Regular measurement is essential but insufficient to improve quality of healthcare

Abstract

Quality of CareRegular measurement is essential but insufficient to improve quality of healthcare Ambrose Agweyu and colleagues argue that large scale improvements in quality of healthcare require strong change management as well as health information systems that can provide continuous and rapid feedback E vidence on the detrimental effect of low quality health systems on preventable mortality worldwide has accelerated investments in large scale healthcare improvement. 1 Regular measurement of quality of care is a core principle of quality improvement programmes that has been promoted in some low resourced settings as the primary means to improve quality of healthcare-that is, the degree to which health services for individuals and populations are effective, safe, and people centred. 2 Advances in information technology over the past decades, along with a growing demand for accountability and regular measurement of quality of care, have resulted in a proliferation of indicators, tools, and approaches to measuring the performance of health systems. 3 4 Routine health information systems (RHIS) that capture high quality data to facilitate regular use of data to monitor realtime trends in healthcare processes and outcomes are essential.Regular measurement, however, will not improve healthcare on its own. Measurement must be coupled with specific actions to improve care, including change management processes to achieve and sustain large scale healthcare improvements. This realignment requires an appreciation of the challenges associated with the current model in healthcare, especially in low resource settings. Unlocking potential of routine health information systemsHigh quality health information on which to base decisions is needed by patients and their communities, healthcare providers and managers, insurers and other payers, governments, and international development agencies. Since health information systems in many settings with high mortality have been developed, to some extent, to facilitate the aggregation of information at subnational, national, and global levels to fulfil reporting requirements, they are often not fully used to improve health service management and quality at the local level. Faced with the challenge of satisfying the diverse information needs of different consumers, health systems often struggle with data generation, collation, analysis, and reporting, let alone using these data to establish or monitor quality improvement efforts.Health information systems in countries across all income levels fall short of their potential to contribute to improving health system performance because of three interrelated factors: technical limitations, including poorly structured data collection tools, limited interoperability, and inadequate investment in maintenance, support, and data privacy [5][6][7] ; behavioural factors, such as poor motivation to generate high quality data 8 9 ; and organisational determinants often arising from weak governance and resource constraints resulting in understaffing...

Sustainability of enhanced recovery after surgery programmes in gastrointestinal surgery: A scoping review

“…Similarly, sustaining change requires ongoing efforts. The finding that audit/feedback and education were the most common strategies in the present review aligns with existing organisational change and sustainability literature, 58,59 and while these strategies are essential, they are rarely sufficient in isolation to improve the quality of healthcare 58,60 . Furthermore, how and if these strategies change from initial implementation to supporting sustainability is unknown.…”

“…This is important to acknowledge as ongoing use of these strategies can be resource intensive and may represent further waste without appropriate accompanying change management processes and strong leadership. 60 Strong leadership, multidisciplinary stakeholder engagement, team communication and a learning culture that embraces change were identified as important enablers by included studies, consistent with sustainability of other EBIs. 59 It has been suggested that sustainability of a programme is dependent on its acceptability, fidelity and feasibility, 61 Sustainability is most often conceptualised as the continuation of intervention activities.…”

“…The finding that audit/feedback and education were the most common strategies in the present review aligns with existing organisational change and sustainability literature, 58,59 and while these strategies are essential, they are rarely sufficient in isolation to improve the quality of healthcare. 58,60 Furthermore, how and if these strategies change from initial implementation to supporting sustainability is unknown. This is important to acknowledge as ongoing use of these strategies can be resource intensive and may represent further waste without appropriate accompanying change management processes and strong leadership.…”

Overcoming the barriers between resource constraints and healthcare quality

“…[17][18][19] Such will obviously influence and support quality improvement, and national surgical policies. 20,21 And finally, implementation science is especially important in low-resource settings to ensure novel solutions are translated into routine practice and benefit the largest possible number of people. 22 To assist in this process, a conceptual framework for facilitating adoption of affordable surgical innovations in LMICs has been developed.…”

“…17–19 Such will obviously influence and support quality improvement, and national surgical policies. 20,21…”