A scoping review of the use of quality improvement methods by community organizations in the United States, Australia, New Zealand, and Canada to improve health and well-being in community settings

Abstract

Background Quality improvement (QI) methods have been used extensively to improve quality of care in healthcare facilities. However, addressing complex public health issues such as Covid-19 and climate change, and their underlying structural determinants require community-level innovations that go beyond health care. Building the capacity of community organizations to use QI methods to improve health and well being of residents is a promising approach to improving community health and well being. This review aims to explore how community health improvement has been defined in the literature, the extent to which community organizations have knowledge and skill in QI and how communities have used QI to drive community-level improvements. Methods Guided by a published study protocol, we searched Scopus, Web of Science, and Proquest Health management for articles between 2000–2019 from US, Australia, New Zealand, and Canada. We included articles describing any QI intervention in a community setting to improve community well being. Following standards for conducting scoping reviews, we screened, extracted and synthesized data. We performed a quantitative tabulation and a thematic analysis to summarize the results. Results Thirty-two articles met criteria for inclusion, with 31 set in the US. QI approaches at the community level were the same as those used in clinical settings, and many involved multifaceted interventions targeting chronic disease management or health promotion, especially among minority and low-income communities. There was little discussion on how well these methods worked in community settings or whether they needed to be adapted for use by community organizations. Moreover, decision making authority over the project design and implementation was typically vested in organizations outside the community and did not contribute to strengthening the capability of community organizations to undertake QI on their own. Conclusion Most QI initiatives undertaken in communities are extensions of projects in health care settings and are not led by community residents. There is an urgent need for additional research on whether community organizations can use these methods on their own to tackle complex public health problems that go beyond healthcare quality.

Quality improvement in public–private partnerships in low- and middle-income countries: a systematic review

“…There is a growing interest in understanding how QI can be leveraged in partnerships of international and local non-governmental organizations (NGOs) as well as community groups that function outside of the clinical arena. QI has been successfully applied to community settings to improve population health and primary care, but reviews of literature have been limited to high-income countries [ 9 ]. Public–private partnerships (PPP) have become increasingly important to fund and improve health in LMICs and to address the shortcomings of other strategies to improve global health.…”