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Essentials for Quality and Safety Improvement in Health Care pp 1–22Cite as

Concept of Quality and Safety Improvement in Health Care

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Abstract

Safety and quality improvement in health care is fundamental to good care and service and is often related to patient safety. This chapter explains how to achieve meaningful improvements in healthcare safety and quality in Africa in the midst of diverse challenges and other competing priorities in health care. An introduction to the theoretical concept of health care and healthcare systems in general is provided with adverse events and errors, including definitions, sources and their impacts on the healthcare system with special attention to the African healthcare system. An explanation of how patient safety, which is the cornerstone of safe and quality care, evolved in Africa is provided with some highlights on the World Health Organization initiatives on the general subject and in connection with Africa in particular. The estimated cost of unsafe and poor-quality care in the region, on the basis of extrapolation from studies in developed countries, is provided, and the challenges of improving safety and quality of health care in the region are elucidated. Specific strategic steps for the successful implementation of the essential features of quality improvement covered in this book are spelt out and areas for further research highlighted.

Keywords

  • Africa healthcare systems
  • Developing countries
  • Adverse events
  • Medical errors
  • Patient safety
  • Patient safety in Africa
  • Africa patient safety challenges
  • Africa patient safety initiatives
  • Poor-quality care in Africa
  • Healthcare management in Africa

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References

  • Agency for Healthcare Research and Quality (2019) Culture of safety. https://psnet.ahrq.gov/primer/culture-safety. Accessed 10 July 2021

  • Allard J, Bleakley A, Hobbs A et al (2011) Pre-surgery briefings and safety climate in the operating theatre. BMJ Qual Saf 20:711–717

    Google Scholar 

  • Amelung VE (2019) Healthcare management – managed care organisations and instruments, 2nd edn. Springe, Berlin

    Google Scholar 

  • Aveling E, Kayonga Y, Nega A et al (2015) Why is patient safety so hard in low-income countries? A qualitative study of healthcare workers’ view into African hospitals. Glob Health 11(6):1–8

    Google Scholar 

  • Azevedo MJ (2017) Historical perspectives on the state of health and health systems in Africa, Volume II: The Modern Era. Palgrave Macmillan, Cham

    Google Scholar 

  • Baker GR, Norton PG, Flintoft V et al (2004) The Canadian adverse events study: the incidence of adverse events among hospitals in Canada. CMAJ 170(11):1678–1686

    Google Scholar 

  • Berwick DM (1998) The NHS: feeling well and thriving at 75. BMJ 317:57–61

    Google Scholar 

  • Boyle BM, Palmer L, Kappelman MD (2009) Quality of health care in the United States: implications for paediatric inflammatory bowel disease. J Paediatr Gastroenterol Nutr 49(3):272–282

    Google Scholar 

  • Boysen P (2013) Just culture: a foundation for balanced accountability and patient safety. Ochsner J 13(3):400–406

    Google Scholar 

  • Buchbinder SB, Thompson JM (2010) Career opportunities in healthcare management: perspectives from the field. Jones and Bartlett Publishers, Sudbury

    Google Scholar 

  • Burstin H, Leatherman S, Goldmann D (2016) The evolution of healthcare quality measurement in the United States. J Intern Med 279(2):154–159

    Google Scholar 

  • Carlo WA, Goudar SS, Jehan I et al (2010) The first breadth study. Newborn-care training and perinatal mortality in developing countries. N Engl J Med 362(7):614–623

    Google Scholar 

  • Carpenter K, Duevel M, Lee P et al (2010) Measures of patient safety in developing and emerging countries: a review of the literature. Qual Saf HealthCare 19(1):48–54

    Google Scholar 

  • Chassin MR, Brook RH, Park RE et al (1986) Variations in the use of medical and surgical services by Medicare population. N Engl J Med 314(5):285–290

    Google Scholar 

  • Clifford C, Clark J (eds) (2004) Getting research into practice. Elsevier, Amsterdam

    Google Scholar 

  • Committee on the Quality of Health Care in America (2001) Crossing the quality chasm: a new health system for the 21st century. National Academies Press, Washington DC

    Google Scholar 

  • Department of Health (2000a) An organisation with a memory. The Department of Health Publication The Stationary Office, London

    Google Scholar 

  • Department of Health (2000b) An organisation with a memory: a report of an expert group on learning from adverse events in the NHS chaired by the chief medical officer. Department of Health, London

    Google Scholar 

  • Department of Health (2016) National policy for patient safety incident reporting and learning in public health sector in South Africa, Republic of South Africa

    Google Scholar 

  • Dixon N (2011) Ethics and clinical audit and Quality Improvement (QI) – a guide for NHS organisations. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.457.4981&rep=rep1&type=pdf. Accessed 19 June 2018

  • Dixon-Woods M, McNicol S, Martin G (2012) Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Qual Saf:1–9. https://doi.org/10.1136/bmjqs-2011-000760

  • Ehsani J, Jackson T, Duckett S (2006) The incidence and cost of adverse events in Victoria hospitals 2003–04. Med J Aust 184(11):551–555

    Google Scholar 

  • Ente C, Oyewumi A, Mpora OB (2010) Healthcare professional understanding and awareness of patient safety and quality of care in Africa: a survey study. Int J Risk & Saf Med 22:103–110

    Google Scholar 

  • Esmail A, Neale G, Elstein M et al (2004) Patient safety: lessons from litigation. Case studies in litigation: claims reviews in four specialties. Manchester Centre for Healthcare Management, University of Manchester, Manchester. Report

    Google Scholar 

  • Firth-Cozens J, Mowbray D (2001) Leadership and the quality of care. Qual Health Care 10(Suppl II):ii3–ii

    Google Scholar 

  • Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137(7):799–804

    Google Scholar 

  • Frankel A, Leonard M, Federico F et al (eds) (2013) The essential guide for patient safety officer, 2 edn. Joint Commission Resources, Institute for Healthcare Improvement, Oakbrook Terrace Illinois

    Google Scholar 

  • Gilpatrick E (1999) Quality improvement projects in health care – problem solving in the workplace. Sage, London

    Google Scholar 

  • Guest G, Namey EE (eds) (2015) Public health research methods. Sage, Los Angeles

    Google Scholar 

  • Heiby J (2014) The use of modern quality approaches to strengthen African health system: a 5-year agenda. Int J Qual Health Care 26(2):117–123

    Google Scholar 

  • Hornby AS (2000) Oxford advanced learner’s dictionary of current English. Oxford University Press, New York

    Google Scholar 

  • Institute of Medicine (2000) To err is human: building a safer health system. National Academy of Sciences, Washington DC

    Google Scholar 

  • Jamison DT, Breman JG, Measham AR (eds) (2006) Disease control priority in developing countries: disease control priorities project, 2 edn. Oxford University Press, Washington DC https://www.ncbi.nlm.nih.gov/books/NBK11728/. Accessed 2 July 2018

  • Jha AK, Larizgoitia I, Audera-Lopez C et al (2013) The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf 22(10):809–815. https://doi.org/10.1136/bmjqs-2012-001748

    CrossRef  Google Scholar 

  • Joint Commission International (2018) JCI-Accredited Organisations. https://www.jointcommissioninternational.org/about-jci/jci-accredited-organizations/. Accessed 8 July 2018

  • Kalish RL, Daley J, Duncan DC et al (1995) Costs of potential complications of care for major surgical patients. Am J Med Qual 10(1):48–54

    Google Scholar 

  • Kannampallil TG, Schauer GF, Cohen F et al (2011) Considering complexity in healthcare systems. J Biomed Inform 44:943–947

    Google Scholar 

  • Kinfu Y, Dal Poz MR, Mercer H et al (2009) The health worker shortage in Africa: are enough physicians and nurses being trained? Bull World Health Org 87:225–230

    Google Scholar 

  • Kohn L, Corrigan J, Donaldson M (1999) To err is human: building a safer health system. Institute of Medicine report. National Academies Press, Washington DC

    Google Scholar 

  • Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health system. National Academies Press, Washington DC

    Google Scholar 

  • Kumaranayake L, Mujinja P, Hongoro C et al (2000) How do countries regulate the health sector? Evidence from Tanzania and Zimbabwe. Health Policy Plan 15(4):357–367

    Google Scholar 

  • Leape LL, Brennan TA, Laird N et al (1991) The nature of adverse events in hospitalised patients. Results of the Harvard medical practice study II. N Engl J Med 324(6):377–384

    Google Scholar 

  • Leatherman S, Ferris TG, Berwick D et al (2010) The role of quality improvement in strengthening health systems in developing countries. Int J Qual Health Care 22(4):237–243. https://doi.org/10.1093/intqhc/mzq028

    CrossRef  Google Scholar 

  • Lee V (2016) A profile of health management industry: health administration for non-clinical professionals. Business Expert Press, New York

    Google Scholar 

  • Lee T, Harrison K (2000) Assessing safety culture in nuclear power stations. Saf Sci 34:61–97

    Google Scholar 

  • Leistikow I, Mulder S, Vesseur J et al (2017) Learning from incidents in healthcare: the journey, not the arrival, matters. BMJ Qual Saf 26:252–256

    Google Scholar 

  • Lock D (2007) Project management, 9th edn. Gower Publishing, London

    Google Scholar 

  • Mekonnen AB, Alhawassi TM, McLachlan AJ et al (2018) Adverse drug events and medication errors in African hospitals: a systematic review. Drugs Real World Outcomes 5(1):1–24

