Amina Sahel, Vincent DeBrouwere, Bruno Dujardin, Guy Kegels, Nejoua Belkaab and Abdelali Alaoui Belghiti
The purpose of this paper is to present an innovative quality improvement intervention developed in Morocco and discuss its implementation. Until 2004, the Moroccan Ministry of…
Abstract
Purpose
The purpose of this paper is to present an innovative quality improvement intervention developed in Morocco and discuss its implementation. Until 2004, the Moroccan Ministry of Health (MoH) encouraged pilots of quality improvement approaches but none of them were revealed to be sustainable. Internal assessments pinpointed factors such as lack of recognition of the participating team’s efforts and lack of pressure on managers to become more accountable. In 2005, Morocco opted for an intervention called “Quality Contest” (QC) targeting health centres, hospitals and health district offices and combining quality measurement with structures ranking, performance disclosure and reward system.
Design/methodology/approach
The QC is organized every 18 months. After the self-assessment and external audit step, the participating structures are ranked according to their scores. Their performances are then disseminated and the highest performing structures are rewarded.
Findings
The results showed an improvement in performance among participating structures, constructive exchange of successful experiences between structures, as well as communication of constraints, needs and expectations between MoH managers at central and local levels; the use of peer-auditors was appreciated as it enabled an exchange of best practices between auditors and audited teams but this was mitigated by the difficulty of ensuring their neutrality; and the recognition of efforts was appreciated but seemed insufficient to ensure a sense of justice and maintain motivation.
Originality/value
This intervention is an example of MoH leadership that has succeeded in introducing transparency and accountability mechanisms (ranking and performance disclosure) as leverage to change the management culture of the public health services; setting up a reward system to reinforce motivation and adapting continuously the intervention to enhance its sustainability and acceptability.
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Keywords
Amina Sahel, Abdelali Alaoui Belghiti, Vincent DeBrouwere, Filomena Valente Soares, Guy Kegels, Nejoua Belkaab, Isabelle Godin, Sabine Ablefoni, Anselm Schneider and Bruno Dujardin
The purpose of this paper is to discuss the results of the first four years of implementation of a quality program called “Quality Contest” (QC). This program was implemented from…
Abstract
Purpose
The purpose of this paper is to discuss the results of the first four years of implementation of a quality program called “Quality Contest” (QC). This program was implemented from 2007 onward to improve the quality of hospital services by the Moroccan Ministry of Health. The peculiarity of this intervention, held every 18 months, is that it combines several approaches (self-evaluation, external audits with feedback, hospital ranking, awards and performance disclosure) and focuses on the quality of management.
Design/methodology/approach
The assessment tool used to evaluate the quality of hospital management consists of 80 items. In each contest, a score is attributed to each item based on the score given for self-evaluation and the score given by external auditors. The sum of these scores allows the global performance score of the hospital to be obtained. To compare the performances over time and among hospitals, Wilcoxon signed-rank, Wilcoxon–Mann–Whitney and Kruskal–Wallis statistical tests were used.
Findings
The results of the QC organized between 2007 and 2010 revealed that the hospitals participating in all the three contests had significantly improved their performance levels in terms of the quality of management. There was also a significant association between the number of times hospitals participated in the QC and the performance scores attained.
Originality/value
The paper reports an original quality improvement approach in a developing country that succeeded in triggering sustainable improvement dynamics by combining support (feedback) with reward (prizes) and pressure measures (ranking, performance disclosure).
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Keywords
The importance of research in appreciating the problems of libraries and the hypothesis examined in this study are described. The historical background of the Ibadan Polytechnic…
Abstract
The importance of research in appreciating the problems of libraries and the hypothesis examined in this study are described. The historical background of the Ibadan Polytechnic and the objectives of the library makes for better understanding of the academic environment of this study. The methodology used is described. Ten tables which emanated from this research are analysed and discussed. Recommendations and conclusions are given for the improvement of resources, facilities and services for the good of the Ibadan Polytechnic students.
Tam Chipawe Cane, Paul Newton and John Foster
It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems…
Abstract
Purpose
It is well established that women face multiple barriers accessing treatment for problematic and unhealthy alcohol use, but less is known about how their interconnected problems affect how they seek help from, and access, alcohol-treatment services. This study aims to explore the dynamic nature of women’s help-seeking for problematic and unhealthy alcohol use and how this can be compounded by unsuitable treatment services, especially when women present with complex needs.
Design/methodology/approach
Thirteen semi-structured interviews with women who had accessed alcohol-support services were conducted, audio-recorded, transcribed and analysed thematically using the complexity theory.
Findings
For women with complex needs, the process of seeking help may trigger unpredictable behaviours, health or social problems and intermittent serial access to treatment. Current services do not always address women’s holistic needs. Unless services focus on addressing interconnected problems – including historic trauma – they may compound the complexity of women’s problems. Complexity theory offers novel insights into this process, a concept not applied to problematic and unhealthy alcohol use treatment previously.
Research limitations/implications
Services should adopt the complexity-focused perspective featured in this study. While the authors acknowledge the increase in gender-responsive provision, the limitations of this study include a small sample size, the self-selecting nature of the sample and retrospective reporting. Participants were recruited and selected by service staff resulting in gatekeeping and possible sampling bias.
Practical implications
Services should adopt non-linear approaches to treatment. Implementing complexity approaches to treating women’s problematic and unhealthy alcohol use should capture the dynamics, complexity and non-linear nature of women’s help-seeking journeys as well as their internal and external responses that may result in relapse. The authors recommend complexity-focused, multiple-component and integrated collaborative strategies to address not only addiction but also all components of women’s needs, including past trauma.
Originality/value
Applying complexity-thinking to help-seeking experiences for alcohol treatment and recovery services is novel and proved useful in understanding the variety of women’s experiences and how these interact with their help-seeking behaviours, including treatment environments.