Quality improvement teams in Morocco: an evaluation of functionality and success.

Research was undertaken to evaluate the implementation of quality improvement teams established by the Ministry of Health at the facility level in Morocco with assistance from John Snow Inc.; University Research Co. LLC; and the Quality Assurance Project. This research addresses the following primary questions: 1. What are the factors that lead to a successful quality improvement (QI) team particularly concerning the impact of coaching received by QI teams on their performance? 2. What is the cost of establishing and supporting QI teams? The research was a cross-sectional evaluation of the team “functionality” and the factors affecting team functionality. QA team functionality is defined as the degree to which teams complete quality improvement work according to a “standard” QI methodology. A preliminary data collection was conducted in June 1999 in order to validate the study tools. The main data collection was conducted in June 2000. The data collection consisted of gathering information from three sources of data; namely QI teams QI team facilitators and regional coordinators or delegues using five separate data collection tools. In general teams were well versed in the QI methodology and both team leaders and team members showed unusual—in comparison to other QAP team evaluations—facility with QI terms and tools. Overall teams in all of the regions were highly motivated in their QI work even in the face of implementation problems. In terms of the team’s functionality as measured by the team data collection tool the evaluation team found that teams did quite well in the identification of problems and in the analysis of problems. Across all of the regions teams rated 72 percent and 74 percent respectively in terms of how they completed these steps of the QI cycle. Teams did slightly less well on developing solutions with only 48 percent of teams following “proper” practice. Overall the evaluation team found that teams were highly satisfied with their work on QI and that they rate their facilitators highly across a range of indicators. In terms of coaching skills it appears that facilitators themselves in Morocco feel relatively confident in their abilities to help teams work through a variety of problems. Areas where coaches feel that they could improve their work are in developing and implementing solutions and beginning work on new problems. In a regression analysis of factors related to getting results it appears that the most significant factor is how well teams follow the standard steps of QI termed in the study team “functionality” with QI (p < .05). Other factors examined but found not to be significant were: resources consumed team climate and satisfaction and coach rating (by team). The research team found a high level of proficiency with the standard QI methodology and a real interest in the use of QI tools. Teams genuinely seemed energized by the methodology and had found many benefits to its use. Future work will need to concentrate on better understanding of monitoring and the need for close facilitation during the solutions implementation and monitoring phase. Concerning the factors related to team success there is little research available that has evaluated the process of doing QI. This research contributes an important finding that “successful” QI is not just any collection of general approaches to thinking about problems. It may make a difference if teams follow the steps in QI and use QI tools correctly; however further prospective intervention studies comparing different methods of doing QI will be necessary in order to answer that question. Finally this report presents specific recommendations for the QA program in Morocco. (authors)