    Google Scholar 

  • National Academies of Sciences, Engineering, and Medicine (2018) Crossing the global quality chasm: improving health care worldwide. National Academies Press, Washington DC

    Google Scholar 

  • National Audit Office (2005) A safer place for patients: learning to improve patient safety. National Audit Office, London

    Google Scholar 

  • National Research Council (2001) Assessing 21 St century skills – summary of a workshop. National Academies Press, Washington DC

    Google Scholar 

  • Nieva VF, Sorra J (2003) Safety culture assessment: a tool for improving patient safety in healthcare organizations. Qual Saf Healthcare 12(Suppl II): ii17–ii23

    Google Scholar 

  • Nolan T, Angos P, Cunha AJ et al (2001) Quality of hospital care for seriously ill children in less-developed countries. Lancet 357(9250):106–110

    Google Scholar 

  • Øvretveit J (2009) Does improving quality save money? A review of evidence of which improvements to quality reduce costs to health service providers. Health Foundation, London

    Google Scholar 

  • Pepper MS, Slabbert MN (2011) Is South Africa on the verge of a medical malpractice litigation storm? SAJBL 4(1):29–35

    Google Scholar 

  • Pittet D, Donaldson L (2005) Clean care is safer care: the first global challenge of the WHO World Alliance for Patient Safety – special report. Infect Control Hosp Epidemiol 26(11):891–894. https://www.who.int/patientsafety/information_centre/ICHE_Nov_05_CleanCare_1.pdf#:~:text=%E2%80%9CClean%20Care%20is%20Safer%20Care%2C%E2%80%9D%20focusing%20on%20the,countries%20and%20everywhere%20that%20health%20care%20is%20provided. Accessed 1 July 2021

  • Powell S, Baily D, Ndili NM et al (2011) Patient safety in Africa: a culture shift? Patient Saf Qual Healthcare:48–51

    Google Scholar 

  • Rowe AK, Onikpo F, Lama M et al (2010) The rise and fall of supervision in a project designed to strengthen supervision of integrated management of childhood illness in Benin. Health Policy Plan 25:125–134

    Google Scholar 

  • Sammer CE, Lykens K, Singh KP et al (2010) What is patient safety culture? A review of the literature. J Nurs Scholarsh 42(2):156–165

    Google Scholar 

  • Scally G, Donaldson LJ (1998) Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 317(7150):61–65

    Google Scholar 

  • Schuster MA, McGlynn EA, Brook RH (1998) How good is the quality of health care in the United States? Milbank Q 76(4):517–563

    Google Scholar 

  • Schuster MA, McGlynn EA, Brook RH (2005) How good is the quality of health care in the United States? Milbank Q 83(4):843–895

    Google Scholar 

  • Siddiqi K, Newell J, Robinson M (2005) Getting evidence into practice: what works in developing countries? Int Qual Health Care 17(5):447–453

    Google Scholar 

  • Singer S, Lin S, Falwell A et al (2009) Relationship of safety climate and safety performance in hospitals. Health Serv Res 44(2 Pt 1):399–421

    Google Scholar 

  • Sorra J, Gray L, Streagle S et al (2016) AHRQ hospital survey on patient safety culture: user’s guide. (Prepared by Westat, under Contract No. HHSA290201300003C). AHRQ Publication No. 15–0049-EF (Replaces 04–0041). Agency for Healthcare Research and Quality, Rockville. http://www.ahrq.gov/professionals/quality-patientsafety/patientsafetyculture/hospital/index.htm. Accessed 12 July 2021

  • State of Queensland (2011) Complexity and health care: health practitioner workforce services, roles, skills and training, to respond to patients with complex needs. Queensland Health, Brisbane

    Google Scholar 

  • Swartz S (2021) Mastering evaluation and Management Services in Healthcare: a resource for professional services. Business Expert Press, New York

    Google Scholar 

  • The Health Foundation (2014) Building capacity to improve safety, event report. The Health Foundation, London

    Google Scholar 

  • Varkey P, Antonio K (2010) Change management for effective quality improvement: a primer. Am J Med Qual 25(4):268–273

    Google Scholar 

  • Vincent C (2010) Patient safety, 2nd edn. Wiley-Blackwell Publishing, London

    Google Scholar 

  • Vincent C, Neale G, Woloshynowych M (2001) Adverse events in British hospitals: preliminary retrospective record review. BMJ 322(7285):517–519

    Google Scholar 

  • Vincent C, Davy C, Esmail A et al (2004) Patient safety: lessons from litigation. Learning from litigation: an analysis of claims for clinical negligence. Manchester Centre for Healthcare Management, University of Manchester, Manchester. Report

