Factors that influence the implementation of quality improvement programmes

Access to poor-quality care has significant adverse effects on both morbidity and mortality. Therefore, it is essential to develop strategies that improve healthcare processes and systems, enhance patient satisfaction, and ensure access to high-quality care. In Haiti, the Ministry of Public Health and Population, donors, and technical and financial partners emphasize quality improvement programmes such as the HEALTHQUAL programme. It has become an essential approach in the Haitian health system. While quality improvement programs are relatively new to Haiti, little data are available on the factors that can facilitate or hinder their implementation.

An evaluative research (implementation analysis) using a multiple case study design was conducted with a qualitative approach. Thirty-eight semistructured interviews were conducted, observations were made, and documents were analysed. Data analysis was performed using the constant comparative method and a synthetic analysis framework with predefined categories (programme components, facilitating factors, inhibiting factors, mechanisms, consequences, and interactions between model elements). Subsequently, these categories were analysed using Atlas.ti software, with additional codes emerging and being incorporated into the predefined categories. Memos and a research journal were used during data collection and analysis.

The main facilitating factors include collaboration between the institutional and community levels, leadership, coordination and collaboration within a multidisciplinary team, external pressures, the characteristics of the networks, team ownership of the process, and quality infrastructure. The main inhibiting factors comprise the sociopolitical context, organizational culture, the influence of previous decisions (policy legacy), provider perceptions of HEALTHQUAL, the lack of accountability mechanisms, an unsuitable health information system, and resource unavailability.

Based on these observations, leaders and decision-makers are encouraged to consider these contextual factors when planning and implementing the HEALTHQUAL programme in Haiti. It is important to consider a range of contextual variables to understand implementation at any given time.