GUIDING PRINCIPLES
To avoid quality improvement efforts becoming a vertical, this standalone initiative requires building quality-related capacity among the existing health system leadership at all levels, with a strong emphasis on primary health care. These system considerations are critical for the sustainability of the actions taken to enhance quality, and together contribute to a set of guiding principles that underpin the guidance described in this resource:
1. Start fast. The only way to reduce mortality and improve experience of care is to change what is happening at facilities and communities; therefore, the focus should be on initiating improvement activities as soon as possible. Planning is most effective when it is informed by implementation..
2. Build on existing structures and functions. Improving quality is a fundamental activity of the health system. The responsibility for quality must lie with system leadership, managers and frontline staff. Sustainability of quality activities is dependent on how aligned they are to existing structures and functions.
3. Support health workers. Health workers often work in conditions that are difficult, under-resourced and that hinder excellence. Systemic conditions – such as poor organization of care, unclear goals, wasteful rules, inadequate information flows – prevent health workers from carrying out their tasks successfully. Thus, a clear focus is required to support health workers.
4. Improve care for people. All efforts to improve service delivery must be directed towards improving clinical outcomes and patient experience of care. Effective and compassionate care for patients and the community should be central to all activities. Changes in systems and processes of service delivery should aim to put people at the centre of care.
5. Adapt to context. Activity plans should be adapted based on evidence from implementation as well as local context. We need to learn what different levels of the system need to do to enhance quality. There is always room for doing things better. It is only when we identify problems that they can be addressed. Good ideas should be shared across the system to support further adaptation.