Process and Level of Institutionalization Achieved in AMOCSA, a Private Health Care Entity in Chinandega, Nicaragua

USAID has supported the introduction and implementation of Continuous Quality Improvement (CQI) activities in Nicaragua since the year 2000, first through the Quality Improvement Project (QAP) and most recently through the Health Care Improvement (HCI) Project. These quality improvement activities focused primarily on Ministry of Health (MINSA) facilities. However, private health care facilities were invited to participate. The Medical Association of the West (Asistencia Médica de Occidente, S.A.) (AMOCSA) was one of these private health care facilities and has participated in CQI activities since 2004. AMOCSA, through this collaboration with QAP/HCI/USAID, participated in a series of improvement activities in order to improve the quality of services offered to clients with a specific focus on maternal and infant health, family planning, and prevention of infections. Assistance was provided for: standardization of the care process, monitoring the compliance with care standards using relevant indicators, guaranteeing the right to proper care for newborns including breast feeding, strengthening the team approach, and measuring the satisfaction of patients in the facilities. In 2007, through technical assistance from HCI/USAID, a Quality Management Program was developed for AMOCSA in order to ensure sustainability of continued quality improvement activities into the future.

While there have been a number of studies examining the process and impact of institutionalization in Ministry of Health facilities in Nicaragua, there have been few studies examining the process and impact of institutionalization in private facilities. This study examines the process and impact of institutionalization in AMOCSA facilities: the development process related to clinical and QI training, the enabling environment for QI, and the evidence for institutionalization and sustainability of CQI.
Research questions/objectives: 
In order to examine the process and level of institutionalization of CQI in AMOCSA, this research study seeks to: 
1.      Identify how CQI activities are organized and implemented in AMOCSA facilities and the leadership that is received from higher authorities with respect to the development process for CQI, including initial training of personnel in key quality improvement activities, additional training (continuing education, workshops, and on the job technical assistance), and training for new personnel. 
2.      Examine which aspects of the supporting environment for CQI contribute to the CQI institutionalization process including leadership, values for CQI, rewards and incentives, CQI team stability, and support from higher authorities.
3.      Analyze the evidence for institutionalization within AMOCSA including how CQI activities have become part of the daily routine, how clinical procedures and norms have become standardized, examples of QI activities that have been incorporated into clinical standards, as well as quantitative results showing the appropriate practice of CQI activities, knowledge and ability with respect to CQI activities, compliance with clinical norms and standards.
4.      Compare AMOCSA facilities and MINSA facilities in Chinandega with respect to several CQI institutionalization indicators.

This study is a qualitative cross sectional study where a sample of heath care professionals working in AMOCSA facilities in Chinandega are surveyed on their exposure to different aspects of continuous quality improvement (CQI). Most of the survey questions refer to CQI activities that are currently being implemented in AMOCSA, while some survey questions refer to activities that may have happened over a longer period of time. Responses from the study participants are used to measure the level of institutionalization achieved in AMOCSA facilities. A convenience sample of 27 study participants was selected. Each of the participants answered a self-administered questionnaire that included questions on the development process for CQI, the enabling environment for CQI, evidence of institutionalization of CQI and other external factors.


Report Author(s): 
Sandino S, Gomez I, Bowser D
ASSIST publication: 
Facebook icon
Twitter icon
LinkedIn icon
e-mail icon