Improvement interventions
Improvement interventions are actions taken at different health system levels to improve quality of health services. The WHO Handbook on national quality policy and strategy and the publication Delivering quality health services produced jointly by WHO, the Organisation for Economic Co-operation and Development and the World Bank outline the need for action across four broad intervention areas:
- shaping the system environment
- reducing harm
- improving clinical care
- engaging and empowering patients, families and communities
The Quality of care in fragile, conflict-affected and vulnerable settings: taking action and its associated Tools and resources compendium provide an additional set of interventions recommended to ensure access and basic infrastructure for quality of care, which may be particularly applicable in challenging settings.
Emphasis is placed on selecting pragmatic interventions that address local quality challenges, are feasible and cost-effective within each given context, and that come together in a coherent manner across different health system levels to support planning for quality, assurance and improvement. While the national level will have a key role in selecting a set of interventions and implementing many of them, implementation often touches each level of health systems. Interventions are also likely to span complex, multi-stakeholder actions right through to the application of discrete tools at the point of care. More detail on interventions is available in the Handbook on national quality policy and strategy and its accompanying Tools and resources compendium.
Tools may support broad approaches, such as the ‘plan–do–study–act’ (PDSA) model or root-cause analysis that each help to define system weaknesses in order to understand quality variations. There are also very specific improvement interventions that aim to improve some specific service provision, practice, or approach in care delivery. In both cases, people who both develop and implement improvement interventions would benefit from the tools in this section of the Toolkit.
Related tools and resources aim to support identification of quality issues and systemic actions to address them and bring about improvements, documenting the process and evaluating results for subsequent action. The application of these tools can guide improvement efforts, as well as support innovative improvement approaches that have shown promise in practice. Capturing the lessons of the application and implementation of these interventions is important through an active focus on learning. Measurement and evaluation efforts can help inform whether an intervention was successful with the potential to lead to positive impact or provide important lessons for future application.
Improvement interventions at the national level are likely to directly affect the sub-national level, and help support administrative and operational functions that impact facilities under their jurisdiction. Working in a decentralized or autonomous sub-national region still requires review of the improvement interventions at the national level. At the facility level, these tools may also support capacity-strengthening among staff and application of improvement interventions. Close coordination between facilities in developing and implementing improvement interventions, and the engagement of communities, are also important to build and strengthen trust and accountability with those being served. This key function encourages accountability and identification of gaps from standards, and adherence to relevant guidelines. Improvement interventions also help engage the community as empowered agents who contribute to improving services across the health system. This can also inform and empower people to understand the quality of health services provided and how to advocate for improvements where necessary. Improvement interventions at the community level are aimed to help support and feed priorities back from the community to improve and offer recommendations, which may be applicable at the national, sub-national and/or facility levels.