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Chapter 26 - Improving the Quality and Safety of Health Care in Low and Middle Income Countries

What Works!

from Section 2 - Transforming Health Systems: Confronting Challenges, Seizing Opportunities

Published online by Cambridge University Press:  08 December 2022

By
Salma W. Jaouni ,
Mondher Letaief ,
Samer Ellaham  and
Samar Hassan
Edited by
Sameen Siddiqi ,
Awad Mataria ,
Katherine D. Rouleau  and
Meesha Iqbal
Sameen Siddiqi
Affiliation:
Aga Khan University
Awad Mataria
Affiliation:
World Health Organization, Egypt
Katherine D. Rouleau
Affiliation:
University of Toronto
Meesha Iqbal
Affiliation:
UTHealth School of Public Health, Houston
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Summary

Poor quality of care is a leading cause of excess morbidity and mortality in low- and middle- income countries (L&MICs). Improving the quality of health care is complex, yet the health care sector has benefitted from many experiences in other industries and developed its own approaches to quality improvement (QI). It is challenging to identify what works in each situation, make the intended improvements, and ensure it is well measured and sustained. Yet there are several examples from L&MICs that offer a lot of learning and illustrate those factors that underpin successful experiences in QI. This Chapter looks at the evolution of QI in health care over time; the types of health care QI approaches, and their relationship with patient safety and UHC; the opportunities to address the commonly occurring health care quality and safety challenges, as well as what works or does not work in L&MICs.

Keywords

Patient SafetyUniversal Health CoverageHealthcare Quality Improvement ModelsAccreditationExternal EvaluationQualityQuality ImprovementSustainability and ContinuityL&MIC
Type
Chapter
Information
Making Health Systems Work in Low and Middle Income Countries
Textbook for Public Health Practitioners
 , pp. 401 - 420
Publisher: Cambridge University Press
Print publication year: 2022

