Using Quality Improvement Collaboratives to Improve Health Service Delivery in the Context of Public Health Emergencies: Lessons From the Zika Epidemic

Abstract

Recent Public Health Emergencies (PHEs) have highlighted gaps in health systems to effectively prepare for, prevent and respond to these emergencies. Quality improvement collaboratives (QICs) promote rapid improvement and learning through collaboration and have been widely used to improve clinical processes and health outcomes at a large-scale. QICs are a potential approach to improve health service delivery during PHEs. As part of the response to the 2016 Zika epidemic, a QIC approach was used to promote the adoption adaptation of evidence-based practices to improve the quality of Zika-related health services. This multi-phase study aimed to develop a better understanding of the role of QICs in responding to PHEs. Changes in outcome measures following the adoption of the QIC and participants’ perspectives regarding QIC implementation were assessed for 38 health facilities from Guatemala and 17 from the Dominican Republic. Phase 1. Results for all outcome measures for both countries were statistically significantly higher (p<0.001) during the implementation phase of the QIC compared with the demonstration phase. Phase 2. Participants perceived the QIC approach to be feasible, appropriate and easy-to-use, and reported high levels of satisfaction and high visibility of outcomes. The speed of adoption was low and a high number of modifications and/or adaptations to the implementation strategy were required. Barriers and challenges identified included insufficient infrastructure and capacity, low levels of commitment and resistance to change from clinical providers. Features that participants valued most included teamwork, shared learning and collaboration, use of data to guide decision-making, flexibility for local-context adaptation, and the ability to see rapid results. Phase 3. Results for outcome measures from the health facilities with higher levels of agreement with the QIC implementation categories were statistically significantly higher (p<0.001) compared with those from the facilities with lower levels of agreement. The QIC approach demonstrated potential to improve health service delivery in the context of the response to a PHE. The results from this study highlighted the importance of understanding how interventions are implemented and participants’ experience and perspectives on the factors that may limit or facilitate its optimal implementation.