Article Text

Ethiopian Pediatric Society Quality Improvement Initiative: a pragmatic approach to facility-based quality improvement in low-resource settings
  1. Jacquelyn Patterson1,
  2. Bogale Worku2,
  3. Denise Jones1,
  4. Alecia Clary3,
  5. Rohit Ramaswamy4,
  6. Carl Bose1
  1. 1Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2School of Medicine, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
  3. 3Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4Department of Maternal and Child Health, and the Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to Dr Jacquelyn Patterson; jackie_patterson{at}med.unc.edu

Abstract

Objectives To describe critical features of the Ethiopian Pediatric Society (EPS) Quality Improvement (QI) Initiative and to present formative research on mentor models.

Setting General and referral hospitals in the Addis Ababa area of Ethiopia.

Participants Eighteen hospitals selected for proximity to the EPS headquarters, prior participation in a recent newborn care training cascade and minimal experience with QI.

Interventions Education in QI in a 2-hour workshop setting followed by implementation of a facility-based QI project with the support of virtual mentorship or in-person mentorship.

Primary and secondary outcome measures Primary outcome—QI progress, measured using an adapted Institute for Healthcare Improvement Scale; secondary outcome—contextual factors affecting QI success as measured by the Model for Understanding Success in Quality.

Results The dose and nature of mentoring encounters differed based on a virtual versus in-person mentoring approach. All QI teams conducted at least one large-scale change. Education of staff was the most common change implemented in both groups. We did not identify contextual factors that predicted greater QI progress.

Conclusions The EPS QI Initiative demonstrates that education in QI paired with external mentorship can support implementation of QI in low-resource settings. This pragmatic approach to facility-based QI may be a scalable strategy for improving newborn care and outcomes. Further research is needed on the most appropriate instruments for measuring contextual factors in low/middle-income country settings.

  • continuous quality improvement
  • global health
  • healthcare quality improvement
  • paediatrics
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Footnotes

  • Contributors JP developed the project design, provided oversight during the execution of the project, assisted with data analyses and wrote the initial draft of the manuscript. BW assisted with development of the project design, recruited sites, provided in-country oversight during the execution of the project, assisted with data analyses and reviewed the manuscript. DJ assisted with the provision of data during the conduct of the project and with data analyses, and reviewed the manuscript. AC assisted with data analyses, particularly with analyses of the MUSIQ data, and reviewed the manuscript. RR assisted with development of the data analytic plan and with data analyses, and with the writing and reviewing of manuscript. CB assisted in the development of the project design, provided oversight during the execution of the project, and assisted with data analyses and writing of the manuscript.

  • Funding This work was supported by a grant (#50008) from the Laerdal Foundation, Stavanger, Norway.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The University of North Carolina at Chapel Hill Institutional Review Board exempted this study from review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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