Sustained improvement activities require attention to the organizational quality management program, in which structures, processes and functions support measurement and improvement activities. Although QI projects can be undertaken successfully and demonstrate results, ongoing QI work will be short-lived without a framework to maintain them. The tasks of initiating, sustaining, and spreading QI throughout a healthcare delivery system are daunting and require more than individual effort.
A framework for QI success involves:
- Sustained leadership
- Staff training and support
- Patient involvement
- Time for teams to meet
- Data systems for tracking outcomes.
As part of the development of a QM program, important elements for implementation that are recommended through coaching include:
- Championship by the quality leader to encourage staff to constantly think about both improving their performance and that of the system of care.
- Active recognition of quality achievements and those who participate in QI.
- Leadership in guiding the planning process to focus on priorities, setting direction and assuring that resources are allocated for it.
- Development of a QM plan, which is a formal document consisting of a quality statement, performance measures and clearly defined roles and responsibilities of committees, teams, and individuals.
- Development of a quality workplan that identifies goals and objectives, key action steps, responsible parties and timeframes for completion.
- Identification of a team, committee or existing meeting where QI information can be discussed.
The OA provides clinic and national level leaders with information geared to these key infrastructure elements.
Current organizational assessment (OA) categories:
- Performance Measurement
- Quality Improvement
- Staff Involvement
- Consumer Involvement
Assessed components of structure include team/committee membership and frequency of meetings, commitment of resources, leadership support and the presence of a comprehensive QM plan. Planning refers to annual goals with specific timelines for implementation and clearly described roles and responsibilities. Appropriate quality indicators routinely measured comprise PM. QI consists of a focus on a team approach to identify QI projects. During the implementation phase, OAs are completed for initial clinics during visits. An in-country team is trained to do the OA by didactic instruction, observation of the HQI staff lead and then perform the OA themselves with coaching from the HQI staff lead. Repeating the OA annually allows monitoring of progress. Ongoing attention to the QMP results in building capacity for and sustainability of improvement.