Factors influencing national rollout of quality improvement approaches to public hospitals in Tanzania

Abstract

Purpose

The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries.

Design/methodology/approach

The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score).

Findings

Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant.

Research limitations/implications

This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries.

Originality/value

The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.

Citation

Ishijima, H., Eliakimu, E., Takahashi, S. and Miyamoto, N. (2014), "Factors influencing national rollout of quality improvement approaches to public hospitals in Tanzania", Clinical Governance: An International Journal, Vol. 19 No. 2, pp. 137-152. https://doi.org/10.1108/CGIJ-09-2013-0033