quality improvement process

Each of these domains is broken into major tasks, specific activities associated with those tasks and the competencies needed to perform the activities. While the idea of the framework is to be comprehensive, not every competency listed will be relevant for all circumstances. 

After a few years of building consensus on the framework, we are excited that it is ready for distribution and use. Our colleagues at ASSIST/Kenya will be working with the Kenya Ministry of Health and four medical training institutions to integrate improvement into the pre-service curricula for different types of health care workers. This framework will serve as one of the key resources for helping to determine and evaluate key competencies which the curricula should focus on.  We look forward to hearing about the experience of using this framework in practice in a few months. 

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