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).
- Althabe, F., Bergelb, E., Cafferatac, M.L., Gibbonsa, L., Ciapponia, A., Colantonioa, A.A.L. and Palaciosa, A.R. , (2008) Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews.
- Miani C, Ball S, Pitchforth E, Exley J, King S, Roland M, et al, (2014) Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment
- Manandhar DS et al, (2004) Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomised controlled trial
- EgenderHealth.org, (Website) Egender Health