Institutionalizing Quality Improvement in Uganda: Facilitators and Barriers
When improvement methods are institutionalized a healthcare system can be more agile in achieving improved service delivery. Understanding both expressions of institutionalization and pathways for moving toward institutionalized improvement methods can provide guideposts for low- and middle-income countries in their improvement journey. In this report we provide findings from a scoping review of the literature on institutionalization of improvement. We then present a case study from Uganda, drawing on the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project’s experience. Finally, we outline possible next steps for continuing to institutionalize improvement in Uganda.
A literature search was conducted to identify English language publications from 2010-2018. Results were screened for relevance. Insights based on key informant interviews were extracted from a USAID cross-bureau report “Uganda’s Quality Improvement Journey” and assessed against the characteristics identified in the literature search.
A total of 3,169 publications were identified. After removing duplicates and screening for content and relevance, 16 papers were included; 4 focused on a single health facility, 5 were not data driven. Most (13) focused on high income settings, while only one was from a low- and middle-income setting. No papers specifically referenced “institutionalization” of QI, instead referring to creating a culture of continuous improvement or a culture of safety.
Key characteristics of institutionalization were extracted from the published documents:
• leadership and governance at all levels of the health system;
• perspectives of and approaches to improvement, both from leadership and relating to the systems put into place to support improvement activities;
• communications and teamwork within improvement teams, across teams and functions, and between management and staff; and
• professional development and human resources around improvement.