Dataset: Factors that influence the implementation of quality improvement programs (HEALTHQUAL Program)
Description
Access to poor quality care has adverse effects in terms of morbidity and mortality. Hence the need to find strategies to improve processes and systems in order to satisfy patients and enable access to good quality care. In Haiti, the Ministry of Public Health and Population, donors as well as technical and financial partners emphasize quality improvement programs such as the HEALTHQUAL program. It has become an essential approach in the health system in Haiti. Quality improvement programs are new to the context of Haiti. However, very little data is available on the factors that can facilitate or hinder the implementation of these quality improvement initiatives. Evaluative research (implementation analysis) with a multiple case study was carried out using a qualitative research design. Thirty-eight semi-structured interviews, observations were made, and documents analyzed. Data analysis was performed using the constant comparative methods and a synthetic analysis framework with predefined categories (program components, facilitating factors, inhibiting factors, mechanisms, consequences and interactions between model elements). Subsequently, these categories were analyzed inductively using the “Atlas ti” software and adding other emerging codes in the pre-defined categories. Memos and a “research journal” were used during data collection and analysis. Those data shed light on the main facilitators and obstacles to the implementation of quality improvement programs in the context of Haiti.
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It is an evaluative research (implementation analysis) (Denis and Champagne, 1992). Case studies of the implementation of quality improvement initiatives have been used for the purpose of constructing theories (Gehman et al., 2018), (Eisenhardt, 1991), (Eisenhardt, 1989). Within-case and a cross-sectional between-case analysis were performed (Miles & Huberman, 2003), (Corbin & Strauss, 2015). Both inductive and deductive methodologies were used. It was a systematic process of generating theory from the mass of collected data and the empirical basis. It was a set of rigorous and systematic research procedures leading to the emergence of categories and conceptual themes from a thorough analysis of the data. In all, 28 concepts belonging to the seven change models and a cross-cutting concept, organizational culture, were tested hypothetico-deductively using the "Atlas ti" software. Field visits were made to conduct interviews, observe the implementation process and collect relevant documentation from the research sites. The unit of analysis is the health facility that undertook QI initiatives. This research focuses on the outpatient management of hospitalized patients and children. 4 sites were selected for the multiple case studies: HUP, public university hospital HUJ, university hospital CDS la Fossette St Damien Hospital / NPFS The main data collection tool, serving as a compass, was the logic model of the HEALTHQUAL program. Purposive sampling methods provided a diversity of perspectives. The “snowball” strategy was used to identify participants. Thirty-eight (38) semi-structured interviews and participant observation sessions were conducted at the sites and with strategic managers, decision makers, and coaches within the context of the HEALTHQUAL program. Informed consent was obtained for all interviewed respondents. The research was approved by the National Bioethics Committee of Haiti. Twenty-nine key concepts (see table 2, appendix 1) were analyzed during this research. For qualitative data analysis, the constant comparative method was used (Silverman, 2010), (Miles & Huberman, 2003), (Corbin & Strauss, 2015). The data was analyzed taking into account the principles and methods of qualitative research: Condensation, presentation, elaboration and verification methods were employed (Miles & Huberman, 2003). However, this approach was not completely inductive, an explanation was developed by going back and forth between the theoretical world and the empirical world in order to deductively verify the correspondence between the theoretical world and the empirical world. Qualitative data analysis software (Atlas ti, version 8) (deductive analysis) was used to make the link between theoretical models and empirical reality (Friese, 2012). The "memo" function of "Atlas ti" and a “research journal” were used to document the understanding of the process during data collection, analysis and to make theoretical inferences.