Organisational strategies

Organisational strategic interventions can be very diverse; they are primarily provider oriented, but also include patient oriented, community oriented or structural interventions.

Examples of provider oriented strategies include creation of teams as an effective model for service provision, integration of services, communication between health professionals to community participation and relocation of services. Specific components of these approaches may include supervision, problem based learning and motivational processes, emphasising creation of a sense of involvement and ownership in the quality improvement process.

One example is the COPE (client-oriented, provider-efficient services) approach, originally developed for family planning. In this model assessment of services are undertaken jointly by all staff at a health facility. The system identifies problems and their causes and locally relevant solutions are developed. Client interviews are also promoted to ensure that their perspective is included. The scheme includes a number of tools which are used to assist the process including client flow analysis, interview guides, action planning and checklists. For more information see the EngenderHealth website.

One review of studies relating to quality and MNH concluded that, although the evidence was not consistent, there is a need for policy makers to give consideration to the integration of primary health services to reduce fragmentation and the number of visits required. In addition it identified scope improve the effectiveness of screening programmes through improvements in the timing, scheduling and organisation of the systems. Specific examples which lead to increased uptake of services include task shifting of screening from doctors to nurses and participatory design of administrative systems and tools (Althabe et al 2008).

Other examples include a review of strategies within the UK National Health Service to reduce the length of hospital stays and to improve health outcomes. The review included strategies such as bringing together different types of professionals into multidisciplinary teams, improved processes for early discharge through better communication between hospital, general practitioners and community services. The review found that a number of interventions ‘contributed to improvements in patient outcomes, such as reducing mortality and complications rates’ (Miani et al 2014).

Case study: Women’s groups in Nepal

Community participation and mobilisation has long been advocated as a way to improve the quality of services. We are now going to look at an organisational intervention in this context.

What was the intervention?

In Nepal, an organisational, community oriented, multifaceted intervention was put into place where a female member of the community discussed perinatal health issues with women and mobilised women’s groups for action using participatory approaches.

What was observed?

Actions resulting from the mobilisation included generation of funds for transport, distribution of clean delivery kits and home visits to pregnant women by other members of the community.

In addition to the main interventions, health services in the area were also upgraded by providing baby resuscitation equipment and training of health staff.

Was the intervention a success?

The intervention was evaluated using a cluster randomised controlled trial. A reduced neonatal mortality rate by 30% was observed in the intervention areas (Manandhar et al 2004).

 

Organisational strategies was last modified: June 18th, 2015 by Adrian Bannister

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