If you can’t measure it- you can’t change it – a longitudinal study on improving quality of care in hospitals and health centers in rural Kenya

Background: The Kenyan Ministry of Health- Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end an integrated quality management system based on validated indicators derived from the Kenya Quality Model for Health (KQMH) was developed and adapted to the area of Reproductive and Maternal and Neonatal Health, implemented and analysed. Methods: An integrated quality management (QM) approach was developed based on European Practice Assessment (EPA) modified to the Kenyan context. It relies on a multi-perspective, multifaceted and repeated indicator based assessment, covering the 6 World Health Organization (WHO) building blocks. The adaptation process made use of a ten step modified RAND/UCLA appropriateness Method. To measure the 303 structure, process, outcome indicators five data collection tools were developed: surveys for patients and staff, a self-assessment, facilitator assessment, a manager interview guide. The assessment process was supported by a specially developed software (VISOTOOL®) that allows detailed feedback to facility staff, benchmarking and facilitates improvement plans. A longitudinal study design was used with 10 facilities (6 hospitals; 4 Health centers) selected out of 36 applications. Data was summarized using means and standard deviations (SDs). Categorical data was presented as frequency counts and percentages. Results: A baseline assessment (T1) was carried out, a reassessment (T2) after 1.5 years. Results from the first and second assessment after a relatively short period of 1.5 years of improvement activities are striking, in particular in the domain ‘Quality and Safety’ (20.02%; p < 0.0001) with the dimensions: use of clinical guidelines (34,18%; p < 0.0336); Infection control (23,61%; p < 0.0001). Marked improvements were found in the domains ‘Clinical Care’ (10.08%; p = 0.0108), ‘Management’ (13.10%: p < 0.0001), ‘Interface In/out-patients’ (13.87%; p = 0.0246), and in total (14.64%; p < 0.0001). Exemplarily drilling down the domain ‘clinical care’ significant improvements were observed in the dimensions ‘Antenatal care’ (26.84%; p = 0.0059) and ‘Survivors of gender-based violence’ (11.20%; p = 0.0092). The least marked changes or even a -not significant- decline of some was found in the dimensions ‘delivery’ and ‘postnatal care’. Conclusions: This comprehensive quality improvement approach breathes life into the process of collecting data for indicators and creates ownership among users and providers of health services. It offers a reflection on the relevance of evidence-based quality improvement for health system strengthening and has the potential to lay a solid ground for further certification and accreditation

Verantwortungsbewusster Umgang mit IT-Sicherheitslücken : Problemlagen und Optimierungsoptionen für ein effizientes Zusammenwirken zwischen IT-Sicherheitsforschung und IT-Verantwortlichen

IT-Sicherheitslücken in Hard- und Software betreffen private, unternehmerische und auch staatliche Systeme. Sobald eine Ausnutzung der Lücken technisch möglich ist, stellen sie eine Bedrohung für die IT-Sicherheit aller Beteiligten dar. Konkret betroffen sind Bürger:innen und Unternehmen als Nutzende, Hersteller von Soft- und Hardware sowie staatliche (kritische) IT-Infrastruktur. Es ist daher im gesamtgesellschaftlichen Interesse, die Zahl der ausnutzbaren Sicherheitslücken so gering wie möglich zu halten. Dieses Whitepaper führt in die rechtlichen und praktischen Probleme der IT-Sicherheitsforschung ein. Zugleich zeigt es vor allem rechtliche Auswege auf, die perspektivisch zu einer rechtssicheren IT-Sicherheitsforschung führen

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

Objectives: To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design: Longitudinal study with three points of measurement. Setting: Primary care practices in Switzerland. Participants: In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes: The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results: Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions: The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care

Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study

Background. Job satisfaction and working atmosphere are important for optimal health care delivery. The study aimed to document working atmosphere and job satisfaction of health care professionals in Kenya and to explore associations between job satisfaction, staff characteristics, and working atmosphere. Methods. Data from the integrated quality management system (IQMS) for the health sector in Kenya were used. Job satisfaction was measured with 10 items and with additional 5 items adapted to job situation in Kenya. Working atmosphere was measured with 13 item questionnaire. A stepwise linear regression analysis was performed with overall job satisfaction and working atmosphere, aspects of job satisfaction, and individual characteristics. Results. Out of 832 questionnaires handed out, 435 questionnaires were completed (response rate: 52.3%). Health care staff indicated high commitment to provide quality services and low levels regarding the adequacy and functionality of equipment at their work station. The aspect &quot;support of the ministry of health&quot; ( = 0.577) showed the highest score of explained variance (32.9%) regarding overall job satisfaction. Conclusions. IQMS which also evaluates job satisfaction and working atmosphere of health care staff provides a good opportunity for strengthening the recruitment and retention of health care staff as well as improving the provision of good quality of care

Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study

Background. Job satisfaction and working atmosphere are important for optimal health care delivery. The study aimed to document working atmosphere and job satisfaction of health care professionals in Kenya and to explore associations between job satisfaction, staff characteristics, and working atmosphere. Methods. Data from the integrated quality management system (IQMS) for the health sector in Kenya were used. Job satisfaction was measured with 10 items and with additional 5 items adapted to job situation in Kenya. Working atmosphere was measured with 13 item questionnaire. A stepwise linear regression analysis was performed with overall job satisfaction and working atmosphere, aspects of job satisfaction, and individual characteristics. Results. Out of 832 questionnaires handed out, 435 questionnaires were completed (response rate: 52.3%). Health care staff indicated high commitment to provide quality services and low levels regarding the adequacy and functionality of equipment at their work station. The aspect “support of the ministry of health” (β = 0.577) showed the highest score of explained variance (32.9%) regarding overall job satisfaction. Conclusions. IQMS which also evaluates job satisfaction and working atmosphere of health care staff provides a good opportunity for strengthening the recruitment and retention of health care staff as well as improving the provision of good quality of care

Quality management: where is the evidence? Developing an indicator-based approach in Kenya

Abstract Introduction The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain. Objective The Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health. Methods The adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context (‘People, Management, Clinical Care, Quality & Safety, Interface between inpatients and outpatients care'), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity. Results The resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties. Conclusions The integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya

Quality management : where is the evidence? Developing an indicator-based approach in Kenya

The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain.; The Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health.; The adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context ('People, Management, Clinical Care, Quality &amp; Safety, Interface between inpatients and outpatients care'), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity.; The resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties.; The integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya