Improvement through Continuous Learning: Key Takeaways from the 1st Africa Forum on Quality and Safety in Healthcare

On February 19–21, 2018, hundreds of health practitioners gathered in Durban, South Africa for the 1st Africa Forum on Quality and Safety in Healthcare, hosted by the Institute for Healthcare Improvement (IHI). The forum brought together established and emerging leaders in the field of quality improvement (QI) for inspiring keynotes, engaging workshops, lively discussions, and exchange of innovative ideas on improving the quality of health services across Africa.

Much of the discussion and buzz during the conference revolved around the culture of QI rather than its technical aspects. The culture of QI involves the leadership and management skills related to QI, what it takes for QI teams to bring about change in their health facilities, and ensuring continuous learning in the workplace. The technical aspects of QI focus on the theory and tools used to systematically and measurably improve the quality of health services and patient outcomes.

Six JSI staff from five different projects attended the conference. Here are some key takeaways:

1) Quality improvement is happening across the continent at an energetic pace

Based on the speakers’ presentations and the poster sessions, it is evident that QI is increasingly a focus and priority for health systems across Africa. The energy around QI is palpable, with lots of emerging examples of improvements in care across diverse types of health facilities. From improving retention in HIV care to increasing the number of women who give birth in a facility with a trained provider, small clinics and large hospitals alike are systematically applying QI tools and documenting changes happening in their districts.

The question now is how do countries scale up successful quality improvement processes and embed a quality-focused culture at a systems level?

Some promising guidance may come in the form of the recently-convened Lancet Global Health Commission on High-Quality Health Systems, chaired by Margaret Kruk and conference keynote speaker Muhammad Pate. The commission, which has set out to stimulate research and propose policy recommendations on improving the quality of care in low- and middle-income health systems, will release a report later this year. Additionally, it’s also critical that we keep meeting and learning in settings such as this Africa Forum so that we can continue sharing and using the knowledge coming out of different countries.

2) Strong leadership is essential to meaningful and long-lasting quality improvement

At its heart, quality improvement is about recognizing a problem and testing out new ways to solve it, while measuring progress and allowing for change along the way until the result is an improvement. For QI initiatives to be successful, leaders must let go of command-and-control leadership and hero complexes. Instead, they must unlock the potential of their teams to bring about advancements in health care and allow for bottom-up improvements. This is the only way change can happen—testing, learning, and adapting to improve the way we plan, manage, and deliver health services within a complex system.

3) Focus more on continuous learning than on inspection

On the final day, keynote speaker Don Berwick discussed fear and trust in the workplace. He noted that health managers or leaders who focus only on the inspection aspects of quality (e.g., ticking a box on what each health worker is supposed to do) can erode trust within a workplace. While some inspection is needed (safety standards in healthcare are critical, for example), leaders in quality improvement should create an environment of continuous learning. When the focus is on continuous learning, health workers are empowered to identify problems in quality of care in their facilities and then test out possible ways to improve them. This fosters trust, rather than fear and ensures that the quality of care is continuously improving.

There were so many ideas that were shared during these exciting three days. With all the enthusiasm and promise we witnessed, we can’t wait to hear about all the progress during the next Africa Forum!

For more information on JSI’s work in quality improvement, check out these resources that were presented on at the conference:

Universal Immunization through Improving Family Health Services Project

Strengthening Ethiopia’s Urban Health Program Project

Last Ten Kilometers Project

Stronger Systems for Routine Immunization Project

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