Promoting quality improvement of healthcare services

One of the decisive factors in determining where to receive quality healthcare services is the quality of healthcare that health facilities offer you.

For instance, if a health facility provides hospitable and reasonable medical care to patients in a timely and equitable manner, it may become your go-to place. On the other hand, a health facility that keeps patients waiting in a long queue, has poor equipment and human resources, lacks medicine in its stock, or offers unfriendly services will discourage one from choosing it.

“Quality” is a fundamental concept in providing healthcare services. According to the Institute of Medicine (IOM), quality healthcare includes six dimensions: Safe, Effective, Patient-centered, Timely, Efficient and Equitable. In addition to these dimensions, the World Health Organisation (WHO) mentions Integrated as another domain in quality healthcare. While observing these elements, promoting quality improvement is essential in maximizing patients’ desired healthcare outcomes and satisfaction.

However, as reported by WHO, in low and middle-income countries, 60% of deaths from conditions requiring health care occur due to poor quality care; 24% of the world population live in fragile contexts with a challenge in delivering quality health services. Indeed, quality health care is one of the longstanding global health concerns.

Promoting quality improvement of healthcare services is a significant milestone for Universal Health Coverage (UHC). Nevertheless, how can we enhance quality of healthcare services? For instance, Uganda has been facing the Ebola Virus Disease (EVD) outbreak, in which as of January 6, 2022, there were 142 confirmed cases including 55 deaths, according to the ministry of Health (MoH).

Remarkably, some EVD infections have occurred at health facilities and at least 19 healthcare workers contracted the disease. From the standpoint of quality of care, nosocomial infection could hinder people’s access to health facilities for medication in fear of infection; this circumstance could be an antagonistic stream to enhancing quality of healthcare services.

Indeed, nosocomial infection could be simply prevented with proper understanding and practice of Infection Prevention and Control (IPC) including frequent and proper handwashing practice by healthcare workers and wearing Personal Protective Equipment (PPE).

This, apparently implies that quality of healthcare services be partially ensured in very simple and common approaches. We can achieve quality healthcare through a wide range of interventions, since its definitions and concepts are expansive as seen in the seven six dimensions.

As such, Government of Uganda, through the ministry of Health (MoH), has been highlighting the importance of quality of healthcare in the past and current Health Sector Strategic Plans by denoting versatile approaches including; development of standards and guidelines, capacity building of healthcare workers for provision of quality healthcare services, and strengthening of monitoring system on Quality Improvement, among others.

In addition to the overarching strategies and interventions, more substantive approaches can be readily implemented in a general medical setting. The “5S-CQI (KAIZEN)” and “Patient Safety”, for instance are ways- forward. 5S stands for ‘Sort, Set, Shine, Standardize, and Sustain’, whereas CQI refers to “Continuous Quality Improvement”.

5S-CQI (KAIZEN) is a way of organizing and managing the workspace and workflow to improve efficiency, by eliminating waste, improving flow and reducing process unreasonableness. Meanwhile, Patient Safety implies averting risks, errors and harm that can occur to patients during provision of healthcare.

Needless to say, “safe” is one of the prerequisite dimensions of healthcare quality. The 5S-CQI (KAIZEN) approach is one of the most efficient and accessible interventions for everyone to improve quality of healthcare services. Consequently, MoH introduced the approach to the Regional Referral Hospitals (RRHs) with support from Japan International Cooperation Agency (JICA) more than a decade ago by aligning to the Health Sector Strategic Plans.

Since 2021, MoH, with JICA’s support is implementing a 5-year “Project on Patient Safety Establishment through 5S-CQI-TQM,” aiming at establishment of a safety culture in all target hospitals (16 RRHs, Naguru NRH, and Tororo General Hospital).

Thus, the country is now moving towards substantial quality improvement of healthcare services, by fostering managerial procedures for patient safety and promoting Hospital Safety Reporting Systems (HSRS). This could finally lead to formulation of hospitable, respectable and reasonable public health facilities selected by Ugandans.

The author is Chief Representative, JICA Uganda