Abstract
BackgroundAs lower-income countries look to develop a mature healthcare workforce and to improve quality and reduce costs, they are increasingly turning to quality improvement (QI), a widely-used strategy in higher-income countries. Although QI is an effective strategy for promoting evidence-based practices, QI interventions often fail to deliver desired results. This failure may reflect a problem with implementation. As the key implementing unit of QI, teams are critical for the success or failure of QI efforts. Thus, we used the model of work-team learning to identify factors related to the effectiveness of newly-formed hospital-based QI teams in Ghana.MethodsThis was a cross-sectional, observational study. We used structural equation modeling to estimate relationships between coaching-oriented team leadership, perceived support for teamwork, team psychological safety, team learning behavior, and QI implementation. We used an observer-rated measure of QI implementation, our outcome of interest. Team-level factors were measured using aggregated survey data from 490 QI team members, resulting in a sample size of 122 teams. We assessed model fit and tested significance of standardized parameters, including direct and indirect effects.ResultsLearning behavior mediated a positive relationship between psychological safety and QI implementation (β = 0.171, p = 0.001). Psychological safety mediated a positive relationship between team leadership and learning behavior (β = 0.384, p = 0.068). Perceived support for teamwork did not have a significant effect on psychological safety or learning behavior.ConclusionsPsychological safety and learning behavior are key for the success of newly formed QI teams working in lower-income countries. Organizational leaders and implementation facilitators should consider these leverage points as they work to establish an environment where QI and other team-based activities are supported and encouraged.
Highlights
As lower-income countries look to develop a mature healthcare workforce and to improve quality and reduce costs, they are increasingly turning to quality improvement (QI), a widely-used strategy in higherincome countries
It is important to note that there are multiple types of teams involved in clinical improvement, including temporary work groups, permanent QI teams, and existing teams focused on patient care
Study population and descriptive statistics A total of 141 hospital-based QI teams participated in Project Fives Alive! (PFA)
Summary
Study setting and sample PFA was a nationwide program in Ghana to reduce under-5 mortality by developing local QI teams to implement evidence-based practices [12]. Teams included in this study were evaluated by project officers and had team members complete the QI team questionnaire. Project officers asked all learning session participants to complete surveys, resulting in a response rate close to 100%. Ratings of QI implementation came from project officer surveys, which included 13 questions on the performance of QI teams. Project officers were instructed to complete the surveys during site visits with each team prior to the fourth round of learning sessions. As outsiders who each worked closely with a subset of the QI teams, project officers were well positioned to evaluate team performance. The bias for our standard error parameters is likely low because all survey questions referenced the group and because the factors should operate at both the individual and team level of analysis [44, 45]. Main results are described using the original scale to indicate the meaning of the effect size
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