What has HCI done to institutionalize improvement? A report from 17 countries

In a March 2012 assessment, HCI put forth a framework comprised of elements which may contribute to the institutionalization of quality improvement at the national, regional/provincial, district, and service delivery levels. These elements are: political will and leadership, roles and responsibilities, organization, orientation, resources, monitoring and tracking of data, and transfer, or the application of improvement methods to areas of service beyond those supported by HCI or other implementing partners. The March 2012 assessment focused on the level and form of institutionalization across all levels of the health system in 15 HCI-supported countries. The purpose of this follow-up assessment was to examine the varying ways HCI has facilitated the institutionalization of improvement at the national level across 17 HCI-supported countries. This qualitative descriptive investigation included all 15 countries that participated in the March 2012 assessment, as well as Ethiopia and Kenya, whose programs had developed and appeared to have made some gains in institutionalization. Semi-structured interviews with HCI Chiefs of Party (COPs) were conducted either in person or via telephone in the period September-October 2012. The interview guides were tailored to focus on HCI's role in supporting institutionalization, based on each country's quarterly and annual reports. The semi-structured nature of the interviews gave COPs the opportunity to reflect upon and highlight those activities they found to be most effective or meaningful. Content analysis was used to identify common themes and patterns across the interviews. The findings of this assessment indicate that HCI has played a significant role in facilitating the institutionalization of quality improvement at the national level across 17 HCI-supported countries. The elements of the institutionalization framework, as identified in the March 2012 assessment, were found to be relevant and applicable in the context of HCI's work. The COPs interviewed highlighted the importance of political will and leadership, roles and responsibilities, organization, orientation, resources, monitoring and tracking of data, and transfer in supporting institutionalization. The assessment also identified several factors that facilitate the institutionalization of quality improvement, including the presence of a strong and committed leadership team, a clear and shared vision for quality improvement, and a well-defined and implemented quality improvement strategy. Additionally, the assessment found that challenges to institutionalizing quality improvement include limited resources, inadequate infrastructure, and a lack of technical capacity. The discussion and recommendations section of the report highlights the importance of continued support for institutionalization efforts, particularly in the areas of leadership development, quality improvement strategy implementation, and resource mobilization. The report also emphasizes the need for a sustained commitment to quality improvement, as well as the importance of monitoring and tracking progress towards institutionalization. The institutionalization framework, as identified in the March 2012 assessment, provides a useful guide for understanding the elements that contribute to the institutionalization of quality improvement. The framework consists of seven elements: political will and leadership, roles and responsibilities, organization, orientation, resources, monitoring and tracking of data, and transfer. The assessment found that these elements were relevant and applicable in the context of HCI's work, and that they played a significant role in facilitating the institutionalization of quality improvement at the national level across 17 HCI-supported countries. The assessment also identified several activities that HCI has undertaken to support institutionalization, including the provision of technical assistance, the development of quality improvement strategies, and the establishment of quality improvement teams. Additionally, the assessment found that HCI has facilitated the transfer of quality improvement methods to areas of service beyond those supported by HCI or other implementing partners.