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Leadership strategies to improve global health

M. Rashad Massoud, MD, MPH, FACP

Director, USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project

Senior Vice President, Quality & Performance Institute

University Research Co., LLC

Victor Boguslavsky, MD, MPH

Deputy Director, USAID ASSIST Project

Director, Quality & Performance Institute


Amanda Ottosson, MSc

Healthcare Improvement Fellow, USAID ASSIST Project

Quality & Performance Institute


USAID Applying Science to Strengthen and Improve Systems

Objectives

After this session, participants will be able to discuss:

• Starting up improvement efforts

• Setting priorities for improving healthcare

• Transitioning to new priorities

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Case 1: Developing a quality improvement effort

The quality improvement effort in Country X is approaching its second year. So far,

emphasis has been placed on developing training curricula in quality improvement and

communicating to the healthcare professionals what quality improvement is all about.

Many professionals, representing a cross section of the health sector, have participated

in various seminars and short training courses on quality improvement. There is a lot of

interest among the healthcare delivery community in improving healthcare quality.

At this stage, the leadership of the quality improvement effort determined it is a priority

to conduct a national healthcare quality survey. They would like to use the results of the

survey as a basis for developing a strategic plan and a national policy for quality

improvement. It is envisaged that the Strategic Plan and the National Policy on Quality

Improvement in Healthcare will detail what needs to be done to improve healthcare

quality country-wide.


Discussion question

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You are a healthcare quality improvement consultant. The leadership team of the quality

improvement effort in Country X asks you to assist them in developing their national

quality improvement effort.

What would you recommend?


Case 2: Leadership resistance

Facility Y is part of a large primary health care system. The health system operates with

standardized policies and procedures. The manager of Facility Y was recently exposed

to improvement and was interested in putting his learnings to use in solving many of the

chronic problems within the system. He proceeded to set up a team at Facility Y,

introduce changes, and demonstrate improvements. After getting the results of the

improvements, he wrote to inform his supervisor of the changes made and the results

obtained. He recommended to disseminate the experience system-wide. To his

surprise, the response was negative requesting him to return things as they were and

not make any other changes in the future without prior approval.


Discussion questions

1. What is the problem?

2. How could the manager have prevented this problem?


Case 3: Priorization

You are the CEO of a large urban hospital. You have decided to launch a

demonstration in improving quality of care using the modern improvement methods and

techniques you have recently learned. You have discussed this idea with the hospital

department heads and received their commitment. You have also conveyed the

message regarding this demonstration to the whole hospital through the regular staff

meetings. Everyone has an opinion on which areas should be selected for

improvement. The areas selected determine which group of staff are to be trained first

and the focus of the effort in the first year.

The Chief Medical Officer has told you he would like to work on improving the

differential diagnosis for children who are admitted with abdominal pain with suspicion

of acute appendicitis. The Chief Administrator is interested in reducing the number of

lost files, while the Head of Nursing suggests working on improving the hospital drug

inventory and the Head of Outpatient Services would like to reduce the wait time in the

outpatient department.

You are feeling confused and ask your quality improvement consultant’s advice as to

how to prioritize the improvements to work on. The consultant says: “It does not matter

what improvements you choose — what matters is to get started with any

improvements in order to learn how to work with improvement methods.”



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1. Do you agree with the consultant’s opinion?

a) If so, why?

b) If not, why not?

2. What alternative means of selecting which improvements to work on would you

suggest? What criteria would you chose in the selection of improvements?


Case 4: Targets for Improvement

The leadership at hospital X decided that in order for the hospital to survive in its

competitive market, they need to improve the quality of care in their hospital. They

convened several meetings with the leadership team, including the CEO, during which

they agreed on a large number of specific improvement goals they needed to attain. A

random sample of five of these goals are:

• 1 hour for completing the management of a patient arriving to the emergency room, during

which the patient should either be discharged or admitted to the hospital.

• 80% higher on the quarterly patient satisfaction survey.

• No lost laboratory specimens.

• All staff arrive to work on time.

• Maximum 10-minute wait time at the emergency room check in.

They held meetings with all staff, informed them what the improvement targets are, and

told them that they have to reach them. They measured the improvement targets

quarterly. They displayed the results so that all staff could see them. Every quarter,

staff review results in staff meetings. The importance of reaching these targets is

stressed constantly.

The results for the above-mentioned indicators are shown in the participant guide.



1. Why are improvements not taking place?

2. What recommendations would you make to the leadership team of this hospital?


Case 5: Completing an Improvement Project

You are the quality improvement consultant for a quality improvement team. The quality

improvement team has been working hard on their improvement project. They have

made significant improvements, which can be seen by the data that was collected to

measure the system before and after changes have been implemented.

At the meeting with the quality improvement team, after reviewing the data together,

you all agree the objectives of the work have been accomplished. Two months later, the

team sends a drawing of the fishbone diagram. The team explains in the accompanying

note that they continued to meet to complete the fishbone diagram and that they are

proud to provide you with a copy.



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1. Why do you think the team continued to work on the fishbone diagram?

2. How would you advise the team to proceed from here?

Documents

Leadership strategies to improve global health - BMJaws-cdn.internationalforum.bmj.com/pdfs/2016_M7_v2_slides.pdfLeadership strategies to improve global health ... note that they continued