Introducing continous quality improvement initiatives: a case study of St Francis community Hospital in Nairobi Kenya
Mwangi, Esther Wairimu
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The purpose of this study was to explore in-depth the experiences within the St Francis Community hospital (STFCH) in its short Quality Improvement (QI) journey; and to identify both the facilitating and hindering factors encountered in the establishment of Continuous QI initiatives for policy analysis through examining policy actors, content, context and policy process involved in the introduction of QI initiatives.The study was informed by the Theoretical frame work of the Donabedian model while the conceptual framework was based on the Policy analysis triangle which identifies four pillars of policy analysis namely; the policy actors, policy context, policy context and policy process. These four interact in such a synchronised way that jointly influences any establishment of Quality Improvement initiatives in the healthcare sector. The study employed Qualitative approaches by use of the Case study design. A sample size of 32 was scientifically identified through a purposeful sampling. A total of 22 (68.75%) respondents were interviewed as follows. Key informants were 7 for the in-depth interview and 2 FGD. The first FGD targeting HMT had 7 respondents while the second FGD targeting QIT comprised of 8 respondents.The study found out that the STFCH has tried to introduce minimal QI initiatives in an informal manner without measurable objectives. Most staff does not understand their specific roles in Continuous Quality Improvement (CQI) hence confusing them with their job descriptions. Even if there was very good will to embrace QI Initiatives due to its positive impact in healthcare delivery, there was a general knowledge gap on the understanding of QI models, QI policy and other accreditation requirements. Efforts on QI were only anchored on the motivation of having the hospital get ISO certified by the year 2019 outside which QI initiatives would not be considered for any resource allocation. The study also revealed that the implementation has been haphazard, uncoordinated and lacking in structural systems, QI Policy manual and professionalism which continuously affected delivery of effective, efficient, safe, timely and satisfactory healthcare services. This was evidenced by absence of measurable outcomes, documented evidence of quality improvement practices and an official adoption of a specific QI model to guide the intended initiatives.The study therefore made five recommendations namely; First there is need for a training of all actors on their different roles and responsibilities as well as form vibrant Work Improvement Teams in every department (WIT) in regards to QI initiatives; Secondly the hospital should adopt a QI model to scientifically guide and support QI initiatives in the facility; thirdly HMT should be fully involved in the development of a QI policy manual and all the other aspects of CQI so as to promote ownership and support of the processes as well as address issues emanating from quality assurance initiatives. Fourthly QI Budgetary allocation should be considered to ensure a serious commitment to the QI activities in the health facility. Finally, a culture of Continuous Quality Improvement should be promoted by establishing a research centre or innovative research initiatives that can continuously decision on QI initiatives.