Quality improvement strategies

The Cochrane Effective Practice and Organisation of Care (EPOC) review group has identified four categories of quality improvement strategies. Figure 3.2 below outlines these and gives examples. To learn more about each one for examples visit the Cochrane Effective Practice and Organisation of Care Group (EPOC) website.

Table: Categories of quality improvement strategies

Figure 3.2: Categories of quality improvement strategies

In the following sections we will use this framework to discuss some of these quality improvement strategies in more detail, focusing on those where there is experience of use for MNH in low and middle income settings.

Other noteable frameworks

Though the focus on this package is around improvement of the quality of MNH Services other frameworks that exist may be more applicable or useful in other circumstances. Below we highlight three different examples.

1. 2014 Lancet special edition on midwifery and quality of care: This framework differentiates between the care provided, how and by whom and categorises strategies such as organisation of care, values, philosophy and care providers across the components of health care required by childbearing women and newborns (Renfrew et al 2014). In the video below, from the 2014 DFID Health Advisers PDC in East Kilbride, Mary Renfrew outlines the context and describes the framework (more in-depth presentation by Mary available here)
2. The QQUIP (Quest for Quality and Improved Performance) research initiative of The Health Foundation (UK): This framework considers six main categories of quality enhancing interventions when reviewing evidence of the influence on quality of health services. These are:
  1. Patient focused interventions
  2. Regulatory interventions
  3. Incentives
  4. Data-driven and IT based interventions
  5. Organisational interventions
  6. Healthcare delivery models
3. The emergent WHO 2015 Quality of Care framework: In a consultation process that engaged a wide range of actors, including member states, WHO has developed a framework to generate ‘a triple return on investment’ by focusing on quality of care during labour, around birth and in the first week. Below, Fran McConville explains this approach to DFID Health Advisers at the 2015 PDC in East Kilbride, how WHO define and frame quality of care and the effective strategies they see for implementation:

Effects of strategic interventions on quality

In addition to quality improvement strategies a number of recent systematic reviews have investigated the effects of various strategic interventions. Some examples are listed in Figure 3.3 below.

Table describing systematic reviews on effectiveness
Table 3.3 – Systematic Reviews on Effectiveness

For example, in the study by Opiyo et al, which looked at different forms of in-service neonatal emergency care courses, the authors found that the evidence for improvement of health workers’ practices when caring for a seriously ill newborn after in-service training was limited, although there is some evidence of benefit in terms of provider practices

Quality improvement strategies was last modified: February 23rd, 2016 by Adrian Bannister

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