#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

What factors do make quality improvement work in primary health care? Experiences of maternal health quality improvement teams in three Puskesmas in Indonesia


Autoři: Ralalicia Limato aff001;  Patricia Tumbelaka aff001;  Rukhsana Ahmed aff001;  Sudirman Nasir aff003;  Din Syafruddin aff001;  Hermen Ormel aff004;  Meghan Bruce Kumar aff005;  Miriam Taegtmeyer aff005;  Maryse Kok aff004
Působiště autorů: Malaria and Vector Resistance Laboratory, Eijkman Institute for Molecular Biology, Jakarta, Indonesia aff001;  Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom aff002;  School of Public Health, Hasanuddin University, Makassar, Indonesia aff003;  KIT Royal Tropical Institute, Amsterdam, The Netherlands aff004;  Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom aff005;  Emory University, Rollins School of Public Health, Center for Humanitarian Emergencies, Atlanta, Georgia, United States of America aff006;  Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226804

Souhrn

Background

Indonesia has been shifting from ensuring access to health services towards improving service quality. Accreditation has been used as quality assurance (QA) mechanism, first in hospitals and subsequently in primary health care facilities, including Puskesmas (community health centres). QA provides measures of whether services meet quality targets, but quality improvement (QI) is needed to make change and achieve improvements. QI is a cyclical process with cycles of problem identification, solution testing and observation. We investigated the factors which influenced the process of QI based on experience of maternal health QI teams in three Puskesmas in Cianjur district, West Java province, Indonesia.

Methods

Qualitative data were collected using 28 in-depth interviews at two points of time: pre- (April 2016) and post- QI intervention (April 2017), involving national, provincial, district and Puskesmas managers; and Puskesmas QI team members. Thematic analysis of transcripts was conducted.

Results

We found four main factors contributed to the process of QI: 1) leadership, including awareness and attitude of leader(s) towards QI, involvement of leader(s) in the QI process and decision-making in budget allocation for QI; 2) staff enthusiasm and multidisciplinary collaboration; 3) a culture where QI is integrated in existing responsibilities; and 4) the ongoing Puskesmas accreditation process, which increased the value of QI to the organisation.

Conclusion

Making QI a success in the decentralised Indonesian system requires action at four levels. At individual level, leadership attributes can create an internal quality environment and drive organisational cultural change. At team level, staff enthusiasm and collaboration can be triggered through engaging and tasking everyone in the QI process and having a shared vision of what quality should look like. At organisational level, QI should be integrated in planned activities, ensuring financial and human resources. Lastly, QI can be encouraged when it is implemented by the wider health system as part of national accreditation programmes.

Klíčová slova:

Antenatal care – Budgets – Decision making – Indonesia – Management of high-risk pregnancies – Maternal health – Midwives – Pregnancy


Zdroje

1. Bappenas. Indonesia Health Sector Review: Consolidated Report. 2014. Available: https://catalogue.nla.gov.au/Record/6933972

2. Kementerian Kesehatan Republik Indonesia. Rencana Strategis Kementerian Kesehatan 2010–2014. HK.03.01/60/I/2010 Indonesia; 2010.

3. Kementerian Kesehatan Republik Indonesia. Rencana Strategis Kementerian Kesehatan 2015–2019. HK.02.02/Menkes/52/2015 Indonesia; 2015. 351.077 Ind r

4. Mahendradhata Y, Trisnantoro L, Listyadewi S, Soewondo P, Marthias T, Harimurti P, et al. The Republic of Indonesia Health System Review. Hort K, Patcharanarumol W, editors. Health Systems in Transition. New Delhi, India: SEARO Library, World Health Organization, Regional Office for South-East Asia, Indraprastha Estate, Mahatma Gandhi Marg; 2017. Available: http://apps.who.int/iris/bitstream/10665/254716/1/9789290225164-eng.pdf

5. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2015. Jakarta, Indonesia; 2016. 351.077 Ind

6. UNICEF Indonesia. Maternal and child health. 2012. Available: https://www.unicef.org/indonesia/A5-_E_Issue_Brief_Maternal_REV.pdf

7. Campbell OMR, Graham W. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368: 1284–1299. doi: 10.1016/S0140-6736(06)69381-1 17027735

8. WHO. Quality and Accreditation in Health Care Services: A Global Review. Geneva, Switzeland; 2003. Available: http://www.who.int/hrh/documents/en/quality_accreditation.pdf

9. Poerwani SK, Sopacua E. Akreditasi Sebagai Upaya Peningkatan Mutu Pelayanan Rumah Sakit. Bul Penelit Sist Kesehat. 2006;9: 125–133.

10. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 46 Tahun 2015 Tentang Akreditasi Puskesmas, Klinik Pratama, Tempat Praktik Mandiri Dokter, dan Prakter Mandiri Dokter Gigi. Kemenkes, No. 46/2015 Indonesia; 2015 pp. 1–289. doi: 10.1073/pnas.0703993104

11. Menteri Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia Nomor 75 Tahun 2014 tentang Pusat Kesehatan Masyarakat. No. 75/2014 Indonesia; 2014 pp. 1–24. doi: 10.1017/CBO9781107415324.004

12. Varkey P, Reller MK, Resar RK. Basics of Quality Improvement in Health Care. Mayo Clin Proc. 2007;82: 735–739. doi: 10.4065/82.6.735 17550754

13. Batalden PB, Davidoff F. What is “Quality Improvement” and How Can it Transform Healthcare? Qual Saf Heal Care. 2007;16: 2–3. doi: 10.1136/qshc.2006.022046 17301192

14. Riley WJ, Moran JW, Corso LC, Beitsch LM, Bialek R, Cofsky A. Defining Quality Improvement in Public Health. J Public Heal Manag Pract. 2010;16: 5–7.

15. Leatherman S, Ferris T, Berwick D, Omaswa F, Crisp N. The Role of Quality Improvement in Strengthening Health Systems in Developing Countries. Int J Qual Heal Care. 2010;22: 237–243. doi: 10.1093/intqhc/mzq028 20543209

16. Singh K, Brodish P, Speizer I, Barker P, Amenga-Etego I, Dasoberi I, et al. Can a Quality Improvement Project Impact Maternal and Child Health Outcomes at Scale in Northern Ghana? Heal Res Policy Syst. 2016;14: 45. doi: 10.1186/s12961-016-0115-2 27306769

17. Horwood C, Butler L, Barker P, Phakathi S, Haskins L, Grant M, et al. A Continuous Quality Improvement Intervention to Improve the Effectiveness of Community Health Workers Providing Care to Mothers and Children: A Cluster Randomised Controlled Trial in South Africa. Hum Resour Health. 2017;15: 39. doi: 10.1186/s12960-017-0210-7 28610590

18. Tesfaye S, Barry D, Gobezayehu AG, Frew AH, Stover KE, Tessema H, et al. Improving Coverage of Postnatal Care in Rural Ethiopia Using a Community-Based, Collaborative Quality Improvement Approach. J Midwifery Women’s Heal. 2014;59: 55–64. doi: 10.1111/jmwh.12168 24588916

19. Tranced T. Implementation of community-level quality improvement in southeastern Tanzania: a mixed methods process evaluation of what worked, what didn’t, and why? London School of Hygine & Tropical Medicine. 2015. Available: http://researchonline.lshtm.ac.uk/2528880/2/2015_ITD_PhD_Tancred_T.pdf

20. Gholipour K, Tabrizi J, Asghari-Jafarabadi M, Iezadi S, Farshbaf N, Rahbar-Farzam F, et al. Customer’s self-audit to improve the technical quality of maternity care in Tabriz: a community trial. East Mediterr Heal J. 2016;22: 309–317. doi: 10.26719/2016.22.5.309 27553397

21. Gholipour K, Tabrizi JS, Jafarabadi MA, Iezadi S, Mardi A. Effects of customer self-Audit on the quality of maternity care in Tabriz: A cluster-randomized controlled trial. PLoS One. 2018;13: 1–19. doi: 10.1371/journal.pone.0203255 30307957

22. Baker U, Petro A, Marchant T, Peterson S, Manzi F, Bergström A, et al. Health workers’ experiences of collaborative quality improvement for maternal and newborn care in rural Tanzanian health facilities: A process evaluation using the integrated’Promoting Action on Research Implementation in Health Services’ framework. PLoS One. 2018;13: 1–21. doi: 10.1371/journal.pone.0209092 30566511

23. Stover KE, Tesfaye S, Frew AH, Mohammed H, Barry D, Alamineh L, et al. Building District-Level Capacity for Continuous Improvement in Maternal and Newborn Health. J Midwifery Women’s Heal. 2014;59: 91–100. doi: 10.1111/jmwh.12164 24588921

24. Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco, CA: Jossey-Bass; 2009.

25. Health Quality Ontario. Quality Improvement Guide. Queen’s Printer for Ontario. 2012. pp. 1–64. Available: www.hqontorio.ca

26. Health Quality Ontario. Quality improvement primers: Quality improvement science. Canada; 2013. pp. 1–15. Available: http://www.hqontario.ca/Portals/0/Documents/qi/qi-science-primer-en.pdf

27. Seksi KIA. Rekapitulasi laporan kematian ibu menurut kecamatan dan Puskesmas kabupaten cianjur bulan Januari—Desember 2013. Cianjur; 2014.

