Better Health Care – Day Three – Pre-Eclampsia in Uganda

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Jul 12, 2016
by Cliff Hughes
Better Health Care – Day Three – Pre-Eclampsia in Uganda

Quality improvement experts examine case studies from around the world

On the second and third days of the Salzburg Global Seminar session Better Health Care: How do we learn about improvement? following input from expert faculty, Fellows expand work on their case studies and consider how they can improve the rigor, attribution and generalizability.

Pre-eclampsia in Uganda

Please see the summary and the case description for background on the case. 

The day started with five case studies, each of which obviously grabbed the attention of the participants.

Our group reviewed an improvement project from the Jinja district in Uganda where the facilities planned to improve processes and outcomes for the screening and management of preeclampsia.

The improvement was well documented and three other hidden changes occurred. Although not primary end points the teams recognised each. Screening and management of malaria, screening and management of anaemia and leadership/team culture all improved.

We discussed in detail Deming’s 14 Principles, and the OAM framework (opportunity, ability and motivation) as theory that could be further applied to the original logic model. Our visiting faculty each provided many additional insights, but the following were highlighted:

  1. Embed evaluation
    Develop a logic model and include rewards
    Use surveys to evaluate human factors and develop these with the team
  2. Always have a clear and shared aim
    Study causal mechanisms explicitly
    Look for both How? and Why?
  3. Think about Health care worker interviews in the beginning and then later
    Consider resources needed
    Data (graphs) changed behaviours
  4. Consider the mechanisms of successful actions proximally, distally  and in context
    Recognise the difference between a drug trial and a human intervention in Quality
  5. Who is the customer?
    Look at time lines and points of change
    Help people see how & why they moved from old to new