Implementing and Leading Health Care Improvement: What We’ve Learned

Yesterday, we had the chance to engage in two great online conversations about quality of care and what it takes to lead it. During a Twitter chat hosted by the Maternal and Child Survival Program, we explored what #QualityCareforAll means in the context of maternal and newborn health, and what it takes to drive improvement in low-resource settings. In the final installment of the ASSIST Legacy Webinar Series, we looked at key leadership qualities and attributes, with experts from the field sharing ways they’ve seen leadership qualities demonstrated in practice to improve HIV care and outcomes.

We share a few nuggets of wisdom from these conversations below:

On quality of care

  • Quality of care describes to what extent the care provided is accessible, effective, efficient & meets the needs and expectations of patients/clients & communities.
  • Quality health care is evidence-based, respectful, people-centered care that is delivered consistently and correctly for all who need it.
  • Quality of care is holistic and encompasses improved outcomes, reduced cost & better patient experience not merely implementation of standards.
  • Understand that the definition of quality of care is contextual and is constantly evolving. Set up a mechanism to identify and address current quality gaps by strengthening the existing processes and systems.

On the greatest opportunities to improve quality of care

  • Rather than adding more resources (people, equipment), think about how you can optimize the process of care to achieve better results.

  • Engaging leaders and improving vertical and horizontal communication is also key.
  • Better data! It's hard to spot gaps in care & opportunities for improvement if we're not gathering data. What goes into good measures for improvement?
  • Waste! 30% of health care resources are wasted. If we can find that waste and eliminate it, we suddenly have more resources for improving care.
  • Work in partnerships to integrate efforts, build on each other’s strengths & maximize gains.
  • Patient education & self-management support helps to achieve the "last mile" in better care for patients.

On practical approaches to improve quality of care in low resource settings

  • Improvement methods are a practical approach to improve quality of care in low resource settings because the focus is on making changes in the process of care, which often doesn't require more resources!
  • Promote teamwork! Rather than focusing on individuals, build teams that draw on the diverse experience and knowledge of team members to improve care, and can motivate and support each other.
    • Offer snacks at team meetings. :)
  • Create intentional opportunities for health facilities and leaders to collaborate & share learning.
  • Adapt the collaborative improvement approach to local settings and available resources.
  • Work through existing networks: In India, we partnered with important, established organizations and institutions (like professional associations and medical schools) to teach and spread improvement methods.
  • Use systematic prioritization and a step-by-step approach to improve quality of care in resource scarce settings.
  • Identify and focus on 20% of barriers causing 80% of gaps in quality of care.
  • Rationalize prescription practices to improve access to essential medications.

On how data can be used to drive quality improvement

On leadership and governance

Leadership for improvement

  • We are not born leaders, but everyone has the potential to lead improvement. Real leaders induce other staff to become leaders.
  • Improvement in care is faster where leadership is engaged and where leadership for improvement is explicitly implemented.
  • Good leaders see the potential of something, honor it, and show people how you can expand care.
  • Leadership must be empowered to improve care in order to empower others.

Leaders are critical for setting goals & then: 1) equipping staff with methods & skills to reach goals, 2) building management structures & aligning systems to support improvement & 3) creating a culture that supports innovation & problem solving.

  • To convince others to join our efforts, good communication skills are needed to explain what changes we are trying to implement and how we think these changes will improve care.
  • Strong leaders couple individual initiative and the ability to collaborate with others.
  • Leadership is rallying a team around a strategy and drawing out the best in each team member to fulfill that strategy.
  • Leadership requires both challenging team members to be better and supporting them to do better.
  • To motive others to make improvements, start by showing the power of testing an idea. Pick a problem, brainstorm a change (solution), and test whether there is an impact on care.

Engaging leaders for improvement

  • Leaders respond to results. Showing leaders better patient outcomes—then explaining the methods used to get these outcomes—is a great way to engage them.
  • Leaders want to work at scale. Couple small improvement tests with plans to go to scale.

It's important to find out WHY leaders are not engaged. Is it lack of motivation? Are they unsure how to improve care or where to start? Trouble understanding data and analyzing the problem? Competing priorities?

  • Engage leaders through institutionalized structures.
  • Provide governments and leaders with practical support & guidance to apply improvement approaches across health system levels (community, clinic, hospital, district, regional).
  • Support governments and leaders to set up supportive learning and data systems and build local individual and institutional capacity.
  • Manage quality improvement (QI) knowledge with the goal of bringing knowledge from the frontline of patient care to the frontline of funding and technical decision making.

Plus, a few of tools and resources we love for improving quality of care...

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Content for this blog draws on the generous insights and wisdom of Mirwais Rahimzai, Nigel Livesley, Esther Karamagi, and Tamar Chitashvili of the USAID ASSIST Project/URC (guided by the questions presented during the MCSP-hosted Twitter chat on “Making the Impossible Possible”) and Maina Boucar, USAID ASSIST Project/URC; Melly Traore, USAID ASSIST Project/URC; Herbert Kadama, AIDS Control Program, MOH, Uganda; and Adrienne Hurst, Office of HIV/AIDS, USAID (guided in reflection by Rashad Massoud, Victor Boguslavsky, and Rachel Gutierrez of the USAID ASSIST Project/URC during the ASSIST Legacy webinar “Leading health care improvement: What leaders need to know to act").

Related blogs:

What we learned while improving care for 180,000 babies annually in India How a Regional Learning Network improved care for mothers and babies in Uganda World Preeclampsia Day: Using a collaborative learning approach to improve early detection and management of preeclampsia in Jinja District, Uganda What I’ve Learned: Reflections on a Quality Improvement Journey Engaging health workers in improving quality of care key to reduce maternal mortality in Uganda

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