28. Seksi KIA. Rekapitulasi laporan kematian ibu menurut kecamatan dan Puskesmas kabupaten Cianjur bulan Januari—Desember 2014. Cianjur; 2015.

29. Seksi KIA. Rekapitulasi laporan kematian ibu menurut kecamatan dan Puskesmas kabupaten Cianjur bulan Januari—Desember 2015. Cianjur; 2016.

30. Pope C, Mays N. Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. BMJ. 1995;311: 42–45. doi: 10.1136/bmj.311.6996.42 7613329

31. Mack N, Woodsong C, McQueen KM, Guest G, Namey E. Qualitative Research Methods: A data collector’s field guide. Family Health International. North Carolina, USA: Family Health International; 2011. doi: 10.1108/eb020723

32. Spencer L, Ritchie J, O’Connor W, Morrell G, Ormston R. Analysis in Practice. Secomd. In: Ritchie J, Lewis J, Nicholls CM, Ormston R, editors. Qualitative research practice: A guide for social science students and researchers. Secomd. London, UK: SAGE Publication Ltd.; 2014.

33. Charmaz K. Constructing grounded theory. Second. London, UK: SAGE Publoications Ltd; 2014.

34. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: A framework for change. Milbank Q. 2001;79: 281–315. doi: 10.1111/1468-0009.00206 11439467

35. Athamneh KA. Assessment of infrastructural determinants for quality improvement programs for healthcare organizations in Qatar. Qscience Connect. 2014;26. Available: http://www.qscience.com/doi/10.5339/connect.2014.26

36. Somatunga LC, Sridharan S, Refai MACM, Malavige KK, Gamini LPS. Factors influencing continuous quality improvement programme in government hospitals of Sri Lanka. Int J Sci Technol. 2015;4: 118–123. Available: http://www.ijstr.org/final-print/june2015/Factors-Influencing-Continuous-Quality-Improvement-Programme-In-Government-Hospitals-Of-Sri-Lanka.pdf

37. Phung VH, Essam N, Asghar Z, Spaight A, Siriwardena AN. Exploration of Contextual Factors in a Successful Quality Improvement Collaborative in English Ambulance Services: Cross-sectional Survey. J Eval Clin Pract. 2016;22: 77–85. doi: 10.1111/jep.12438 26303398

38. Law MP, Graham R, Ross K. A Primer on Quality in Public Health: What’s Needed to Advance CQI in Ontario Public Health? 2013.

39. Siriwardena AN. Improving primary care quality now and into the next decade. Qual Prim Care. 2010;18: 357–358. 21294979

40. Paulová I, Kva MMĹ. Leadership–the Key Element in Improving Quality Management. Qual Innov Prosper. 2011;XV: 27–36.

41. Cianfrani CA, West JE (Jack). Cracking the case of ISO 9001:2008 for service: A simple guide to implementing quality management to service. Second. Milwaukee, Winsconsin: ASQ Quality Press; 2010.

42. Kliger J. Sustaining and spreading quality improvement. In: AHRC (Agency for Healthcare Research and Quality [Internet]. 2014 [cited 28 Nov 2017]. Available: https://innovations.ahrq.gov/perspectives/sustaining-and-spreading-quality-improvement

43. Bonias MD, Bartram T, Leggat S. Benefits and barriers of clinical engagement: A qualitative study of perceptions of medical practitioners and human resource managers in three Victorian public hospitals. ANZAM. 2011. pp. 1–17. Available: http://www.anzam.org/wp-content/uploads/pdf-manager/459_ANZAM2011-118.PDF

44. Ehlers U. Quality literacy—Competences for quality development in education and e-learning. REM-Research Educ Media. 2011;3: 2195–218. ISSN:2037-0849

45. Department of Health Republic of South Africa. A policy on quality in health care for South Africa. Dep Heal Repub South Africa. Pretoria; 2007. Available: http://www.cohsasa.co.za/sites/cohsasa.co.za/files/publication_pdfs/qhc.pdf

46. Simpson LA, Fairbrother G. The role of policy in quality improvement. Acad Pediatr. 2013;13: S16–S20. doi: 10.1016/j.acap.2013.03.014 24268079

47. Joshi MS, Hines SC. Getting the board on board: Engaging hospital boards in quality and patient safety. J Qual Patient Saf. 2006;32: 179–187. Available: http://www.jointcommissionjournal.com/article/S1553-7250(06)32023-5/pdf

