Institute for Healthcare Improvement: Developing Countries

Essential Program Components

Each program is created using the principles of quality improvement to ensure the best outcomes at the most efficient costs and speeds. The projects focus on redesigning how care is delivered, while building lean and efficient models of treatment for a variety of settings (urban, suburban, and rural). Projects then begin to develop methods to broadly and rapidly spread those models across provinces, regions, or countries. The projects follow the Model for Improvement methodology and the Breakthrough Series Collaborative model in order to achieve these goals and participate in shared learning to create effective and timely change.

Local Partnership and Collaboration

IHI works with local organizations and government bodies in order to encourage peer-to-peer exchange of knowledge in the context of the aims they have set together. In this way, local partners have ownership over changes and innovations within their organizations, and improvement programs are sustainable after IHI’s involvement comes to a close.

Data and Testing

Each of the programs is centered on data collection and the use of data to drive and test change. Rather than creating new data collection systems, programs focus on leveraging existing data collection structures. The programs also collaborate with independent evaluators to measure the impact of interventions and changes made.

IHI programs use data to:

Properly measure the progress and processes of local health care settings
Scientifically inform process changes as the best route to improved performance
Promote rapid cycles of learning and testing through the Plan-Do-Study-Act model

Capacity Building

Building capacity for continuous and sustainable improvement is essential to the institutionalization of positive changes and quality improvement principles within health care organizations. IHI recognizes the value of total workforce participation in order to ensure a commitment to continuous improvement.

Dissemination

In addition to building capacity for continuous improvement, programs are dedicated to spreading changes and knowledge gained from pilot sites to other hospitals, districts, regions, and countries in order to reach the most people in a timely manner.

Quality Improvement in Developing Countries

"Anytime you approach improvement work in the developing world — or anywhere, really — you are faced with issues of sustainability. How are you going to create a system of care that will outlast your particular intervention?"

— Brandon Bennett, Process Improvement Specialist, IHI Developing Countries Team

Adopting Our Models to Resource-Poor Settings

Health care facilities across developing nations face a myriad of challenges from limited power supply to staff shortages and high staff turnover rates. Models for improvement and for learning improvement must be adapted to local contexts in order to achieve the highest level of impact within an organization and for its patients.

Staffing

Many of the clinics participating in projects with IHI experience severe staff shortages and high rates of staff turnover, creating barriers to instituting continuous and sustainable quality improvement within health care organizations. Each of the programs focuses on creating staff-driven changes to increase staff satisfaction, and these changes are often supported by systems that can be easily learned by new staff.

Spread

Success in isolated clinics is an excellent starting point for improving health care but in order to make a lasting impact, IHI's programs aim to be sustainable in the long term and on a large scale. Challenges to disseminating effective systems and processes across hospitals, districts, regions and countries include: political climate, leadership support, capacity, and resources.

Learn more about the science of spread.

Data Integrity

Data provides concrete evidence that speaks to the impact of changes made and so a focus on data quality, collection, and analysis is crucial to all the programs. Record keeping and data storage are often challenging in clinics where resources are scarce.

Problem Solving, The QI Way

Mitchell's Plain, Western Cape, South Africa

In Inzame Zabantu, new patient folders were being misfiled or lost as patients were referred to clinics for antiretroviral (ARV) therapy. In response to this challenge, clinic staff created a file identification system by placing the first letter of a patient’s last name on their folder when they were referred outside the clinic. When folders arrived back at the ARV clinic, a number was added to indicate that it had been returned. The clinic tested and implemented the system and today almost no files are lost in the shuffle between clinics.

Project Fives Alive!, Ghana

In Ghana, cultural barriers to care are being broken down by incorporating traditional birthing practices into hospital settings. As a result, more women are giving birth in clinical settings where complications can be dealt with quickly and both mothers and babies are being given essential obstetric and newborn care.

MaiKhanda, Malawi

Clinics participating in MaiKhanda discovered that many essential medicines and equipment needed during the birthing process were located in different areas around health facilities. As a result, mothers who experienced complications during birth (such as hemorrhaging) also experienced delays in getting proper treatment. Clinics began putting together delivery trays, stocked with essential labor and delivery equipment. Health workers began using these trays routinely during deliveries and today the trays are integrated into the daily medical routine of the clinics.