Improving Quality of Care in Low- and Middle-Income Countries Workshop Summary (2015) / Chapter Skim
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6 Cross-Cutting Approaches to Improve Quality
6 Cross-Cutting Approaches to Improve Quality
Pages 73-84
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From page 73... ...
• uality improvement work confronts tradeoffs among generalizability, Q simplicity, and local usefulness; though all three are desirable, it is not possible to have them all in one program. (Berwick)
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From page 74... ...
Barker reported a common concern that quality improvement programs neglect patient-centeredness -- respecting the patient's needs and supporting them to make good decisions regarding their health. This problem could be corrected with more explicit attention to patient-centeredness in capacity building programs.
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From page 75... ...
Some suggested that, when involved with any quality program, whether implementing a collaborative or accrediting a clinic, the technical experts could include policy makers as part of the effort. This would ensure that policy makers are better informed of the quality strategies used in their countries and better able to translate quality improvement programs into policy.
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From page 76... ...
In gen s eral, clearer guidelines on the best methods for evaluating quality improvement programs would be beneficial. Many participants in the research discussion were positive about using standardized patients to test providers, but acknowledged that observation may work better in some settings.
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From page 77... ...
Kruk reported that the group members discussed the importance of establishing baseline performance before rushing into any improvement program because baseline data has a strong influence on possible effect sizes. Members of the group were interested in having better data, especially from low-income countries.
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From page 78... ...
One option was to place the central office, with its highly trained and intelligent staff, in charge; the alternative was to delegate responsibility to the provincial o ffices, where staff would be more familiar with local conditions. Through a field test comparison, they determined that the central office and provin
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From page 79... ...
CLOSING REMARKS Don Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement, gave closing remarks for the workshop. Patrick Kelley, who directs the IOM Board on Global Health, briefly introduced the session, telling the audience how Berwick, along with Heiby and Sheila
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From page 80... ...
The often-cited 2001 IOM report Crossing the Quality Chasm changed the way people think about quality of care in the United States, and Kelley described the challenges of adapting the earlier report to a global audience. Quality improvement in the United States makes certain assumptions -- the stability and safety of the drug supply, for example -- that do not always apply in low- and middle-income countries.
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From page 81... ...
The concept of removing poor performers from a system goes back to the 1920s: it was Henry Ford's method of keeping production lines consistent. Berwick explained that modern quality improvement has moved beyond that in every field but health.
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From page 82... ...
In quality improvement, the process by which some changes take root and others do not is as important as the final effects on health. Berwick suggested that both methodological rigor and the utility of evaluation would be enhanced with deeper understandings of local contexts and how they influence processes and outcomes.
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From page 83... ...
Berwick spoke of how the IOM reports Crossing the Quality Chasm and To Err Is Human changed the way Americans think about medical error and quality of care. Although progress on the reports' recommendations has been variable, the influence they had in terms of making managers aware of safety, timeliness, effectiveness, patientcenteredness, efficiency, and equity is undeniable.
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