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References

Quality and Reliability Engineering International. Editorial: giants of quality – Walter Shewhart. Qualit Reliab Eng Int 2011. https://onlinelibrary.wiley.com/doi/epdf/10.1002/qre.1283 (accessed September 12, 2021).Google Scholar
Best, M., Neuhauser, D.. W Edwards Deming: father of quality management, patient and composer. Qual Saf Health Care 2005; 14(4): 310–312.Google Scholar
Neyestani, B.. Principles and contributions of total quality mangement (TQM) gurus on business quality improvement. 2017. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2950981 (accessed February 16, 2022).Google Scholar
National Academies of Sciences, Engineering, and Medicine. Crossing the global quality chasm: improving health care worldwide. 2019. www.nap.edu/catalog/25152/crossing-the-global-quality-chasm-improving-health-care-worldwide (accessed September 11, 2021).Google Scholar
Ayanian, J. Z., Markel, H.. Donabedian’s lasting framework for health care quality. N Engl J Med 2016; 375(3): 205–207.Google Scholar
Cantiello, J., Kitsantas, P., Moncada, S., et al. The evolution of quality improvement in healthcare: patient-centered care and health information technology applications. J Hosp Admin 2016; 5(2): 62–68.Google Scholar
World Health Organization. Quality of care. 2022. www.who.int/health-topics/quality-of-care#tab=tab_1 (accessed February 16, 2022).Google Scholar
Agency for Healthcare Research and Quality. Practice facilitation handbook module 4. Approaches to quality improvement. 2021. www.ahrq.gov/ncepcr/tools/pf-handbook/mod4.html#:~:text=In%20health%20care%2C%20quality%20improvement,analyzed%2C%20improved%2C%20and%20controlled (accessed February 16, 2022).Google Scholar
World Health Organization. Patient safety. www.who.int/patientsafety/research/ps_online_course_session1_intro_1in1_english_2010_en.pdf (accessed February 16, 2022).Google Scholar
Burstin, H., Leatherman, S., Goldmann, D.. The evolution of healthcare quality measurement in the United States. J Intern Med 2016; 279(2): 154–159.Google Scholar
Toyota Production System. Lean Six Sigma definition. www.leansixsigmadefinition.com/glossary/toyota-production-system/ (accessed February 10, 2022).Google Scholar
Donabedian, A.. Evaluating the quality of medical care 1966. Milbank Q 2005; 83(4): 691–729.CrossRefGoogle ScholarPubMed
Harry, M. J.. Six Sigma: a breakthrough strategy for profitability. Qual Prog 1998; 31(5): 60.Google Scholar
Montgomery, D. C., Woodall, W. H.. An overview of six sigma. Int Stat Rev 2008; 76: 329–346.CrossRefGoogle Scholar
Hines, K.. A brief history of quality improvement in health care and spinal surgery. Global Spine J 2020; 10: 5S–9S.Google Scholar
Aboelmaged, M. G.. Six Sigma quality: a structured review and implications for future research. Int J Qual Reliab 2010; 27: 268–317.Google Scholar
Batalden, P. B., Davidoff, F.. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care 2007; 16(1): 2–3.Google Scholar
Wakefield, M.. To err is human: an Institute of Medicine report. Prof Psychol Res Pract 2000; 31(3): 243.Google Scholar
Askitopoulou, H., Vgontzas, A. N.. The relevance of the Hippocratic Oath to the ethical and moral values of contemporary medicine. Part I: the Hippocratic Oath from antiquity to modern times. Eur Spine J 2018; 27(7): 1481–1490.Google Scholar
World Health Organization. Patient safety: making health care safer. 2017. https://apps.who.int/iris/handle/10665/255507 (accessed September 16, 2021).Google Scholar
World Health Organization. Global patient safety action plan 2021–2030: towards eliminating avoidable harm in health care. 2021. https://apps.who.int/iris/handle/10665/343477 (accessed February 10, 2022).Google Scholar
Steffner, K. R., McQueen, K. A., Gelb, A. W.. Patient safety challenges in low-income and middle-income countries. Curr Opin Anaesthesiol 2014; 27(6): 623–629.Google Scholar
World Bank. Delivering quality health services: a global imperative for universal health coverage. 2018. www.worldbank.org/en/topic/universalhealthcoverage/publication/delivering-quality-health-services-a-global-imperative-for-universal-health-coverage (accessed September 18, 2021).Google Scholar
Murray, C. J. L., Hanlon, M., Dieleman, J., et al. Financing global health 2012: the end of the golden age? 2012. www.healthdata.org/policy-report/financing-global-health-2012-end-golden-age (accessed September 19, 2021).Google Scholar
Agyeman-Duah, J. N., Theurer, A., Munthali, C., et al. Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi. BMC Health Serv Res 2014; 14: 1.Google Scholar
Letaief, M., Leatherman, S., Tawfik, L., et al. Quality of health care and patient safety in extreme adversity settings in the Eastern Mediterranean Region: a qualitative multicountry assessment. East Mediterr Health J 2021; 27(2): 167–176.Google Scholar
Leatherman, S., Tawfik, L., Jaff, D., et al. Quality health care in extreme adversity: an action framework. Int J Qual Health Care 2019; 31(9): G133–G135.Google Scholar
Varkey, P.. Medical Quality Management: Theory and Practice, 2nd ed. Burlington, Jones & Bartlett Learning, 2010.Google Scholar
Nelson, E. C., Mohr, J. J., Batalden, P. B., et al. Improving health care, Part 1: the clinical value compass. Jt Comm J Qual Improv 1996; 22(4): 243–258.Google Scholar
Institute for Healthcare Improvement. Model for improvement. 2012. www.ihi.org/resources/Pages/HowtoImprove/default.aspx (accessed February 10, 2022).Google Scholar
Ruth, B., Gill, H., Claire, M., et al. Quality improvement: theory and practice in healthcare. 2008. www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Quality-Improvement-Theory-and-Practice-in-Healthcare.pdf (accessed September 19, 2021).Google Scholar
Lawal, A. K., Rotter, T., Kinsman, L., et al. Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol). Syst Rev 2014; 3: 103.Google Scholar
Wagner, E. H.. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract 1998; 1(1): 2–4.Google Scholar
Langley, G. J., Moen, R. D., Nolan, K. M., et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Chichester, Wiley, 2009.Google Scholar
Aggarwal, A., Aeran, H., Rathee, M.. Quality management in healthcare: the pivotal desideratum. J Oral Biol Craniofac Res 2019; 9(2): 180–182.CrossRefGoogle ScholarPubMed
de Jonge, V., Sint Nicolaas, J., van Leerdam, M. E., et al. Overview of the quality assurance movement in health care. Best Pract Res Clin Gastroenterol 2011; 25(3): 337–347.Google Scholar
Desveaux, L., Mitchell, J. I., Shaw, J., et al. Understanding the impact of accreditation on quality in healthcare: a grounded theory approach. Int J Qual Health Care 2017; 29(7): 941–947.Google Scholar
Greenfield, D., Lawrence, S. A., Kellner, A., et al. Health service accreditation stimulating change in clinical care and human resource management processes: a study of 311 Australian hospitals. Health Policy 2019; 123(7): 661–665.CrossRefGoogle ScholarPubMed
Brixi, H., Lust, E., Woolcock, M.. Trust, voice, and incentives: learning from local success stories in service delivery in the Middle East and North Africa. 2015. https://openknowledge.worldbank.org/handle/10986/21607 (accessed February 10, 2022).Google Scholar
Fortune, T., Connor, E., Donalds, B.. Guidance on designing healthcare external evaluation programmes including accreditation. 2015. https://login.isqua.org/navless/resources/resource/19 (accessed September 19, 2021).Google Scholar
Falstie-Jensen, A. M., Bogh, S. B., Johnsen, S. P.. Consecutive cycles of hospital accreditation: persistent low compliance associated with higher mortality and longer length of stay. Int J Qual Health Care 2018; 30(5): 382–389.Google Scholar
Halasa, Y. A., Zeng, W., Chappy, E., et al. Value and impact of international hospital accreditation: a case study from Jordan. East Mediterr Health J 2015; 21(2): 90–99.Google ScholarPubMed
Health Care Accreditation Council. What we do. 2021. https://hcac.jo/en-us/About-Us/What-We-Do (accessed September 23, 2021).Google Scholar
Scally, G., Donaldson, L. J.. The NHS’s 50 anniversary: clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998; 317(7150): 61–65.Google Scholar
Waston, R.. Clinical governance: a guide to implementation for healthcare professionals. J Adv Nurs 2001; 38: 1.Google Scholar
Australian Commission on Safety and Quality in Health Care. National model clinical governance framework. 2017. www.safetyandquality.gov.au/sites/default/files/migrated/National-Model-Clinical-Governance-Framework.pdf (accessed February 10, 2022).Google Scholar
Nicholls, S., Cullen, R., O’Neill, S., et al. Clinical governance: its origins and its foundations. Clin Perform Qual Health Care 2000; 8(3): 172–178.Google Scholar
Walshe, K. M.. Principles for best practice in clinical audit. 2002. www.nice.org.uk/media/default/About/what-we-do/Into-practice/principles-for-best-practice-in-clinical-audit.pdf (accessed September 23, 2021).Google Scholar
Ettorchi-Tardy, A., Levif, M., Michel, P.. Benchmarking: a method for continuous quality improvement in health. Healthc Policy 2012; 7(4): e101–e119.Google Scholar

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