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.

Anaemia in Mali

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

How to assess the mind set of stakeholders?

It is important to asses and monitor the motivation, willingness, readiness of stakeholders. Moreover we need to understand all different (possible) barriers: e.g regulatory, structural, process related. Barriers may also exist of getting all stakeholders together for a participatory planning process. If one important barrier remains unknown and unaddressed, it can negatively influence the entire project. 

This calls for a regular follow up (monitoring) and for flexibilty to adapt plans to contextual changes in an iterative process. This may also influence the project design. For example:  if you have a theory you may introduce a "change package". If contextual factors are not well known/unpredictable at the start of the intervention, an incremental planning approach or an open system planning may be more suitable. In this case one can also narrow down the scope and segment people with whom we do improvement work.

Do we measure the right indicators? 

We need to be clear about the actual customer who this information is for. This will determine also the scope and the methods of an evaluation. Information is needed on what was new and different, e.g. data about changes? It is important to link up with existing data collection instruments/ tools to make sure that there is no parallel system introduced.  However, specific indicators may need to be introduced and measured – being part of the actual intervention.    

Scaling up from one to 37 districts

10 accountability questions: to be addressed: 

1. Why? 
2. Success factors? 
3. Evidence based approach? 
4. Fit with community expectations? 
5. Capacities available? 
6. Implementation plan? 
7. Implementation of the plan? 
8. Successful outcomes? 
9. Continuous QI?  
10. Sustainability?