48. Vaughn T, Koepke M, Kroch E, Lehrman W, Sinha S, Levey S. Engagement of leadership in quality improvement initiatives: Executive quality improvement survey results. J Patient Saf. 2006;2: 2–9. Available: https://www.researchgate.net/publication/232114090_Engagement_of_Leadership_in_Quality_Improvement_Initiatives_Executive_Quality_Improvement_Survey_Results

49. Versteeg MH, Laurant MGH, Franx GC, Jacobs AJ, Wensing MJP. Factors associated with the impact of quality improvement collaboratives in mental healthcare: an exploratory study. Implement Sci. 2012;7: 1. doi: 10.1186/1748-5908-7-1 22230594

50. Geonnotti K, Taylor EF, Peikes D, Schottenfeld L, Burak H, McNellis R, et al. Engaging primary care practices in quality improvement: Strategies for practice facilitators. Rockville; 2015. 15-0015-EF

51. Williams DM. How do people sustain their enthusiasm for QI? In: Institute for Healthcare Improvement [Internet]. 2017 [cited 23 Nov 2017]. Available: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/WilliamsSustainEnthusiasm.aspx

52. Pettigrew A, Ferlie E, McKee L. Shaping strategic change-the case of the nhs in the 1980s. Public Money Manag. 1992;12: 27–31. doi: 10.1080/09540969209387719

53. Dixon-Woods M, McNicol S, Martin G. Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Qual Saf. 2012;21: 876–884. doi: 10.1136/bmjqs-2011-000760 22543475

54. White M, Wells JSG, Butterworth T. The impact of a large-scale quality improvement programme on work engagement: Preliminary results from a national cross-sectional-survey of the “Productive Ward.” Int J Nurs Stud. 2014;51: 1634–1643. doi: 10.1016/j.ijnurstu.2014.05.002 24890896

55. Parand A, Benn J, Burnett S, Pinto A, Vincent C. Strategies for sustaining a quality improvement collaborative and its patient safety gains. Int J Qual Heal Care. 2012;24: 380–390. doi: 10.1093/intqhc/mzs030 22669328

56. ASQ. Culture of Quality: Accelerating growth and performance in the enterprise. New York; Available: http://eaq.ee/sites/default/files/lisad/culture-of-quality.pdf

57. Scott T, Mannion R, Davies HTO, Marshall MN. Implementing culture change in health care: Theory and practice. Int J Qual Heal Care. 2003;15: 111–118. doi: 10.1093/intqhc/mzg021 12705704

58. Gordon G. The Roles of leadership and ownership in building an effective quality culture. Qual High Educ. 2002;8: 97–106. doi: 10.1080/1353832022012749

59. Srinivasan A, Kurey B. Creating a culture of quality. In: Harvard Businness Review [Internet]. 2014 [cited 21 Nov 2017]. Available: https://hbr.org/2014/04/creating-a-culture-of-quality

60. Scoville R, Little K, Rakover J, Luther K, Mate K. Sustaining Improvement. Cambridge, MA; 2016. Available: http://drspweb.ihi.org/resources/Pages/IHIWhitePapers/Sustaining-Improvement.aspx

61. O’Regan N, Sims M, Ghobadian A. High performance: ownership and decision‐making in SMEs. Manag Decis. 2005;43: 382–396. Available: http://www.emeraldinsight.com/doi/pdfplus/10.1108/00251740510589760

62. Utami Yeni Tri Tamtomo D, Sulaeman ES. Patient Characteristics, Financing Type, Accreditation Status, and Quality of Health Services at Community Health Center, Surakarta. J Heal Policy Manag. 2017;2: 79–90. Available: http://www.thejhpm.com/index.php?journal=thejhpm&page=article&op=view&path%5B%5D=27

63. Shaw C. External Assessment of Health Care. BMJ. 2001;322: 851–4. doi: 10.1136/bmj.322.7290.851 11290644

64. Shaw C. The External Assessment of Health Services. World Hosp Heal Serv Off J Int Hosp Fed. 2004;40: 24–27, 50, 51. Available: http://www.who.int/management/ExternalAssessmentofHealthServices.pdf

65. Scrivens E. Putting continuous quality improvement into accreditation: improving approaches to quality assessment. Qual Health Care. 1997;6: 212–8. doi: 10.1136/qshc.6.4.212 10177038

66. Hamm MSHS. The fundamentals of accreditation. Washington, DC: American Society of Association Executives; 1997.

67. Berwick DM, James B, Coye MJ. Connections Between Quality Measurement and Improvement. Med Care. 2003;41: I30–I38. Available: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12544814 doi: 10.1097/00005650-200301001-00004 12544814


Článek vyšel v časopise

PLOS One


2019 Číslo 12
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#