Factors influencing national rollout of quality improvement approaches to public hospitals in Tanzania

Effect of total quality management intervention on nurse commitment and nurse performance: A quasi-experimental study

BACKGROUND

The purpose of this study is to design, implement, and evaluate the impact of a total quality management intervention on job performance and commitment among Jordanian nurses working in government hospitals.

METHODS

A quasi-experimental multiple time series was conducted starting in September 2017 and ending in June 2018. 140 nurses were sampled using the proportionate stratified random sampling technique; 132 were completed the study 67 the intervention group, while 65 in the control group.

RESULTS

There were no significant differences in nurses' job performance or commitment between the 2 groups (control and intervention). A repeated measure MANOVA test for both groups revealed that the interaction between group and time was statistically significant (F (4, 127) = 144.841; P = .001; Wilk's Λ = 0.180; η2 = .820), indicating that groups had a significantly different pattern of job performance and commitment over time. A repeated test The MANCOVA test for both groups across time revealed significant differences in nurses' job performance and nurses' commitment at a less than 0.05 significance level (F (2127) = 320.724; P = .001; Wilk's Λ = 0.165; η2 = 0.835), and the overall effect of time was significant for all dependent variables (F (4125) = 36.879; P = .001; Wilk's Λ = 0.459; η2 = 0.541).

CONCLUSION

The educational intervention was effective in improving nursing job performance among the study sample. The improved commitment of respondents in the intervention group was attributed to the improvement in job performance.

Barriers and facilitators to implementing evidence-based health innovations in low- and middle-income countries: A systematic literature review

The unsuccessful implementation of health innovations occurs frequently, leading to missed opportunities where improvements could have been made on various aspects of a health system. The purpose of this study is to identify, assess and synthesise the facilitators and barriers to sustainably implementing evidence-based health innovations in a low- and middle-income country (LMIC) context. To identify the LMIC specific facilitators and barriers, a systematic literature review was conducted. 79 studies were analysed, and the implementation barriers and facilitators identified in each study were extracted. The extracted barriers and facilitators were categorised and synthesized into one of seven concepts: context, innovation, relations and networks, institutions, knowledge, actors or resources. There were no substantial variations between the frequency that each concept was identified as a facilitator or barrier to implementation. However, resources, which includes time, human, financial and physical resources, was the most frequently mentioned concept; emphasising the need to focus on the resource situation in LMICs. This study contributes to the growing literature that aims to inform health system planners and evaluators in LMICs on effectively and sustainably implementing evidence-based health innovations.

Introducing the "5S-KAIZEN-TQM" approach into public hospitals in Egypt

PURPOSE

The purpose of this paper is to identify how the introduction and dissemination of the 5S-KAIZEN-TQM approach positively influence the Egyptian health sector and its sustainability. It also seeks to encourage effective and efficient introduction of the 5S-KAIZEN-TQM approach into the health sectors of low- and middle-income countries.

DESIGN/METHODOLOGY/APPROACH

The pilot program introducing the 5S-KAIZEN-TQM approach into five Egyptian public hospitals spanned over 13 months from January 2016 to February 2017. During the pilot program, a series of interventions occurred to introduce the approach, such as seminars on the 5S and KAIZEN approach, consultation visits and progress report meetings. Data and information were collected through conducting interviews, observing directly and evaluating the implementation progress of 5S-KAIZEN-TQM activities.

FINDINGS

The study identified the following factors in effective and efficient dissemination of 5S-KAIZEN-TQM activities in the Egyptian health sector: restructuring the quality management structure to establish Quality Improvement Teams and Work Improvement Teams in hospitals, generating strong leadership and commitment among leaders, conducting effective in-house trainings on the 5S-KAIZEN-TQM approach, monitoring and following up on 5S-KAIZEN-TQM activities and introducing the 5S-KAIZEN-TQM approach using non-clinical sections, which could also influence the sustainability of the activities.

ORIGINALITY/VALUE

This study holds value in its clarification of meaningful ways to disseminate and encourage the sustainability of the 5S-KAIZEN-TQM approach in Egyptian public health facilities. Moreover, officials from the Ministry of Health and Population and hospital managers in Egypt can use the findings to plan and disseminate this approach nationwide.

The current status of nurses-doctors collaboration in clinical decision and its outcome in Tanzania

AIM

The aim of this study was to establish the current level of collaboration between nurses and medical doctors (MDs) in the making of clinical decisions.

DESIGN

Descriptive qualitative design was applied in this study.

METHODS

Semi-structured interviews were conducted to collect qualitative data. Contents were arranged according to their similarities, whereas content analysis was used to identify explanatory themes.

RESULTS

Nurses feel disrespected when medical doctors (MDs) ignore their opinions. The impression of lower level of education of nurses is seen as a cause to their opinions been ignored by the medical doctors. Nurses sometimes adhere to the instructions of MDs, but on other times, they carry on with their own proposed treatment.

IMPLICATIONS FOR NURSING PRACTICES

Involvement of nurses in clinical decisions will enable nurses to effectively advocate for patients.

Lean leadership attributes: a systematic review of the literature

Purpose

Emphasis on quality and reducing costs has led many health-care organizations to reconfigure their management, process, and quality control infrastructures. Many are lean, a management philosophy with roots in manufacturing industries that emphasizes elimination of waste. Successful lean implementation requires systemic change and strong leadership. Despite the importance of leadership to successful lean implementation, few researchers have probed the question of ideal leadership attributes to achieve lean thinking in health care. The purpose of this paper is to provide insight into applicable attributes for lean leaders in health care.

