UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT
BUREAU FOR GLOBAL HEALTH
OFFICE OF HEALTH, INFECTIOUS DISEASES AND NUTRITION
& OFFICE OF HEALTH SYSTEMS
CHILD SURVIVAL AND HEALTH GRANTS PROGRAM
TECHNICAL REFERENCE MATERIALS
2014
QUALITY IMPROVEMENT
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 i
Acknowledgements
This Technical Reference Material on Quality Improvement was prepared by the USAID
Applying Science to Strengthen and Improve Systems (ASSIST) Project for the Child Survival
and Health Grants Program. The USAID ASSIST Project is made possible by the generous
support of the American people and is managed by University Research Co., LLC (URC) under
the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC’s global partners on
USAID ASSIST include EnCompass LLC, FHI 360, Harvard University School of Public
Health, HEALTHQUAL International, Institute for Healthcare Improvement, Initiatives Inc.,
Johns Hopkins University Center for Communication Programs, and Women Influencing Health
Education and Rule of Law, LLC.
For more information on the work of the USAID ASSIST Project, please visit
www.usaidassist.org or write [email protected]
This Technical Reference Material on Quality Improvement was coordinated and published by
the Maternal and Child Health Integrated Program. The Maternal and Child Health Integrated
Program (MCHIP) is funded by the United States Agency for International Development, Bureau
for Global Health’s Office of Health, Infectious Diseases and Nutrition (USAID/GH/HIDN),
Cooperative Agreement #GHS-A-00-08-00002-000.
For further information on MCHIP, please contact: ICF International, 530 Gaither Road,
Rockville, MD 20850, USA. Email: [email protected]; Internet: www.mchipngo.net
Recommended citation:
USAID Applying Science to Strengthen and Improve Systems Project. 2014. Quality
Improvement. Technical Reference Material. Published by the Maternal and Child Health
Integrated Program for USAID.
DISCLAIMER
The contents of this report are the sole responsibility of the USAID Applying Science to
Strengthen and Improve Systems Project and do not necessarily reflect the views of the
United States Agency for International Development or the United States Government.
http://www.usaidassist.org/
mailto:[email protected]
mailto:[email protected]
http://www.mchipngo.net/
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 ii
TABLE OF CONTENTS
ABBREVIATIONS AND ACRONYMS ..................................................................................................................... iii
INTRODUCTION TO THE TECHNICAL REFERENCE MATERIALS ............................................................................... 1
INTRODUCTION ............................................................................................................................................... 2
1. WHY QUALITY? ............................................................................................................................................ 2
1.1 THE QUALITY GAP ............................................................................................................................ 2
1.2 QUALITY IS A FUNCTION OF THE HEALTH SYSTEM .............................................................................. 3
1.3 WHAT DO WE MEAN BY QUALITY IN HEALTH CARE? ........................................................................... 3
2. HOW DO WE IMPROVE QUALITY?.................................................................................................................. 6
2.1 A MODEL FOR IMPROVEMENT .......................................................................................................... 6
2.2 INTEGRATING EVIDENCE-BASED PRACTICES INTO CARE PROCESSES..................................................... 8
2.3 IMPROVING HEALTH SERVICES AT THE COMMUNITY LEVEL ................................................................ 8
2.4 MAJOR IMPROVEMENT APPROACHES ............................................................................................... 9
2.4.1 AUDIT AND FEEDBACK ................................................................................................................ 10
2.4.2 SUPERVISION ............................................................................................................................. 11
2.4.3 PROCESS IMPROVEMENT, DESIGN AND REDESIGN ....................................................................... 12
2.4.4 COLLABORATIVE IMPROVEMENT ..................................................................................................... 14
2.4.5 ORGANIZATION OF WORK .......................................................................................................... 16
2.4.6 REMINDERS ............................................................................................................................... 18
2.4.7 STANDARDS AND EVIDENCE-BASED GUIDELINES .......................................................................... 19
2.4.8 REGULATORY APPROACHES ........................................................................................................ 21
2.4.9 PERFORMANCE-BASED INCENTIVES............................................................................................. 23
3. MEASURING QUALITY TO DRIVE IMPROVEMENT .......................................................................................... 24
3.1 WHY IS MEASUREMENT IMPORTANT? ............................................................................................. 24
3.2 MEASUREMENT METHODS ............................................................................................................. 24
3.3 DEFINING QUALITY INDICATORS ..................................................................................................... 27
4. CONCLUSION ............................................................................................................................................. 29
HYPERLINK REFERENCES ................................................................................................................................. 31
REFERENCES .................................................................................................................................................. 32
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 iii
ABBREVIATIONS AND ACRONYMS
AIDS Acquired immunodeficiency syndrome
ANC Antenatal care
ASSIST USAID Applying Sciences to Strengthen and Improve Systems
BTS Breakthrough Series
CME Continuing medical education
HCI USAID Health Care Improvement Project
HIV Human immunodeficiency virus
HMIS Health management information systems
iCCM Integrated community case management
IHI Institute for Healthcare Improvement
IMCI Integrated management of childhood illness
LMIC Low- and middle-income country
MCHIP Maternal and Child Health Integrated Program
MDGs Millennium Development Goals
MOH Ministry of Health
PBI Performance-based incentives
PDQ Partnership Defined Quality
PDSA Plan-do-study-act
PEPFAR U.S. President’s Emergency Plan for AIDS Relief
QA Quality assurance
QAP Quality Assurance Project
QI Quality improvement
TRM Technical reference material
UNICEF United Nations Children's Fund
USAID United States Agency for International Development
WHO World Health Organization
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 1
INTRODUCTION TO THE TECHNICAL REFERENCE MATERIALS
The Technical Reference Materials (TRMs), products of the United States Agency for
International Development, Bureau for Global Health, Office of Health, Infectious Diseases, and
Nutrition (USAID/GH/HIDN), are a series of guides to help program planners and implementers
consider the many elements in a particular technical area of the Child Survival and Health Grants
Program (CSHGP). These guides are not an official policy for practice; rather, they are basic
everyday summaries to be used as field reference documents. They also may be accessed in the
form of electronic toolkits on the Knowledge for Health website.
The TRMs are organized in modules that correspond to the primary interventions and key
strategies that are central to CSHGP. Each module covers the essential elements that need to be
considered during implementation, resources for nongovernmental organizations (NGOs) and
others implementing community-oriented programs to consult when planning interventions, and
examples of tools most commonly used among CSHGP grantees to collect baseline population-
level data.
The TRM modules cover the following topics:
Technical specialists in the USAID Collaborating Agency community, CORE Group Working
Groups, USAID technical staff, and community-oriented practitioners all contribute to updating
the TRMs on an ongoing basis. The revision date for each TRM module is at the bottom of each
page. The modules are living documents, and we depend on readers to tell us of the usefulness of
the information, the need for additions or amendments, and general comments. This feedback
will help us keep the modules alive and responsive to readers’ needs. Please share comments
with the Maternal and
