Providers’ perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative

Abstract

Background. In South Africa, concerns exist about the quality of substance abuse treatment. We developed a performance measure ment system, known as the Service Quality Measures (SQM) initiative, to monitor the quality of treatment and assess efforts to improve quality of care. In 2014, the SQM system was implemented at six treatment sites to evaluate how implementation protocols could be improved in preparation for wider roll-out. Objective. To describe providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers to and facilitators of implementation. Methods. We conducted 15 in-depth interviews (IDIs) with treatment providers from six treatment sites (two sites in KwaZulu-Natal and four in the Western Cape). Providers were asked about their experiences in implementing the system, the perceived feasibility of the system, and barriers to implementation. All IDIs were audio-recorded and transcribed verbatim. A framework approach was used to analyse the data. Results. Providers reported that the SQM system was feasible to implement and acceptable to patients and providers. Issues identified through the IDIs included a perceived lack of clarity about sequencing of key elements in the implementation of the SQM system, questions on integration of the system into clinical care pathways, difficulties in tracking patients through the system, and concerns about maximising patient participation in the process. Conclusion. Findings suggest that the SQM system is feasible to implement and acceptable to providers, but that some refinements to the implementation protocols are needed to maximise patient participation and the likelihood of sustained implementation.

Openness to Adopting Evidence-Based Practice in Public Substance use Treatment in South Africa Using Task Shifting: Caseload Size Matters

“…Additionally, interpretation of the EBPAS scales would be further enhanced by qualitative evaluations of barriers to adopting new evidence-based practices. Although qualitative research was conducted as part of this initiative 25 , it was separate from the current study. Further research would benefit from mixed methods evaluations of factors influencing readiness to adopt new evidence-based practices.…”

Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative

“…For instance, the pilot implementation of the SQM system was preceded by an intensive community engagement phase that included a series of focus group discussions with treatment providers, presentations at treatment facilities to discuss the need for such a system, and marketing by means of posters and information brochures. [6][7][8] Collectively, RESEARCH these activities could have enhanced awareness and acceptance of the SQM system among treatment staff, partially accounting for the high degree of readiness to adopt the SQM initiative observed among this sample of treatment providers. We also found that leadership support for the implementation of the SQM initiative was strongly associated with readiness to adopt; this effect prevailed even after controlling for other potential influences on system implementation.…”

“…[13] In addition to providing staff with training in the implementation of the SQM system, [8] we provided facility-wide training and information on the purpose and benefits of performance measurement as well as the organisation's need for such a system. Building awareness of the organisation's need for a performance measurement system and the associated benefits to the individual and organisation, arguably enhanced treatment providers' readiness to adopt the system.…”

“…[7] The developmental process [6,7] and the process evaluation of this system's initial implementation have been reported elsewhere. [8] Despite a robust developmental phase, questions remain about the extent to which treatment facilities will adopt the SQM system. As the implementation of this system creates some additional paperwork for treatment counsellors and support staff, and the system draws conclusions about the quality of services they provide, treatment staff may feel threatened by adopting it.…”

A Mixed-Methods Evaluation of the Implementation of a Performance Measurement System for South Africa’s Substance Use Treatment Services

“…To address this gap, we developed a performance measurement system for South Africa’s SUD treatment system known as the Service Quality Measures (SQM) initiative. The development and initial implementation of this system is described elsewhere (Myers et al, 2015, 2016b).…”