Leveraging healthcare standards-based improvement initiatives to support learning and continuous improvement: lessons from implementing the Ideal Clinic programme in Cape Town, South Africa

Abstract

Abstract Background This paper draws on the experiences of a group of health system leaders and researchers in leading and supporting, respectively, the implementation of the Ideal Clinic Realisation and Maintenance Framework (ICRMF) in Cape Town, South Africa. The ICRMF is a national standards-based quality improvement initiative that seeks to improve the quality of care in public primary healthcare (PHC) facilities. We share lessons learned on how efforts to improve healthcare standards can be leveraged for learning and meaningful system change. Methods A three-pronged approach to improving the implementation of the ICRMF was used in 15 PHC facilities across two sub-districts. The approach included (i) nurturing trust, (ii) changing the ICRMF assessment strategy, and (iii) promoting a collaborative and collective sense-making approach to understanding performance and addressing gaps. Routine ICRMF quantitative data and qualitative feedback from both the ICRMF assessment process and routine management meetings were used to reflect on the experience of using this approach and to draw lessons. The results and conclusions were further confirmed through member-checking. Results We found that using the three-pronged approach, the ICRMF assessments were able to facilitate deep and reflexive conversations about everyday health system challenges facing healthcare delivery in the sub-districts, while encouraging collective sensemaking and collaboration. The ICRMF was often perceived as a compliance-driven exercise with limited value on the actual quality of care. The three-pronged approach helped shift some of these perceptions and improved the experiences of facility managers in implementing the programme. Conclusion When supported by trusting relationships, reflexive processes and multidisciplinary ownership and collaboration, healthcare standards programmes such as the ICRMF can provide powerful avenues for learning and meaningful change. Our limited dataset could not demonstrate if our approach addresses the challenge of maintaining standards or not (which is linked to continuous improvement).