Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

English, Mike; Nzinga, Jacinta; Irimu, Grace; Gathara, David; Aluvaala, Jalemba; McKnight, Jacob; Wong, G.; Molyneux, Sassy

doi:10.12688/wellcomeopenres.16379.1

Cited by 7 publications

(1 citation statement)

References 112 publications

(119 reference statements)

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“…A culture of continued learning amongst team members is important to improve healthcare and the leader central in creating this culture [ 33 ]. Team members respond positively to a leader’s feedback when the leader is someone that they trust [ 24 , 34 ]. Secondly, the leader must possess the necessary technical QI skills [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

Odendaal,

Chetty,

Tomlinson

et al. 2023

BMC Health Serv Res

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The South African National Department of Health developed a quality improvement (QI) programme to reduce maternal and neonatal mortality and still births. The programme was implemented between 2018 and 2022 in 21 purposively selected public health facilities. We conducted a process evaluation to describe the characteristics and skills of the QI team leaders of well-performing teams. The evaluation was conducted in 15 of the 21 facilities. Facilities were purposively selected and comprised semi-structured interviews with leaders at three time points; reviewing of QI documentation; and 37 intermittently conducted semi-structured interviews with the QI advisors, being QI technical experts who supported the teams. These interviews focused on participants’ experiences and perceptions of how the teams performed, and performance barriers and enablers. Thematic data analysis was conducted using Atlas.ti. Variation in team performance was associated with leaders’ attributes and skills. However, the COVID-19 pandemic also affected team functioning. Well-performing teams had leaders who effectively navigated COVID-19 and other challenges, who embraced QI and had sound QI skills. These leaders cultivated trust by taking responsibility for failures, correcting members’ mistakes in encouraging ways, and setting high standards of care. Moreover, they promoted programme ownership among members by delegating tasks. Given the critical role leaders play in team performance and thus in the outcomes of QI programmes, efforts should focus on leader selection, training, and support.

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Section: Introductionmentioning

confidence: 99%

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

Odendaal,

Chetty,

Tomlinson

et al. 2023

BMC Health Serv Res

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Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya

et al. 2021

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We have worked to develop a Clinical Information Network (CIN) in Kenya as an early form of learning health systems (LHS) focused on paediatric and neonatal care that now spans 22 hospitals. CIN’s aim was to examine important outcomes of hospitalisation at scale, identify and ultimately solve practical problems of service delivery, drive improvements in quality and test interventions. By including multiple routine settings in research, we aimed to promote generalisability of findings and demonstrate potential efficiencies derived from LHS. We illustrate the nature and range of research CIN has supported over the past 7 years as a form of LHS. Clinically, this has largely focused on common, serious paediatric illnesses such as pneumonia, malaria and diarrhoea with dehydration with recent extensions to neonatal illnesses. CIN also enables examination of the quality of care, for example that provided to children with severe malnutrition and the challenges encountered in routine settings in adopting simple technologies (pulse oximetry) and more advanced diagnostics (eg, Xpert MTB/RIF). Although regular feedback to hospitals has been associated with some improvements in quality data continue to highlight system challenges that undermine provision of basic, quality care (eg, poor access to blood glucose testing and routine microbiology). These challenges include those associated with increased mortality risk (eg, delays in blood transfusion). Using the same data the CIN platform has enabled conduct of randomised trials and supports malaria vaccine and most recently COVID-19 surveillance. Employing LHS principles has meant engaging front-line workers, clinical managers and national stakeholders throughout. Our experience suggests LHS can be developed in low and middle-income countries that efficiently enable contextually appropriate research and contribute to strengthening of health services and research systems.

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Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

English,

Oliwa,

Khalid

et al. 2023

BMJ Glob Health

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Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals’ ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients’ care and their transitions and not be focused on a single location providing ‘critical care’. We propose a five-part strategy to support the system changes needed.

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Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

Cited by 7 publications

References 112 publications

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

“If you work alone on this project, you can’t reach your target”: unpacking the leader’s role in well-performing teams in a maternal and neonatal quality improvement programme in South Africa, before and during COVID-19

Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

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