Design/methodology/approach

The authors systematically reviewed the literature on principles of leadership and, using Dombrowski and Mielke’s (2013) conceptual model of lean leadership, developed a parallel theoretical model for lean leadership in health care.

Findings

This work contributes to the development of a new framework for describing leadership attributes within lean management of health care.

Originality/value

The summary of attributes can provide a model for health-care leaders to apply lean in their organizations.

Improving Tanzanian childbirth service quality

Purpose

The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania.

Design/methodology/approach

A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs.

Findings

Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months.

Research limitations/implications

The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures.

Originality/value

Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

Evaluating the impact of continuous quality improvement methods at hospitals in Tanzania: a cluster-randomized trial

Objective

To evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania.

Design

Cluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted.

Setting

Sixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania.

Participants

Outpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012.

Intervention

Implementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months.

Main outcome measures

Cleanliness, waiting time, patient's experience, patient's satisfaction.

Results

The 5S increased cleanliness in the outpatient department, patients' subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours.

Conclusions

The 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care.

Analysis of interaction among the barriers to 5S implementation using interpretive structural modeling approach

Purpose

The purpose of this paper is to ascertain and analyze the interactions among different barriers of 5S implementation in manufacturing organizations.

Design/methodology/approach

In this paper, 15 barriers affecting the implementation of 5S in manufacturing organizations have been identified from literature analysis and discussion with academic and industrial experts. Afterwards, identified barriers were validated by using nation-wide questionnaire-based survey. Then, interpretive structural modeling (ISM) approach has been utilized to find out the interaction among the identified barriers in order to develop hierarchy-based model.

Findings

The research identifies several key barriers which have high driving power and weak dependence power. In this concern, these barriers entail extreme care and handling for successful implementation of 5S. Financial constraints, lack of top management commitment, and no proper vision and mission are found to be the key barriers.

Research limitations/implications

The developed ISM model is based on experts’ opinion. This developed hierarchy-based model requires further validation by using structural equation modeling approach or by performing detailed case studies.

Originality/value

In this paper, ISM-based structural model has been recommended for Indian manufacturing organizations, which is a novel exertion in the area of 5S implementation.

5S – a quality improvement tool for sustainable performance: literature review and directions

Purpose

The purpose of this paper is to present the comprehensive literature review on 5S and suggest possible gaps from the point of view of researchers and practitioners. The manuscript presents the overview of 5S implementation and highlights the achievements realized from deployment of 5S initiatives for sustainable performance of organizations.

Design/methodology/approach

The paper critically examines the literature on 5S, analyzes and reviews it systematically. The study highlights the critical barriers and success factors for sustainable 5S implementation in the organizations in the competitive world.

Findings

5S is an outstanding Japanese philosophy for the development of any type organization all over the world. This study bring out the concept of 5S, requirements for its holistic implementation, relationship with other lean tools, benefits, success factors and obstacles in 5S implementation. The significant contributions through 5S initiatives in the organization like production, quality, safety and effective utilization of workspace for the sustained organizational improvement have also been highlighted in the study.

Practical implications

The literature on assortment of 5S technique has been so far very limited. The present paper reviews large number of research publications related to 5S to highlight the significance of 5S philosophy in the sustainable organizational improvement across the world. It foregrounds the approach advised by the various researchers, practitioners and appraises censoriously the reason behind the demand of 5S program in the organization. The needful steps and obstacles are also foreground for the effective implementation of 5S in the organization.

Originality/value

The paper presents a comprehensive review of literature publications in the area of 5S and their assortment to develop an understanding of the significance and implementation of 5S in the organizations. The paper will be helpful or useful to researchers, safety executives, development professionals and managers in the organizations.

Applicability of the 5S management method for quality improvement in health-care facilities: a review

BACKGROUND

The 5S management method (where 5S stands for sort, set in order, shine, standardize, and sustain) was originally implemented by manufacturing enterprises in Japan. It was then introduced to the manufacturing sector in the West and eventually applied to the health sector for organizing and standardizing the workplace. 5S has recently received attention as a potential solution for improving government health-care services in low- and middle-income countries. We conducted a narrative literature review to explore its applicability to health-care facilities globally, with a focus on three aspects: (a) the context of its application, (b) its impacts, and (c) its adoption as part of government initiatives.

METHODS

To identify relevant research articles, we researched public health databases in English, including CINAHL, PubMed, ScienceDirect, and Web of Science. We found 15 of the 114 articles obtained from the search results to be relevant for full-text analysis of the context and impacts of the 5S application. To identify additional information particularly on its adoption as part of government initiatives, we also examined other types of resources including reference books, reports, didactic materials, government documents, and websites.

RESULTS

The 15 empirical studies highlighted its application in primary health-care facilities and a wide range of hospital areas in Brazil, India, Jordan, Senegal, Sri Lanka, Tanzania, the UK, and the USA. The review also found that 5S was considered to be the starting point for health-care quality improvement. Ten studies presented its impacts on quality improvements; the changes resulting from the 5S application were classified into the three dimensions of safety, efficiency, and patient-centeredness. Furthermore, 5S was adopted as part of government quality improvement strategies in India, Senegal, Sri Lanka, and Tanzania.

CONCLUSIONS

5S could be applied to health-care facilities regardless of locations. It could be not only a tool for health workers and facility managers but also a strategic option for policymakers. They could consider 5S as the starting point of a government-led quality improvement initiative for improving safety, efficiency, or patient-centeredness aspects particularly in low- and middle-income countries. However, the evidence base, particularly in resource-poor settings, must be expanded.