Seeking quality: some experiences in South Africa

Although definitions of quality in healthcare may vary, it is accepted that there are standards towards which we should be aiming. Thus quality improvement is an important part of developing rural health services. At the same time rural settings provide unique challenges to this process. The quality improvement cycle provides a tool to assist rural practitioners wishing to work towards better quality health care. The cycle starts with identifying the problems that need to be addressed and thereafter forming a team to deal with the issues identified. The team together sets standards, which provide targets appropriate to the context and towards which the service should aim. They then gather data to assess how the healthcare service is currently performing in terms of those standards. On the basis of this information, an analysis is made of the problems and their causes, which then allows the team to develop a specific plan to address the important limiting factors in the context. Implementation of the plan continues on an ongoing basis, repeating the steps as needed, with evaluation occurring as part of each cycle to assess whether quality is indeed improving. The process is described as a cycle because it needs to be ongoing, in various ways, as part of continuous quality improvement. Examples of each of the stages of the cycle are given from the South African context as illustrations of the tasks inherent in quality improvement.