Implementing a nationwide quality improvement approach in health services

Area of Science:

• Public Health
• Healthcare Management
• Quality Improvement

Background:

• Previous quality improvement initiatives in Morocco lacked sustainability.
• Key factors identified included lack of recognition and manager accountability.
• The Ministry of Health (MoH) sought a new, sustainable approach.

Purpose of the Study:

• To present an innovative quality improvement intervention, the "Quality Contest" (QC), developed in Morocco.
• To discuss the implementation and impact of the QC.
• To explore mechanisms for enhancing sustainability and acceptability in public health services.

Main Methods:

• The Quality Contest (QC) is an 18-month intervention involving self-assessment and external audits.
• Participating health structures are ranked based on performance scores.
• Performance data is disseminated, and top-performing structures receive rewards.

Main Results:

• Observed improvements in performance among participating health structures.
• Facilitated constructive exchange of experiences and communication between MoH levels.
• Peer-auditors enabled best practice sharing, though neutrality was a challenge.
• Recognition was appreciated but insufficient for sustained motivation.

Conclusions:

• The QC introduced transparency and accountability through ranking and performance disclosure.
• It leveraged a reward system to boost motivation.
• Continuous adaptation is key to enhancing the intervention's sustainability and acceptability.