Evaluating a Quality Improvement Initiative in a High Dependency Unit in Tanzania Open Access
Strelzer, Samantha (Spring 2023)
Abstract
Background: Historically, the United Republic of Tanzania has had a 41.4% mortality rate in the Intensive Care Unit (ICU) setting, and a 2018 study reported that in LMICs, poor-quality care resulted in 5 million excess deaths. It was found that the average knowledge of critical care amongst providers was 38.6% in hospitals in Tanzania. In Tanzania, the Ministry of Health and Social Welfare (MoHSW) has taken steps toward Quality Improvement (QI), yet the Tanzanian health sector continues to face resource constraints, unsustainable QI projects, and gaps in knowledge and skills. These conditions have contributed to unacceptably high mortality rates for Tanzanian patients.
Purpose: This research aims to elucidate a more robust understanding of how to transform quality of care in a low resource setting, considering the gap in published research. The goal is to understand barriers and facilitators to implementing QI projects in Tanzania.
Methods: Through the Emory-Muhimbili Partnership for Health Administration Strengthening and Integration of Services (EMPHASIS) and with support from Abbott Fund Tanzania, a two-day critical care training program was developed for providers. It included the following modules: Vital Signs Directed Therapy (VSDT), Cardiopulmonary and Brain Resuscitation (CPBR) knowledge, Blood Glucose Monitoring and Introduction to Critical Care Concepts. In a pre-post study, data was collected from pre- and post-tests and reported in REDCap. Descriptive statistics and paired t-tests were performed, setting alpha at 0.05. Qualitative semi-structured interviews were used to understand the experience of those involved in the training program. Utilizing inductive conventional content and rapid qualitative analysis, interview themes were extracted. A total of seven providers were interviewed.
Conclusion: A pre-/post-test analysis demonstrated an improvement in knowledge, skills and increased comfort in responding to emergencies. Themes from interviews showed respondents appreciated the training and found change management concepts useful. This study suggests a Critical Care Training Program significantly improves the knowledge amongst ICU/HDU providers and that QI programs impact the culture of change. This research exemplifies a systematic approach to strengthening capacity of critical care delivery in limited resource settings, with implications for further innovation in other LMICs.
Table of Contents
Table of Contents
CHAPTER 1: Introduction - 1
Problem Statement - 2
Synergy Statement - 3
Purpose Statement & Research Question - 3
Significance Statement - 4
Definition of Terms - 5
CHAPTER 2: Comprehensive Review of the Literature - 6
INTRODUCTION AND RELEVANCE TO RESEARCH - 6
QUALITY IMPROVEMENT - 7
THE 5-S METHOD - 13
CHANGE MANAGEMENT AND HEALTHCARE - 17
CASE STUDIES: HEALTHCARE AND QI - 21
LESSONS FROM LMICS - 23
TANZANIA - 26
RESUSCITATION SKILLS AMONGST NURSING PROVIDERS - 36
SUMMARY - 37
CHAPTER 3: Manuscript I Quantitative - 39
INTRODUCTION - 42
METHODS - 47
RESULTS - 52
DISCUSSION - 67
CHAPTER 4: Manuscript II Qualitative - 73
INTRODUCTION - 76
METHODS - 79
RESULTS - 84
DISCUSSION - 106
CHAPTER 5: Conclusion and Recommendations - 112
RECOMMENDATIONS - 126
CHAPTER 6: Extended Results - 129
References - 135
APPENDICES - 150
Appendix I: In-Depth Interview Guide - 150
Appendix II: Data Entry Forms - 152
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