    Google Scholar 

  • Walsh K, Antony J (2009) An assessment of quality costs within electronic adverse event and recording systems. Int J Health Care Qual Assur 22(3):203–220

    Google Scholar 

  • Wami SD, Demssie AF, Wassie MM et al (2016) Patient safety culture and associated factors: a quantitative and qualitative study of healthcare workers’ view in Jimma zone Hospitals, Southwest Ethiopia. BMC Health Serv Res 16(495):1–10

    Google Scholar 

  • WHO Patient Safety Methods and Measures for Patient Safety Working Group (2009) Human factors in patient safety review of topics and tools. World Health Organization. Report number: WHO/IER/PSP/2009.05

    Google Scholar 

  • WHO Regional Office for Africa (2008) Patient safety in African health services: Issues and solutions, Report of the Regional Director to the 58th Regional Committee. Report No: AFR/RC58/8, Geneva

    Google Scholar 

  • WHO Regional Office for Africa (2012) Health Systems in Africa Community Perceptions and Perspectives - The Report of a Multi-Country Study. WHO Regional Office for Africa. Report number: ISBN: 978 929 023 2018 (NLM Classification: WA 540 HA1)

    Google Scholar 

  • WHO Regional Office for Africa (2021) Framework for improving access to assistive technology in the WHO African region – Report of the Secretariat. World Region Office for Africa. Report number: AFR/RC71/11

    Google Scholar 

  • WHO Regional Office for Africa (2021a) Framework for strengthening the use of evidence, information and research for policy – making in the African region - Report of the Secretariat World Region Office for Africa Report number: AFR/RC71/13

    Google Scholar 

  • Wilson RM, Runcima WB, Gibberd RW et al (1995) The quality in Australian health care study. Med J Aust 163(9):458–471

    Google Scholar 

  • Woloshynowych M, Roger S, Taylor-Adams S (2005) The investigation and analysis of critical incidents and adverse events in health care. Health Care Technol Assess 9(19):1–143. iii. https://doi.org/10.3310/hta9190

  • Word Health Organization (2015) Partnerships for safer health service delivery: Evaluation of WHO African Partnership for Patient Safety 2009–2014. Report No: WHO/HIS/SDS/2015/2015.13

    Google Scholar 

  • Word Health Organization (2020) World Patient Safety Day. https://www.who.int/campaigns/world-patient-safety-day/2020. Accessed 25 Sept 2020

    Google Scholar 

  • Word Health Organization Regional Office for Europe (2021) Patient Safety Day. https://www.euro.who.int/en/health-topics/Health-systems/patient-safety/patient-safety. Accessed 23 June 2021

  • World Health Organization (2004) World Alliance for Patient Safety Forward Programme. https://www.who.int/patientsafety/en/brochure_final.pdf. Accessed 2 July 2021

  • World Health Organization (2016) Patient Safety APPS Achievements. http://www.who.int/patientsafety/implementation/apps/achievements/en/. Accessed 10 Oct 2016

  • World Health Organization (2017) Patient safety: making health care safer. World Health Organisation, Geneva. Report number: WHO/HIS/SDS/2017.11

    Google Scholar 

  • World Health Organization (2019) Patient safety: global action on patient safety. Report by the Director-General. World Health Organization, Geneva https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_26-en.pdf. Accessed 01 July 2021

  • World Health Organization (2021) Patient Safety. https://www.who.int/news-room/fact-sheets/detail/patient-safety. Accessed 30 June 2021

  • World Health Organization Reginal Office for Africa (2021) Patient Safety. https://www.afro.who.int/health-topics/patient-safety. Accessed 29 June 2021

  • World Health Organization, Organisation for Economic Co-operation and Development, and World Bank (2018) Delivering quality health services: a global imperative for universal health coverage. World Health Organization, Organisation for Economic Co-operation and Development, and World Bank, Geneva Licence: CC BY-NC-SA 3.0 IGO

    Google Scholar 

  • World Healthcare Organisation (2007) Everybody business: strengthening health systems to improve health outcomes: WHO’s framework for action. WHO Press, Switzerland

    Google Scholar 

  • Yu A, Flott K, Chainani N et al (2016) Patient safety 2030. NIHR Imperial Patient Safety Translational Research Centre, London

    Google Scholar 

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  1. Patient Safety and Quality Care for Africa (PASQUA), Ashford, Kent, UK

    Christopher Ente

  2. Romivic Specialists Hospital, Eket, Nigeria

    Michael Ukpe

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Ente, C., Ukpe, M. (2022). Concept of Quality and Safety Improvement in Health Care. In: Essentials for Quality and Safety Improvement in Health Care . Springer, Cham. https://doi.org/10.1007/978-3-030-92482-9_1

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