Good practices to optimise the performance of maternal and neonatal quality improvement teams: Results from a longitudinal qualitative evaluation in South Africa, before, and during COVID-19

• Published in: PloS one Vol. 19; no. 11; p. e0314024
• Main Authors: Odendaal, Willem, Tomlinson, Mark, Goga, Ameena, Singh, Yages, Kauchali, Shuaib, Marshall, Carol, Pillay, Yogan, Makua, Manala, Chetty, Terusha, Hunt, Xanthe
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.11.2024; Public Library of Science (PLoS)
• Subjects: Advisors; Analysis; Biology and Life Sciences; COVID-19; COVID-19 - epidemiology; Female; Health care; Health care facilities; Health care reform; Health services; HIV; Hospitals; Human immunodeficiency virus; Humans; Infant mortality; Infant, Newborn; Infants; Infants (Newborn); Longitudinal Studies; Maternal health services; Maternal Health Services - organization & administration; Maternal Health Services - standards; Medical care; Medical personnel; Medical research; Medicine and Health Sciences; Mothers; Neonates; Neonatology; Optimization; Participation; Patient outcomes; People and Places; Performance enhancement; Performance evaluation; Pregnancy; Public health; Qualitative analysis; Qualitative Research; Quality control; Quality Improvement; Quality management; SARS-CoV-2; Social Sciences; South Africa - epidemiology; Stillbirth; Team leaders; Teams; Work groups; South Africa; India
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0314024

Many maternal and neonatal deaths can be avoided if quality healthcare is provided. To this end, the South African National Department of Health implemented a quality improvement (QI) programme (2018-2022) to improve maternal and neonatal health services in 21 public health facilities. This study sought to identify good practices aimed at improving QI teams' performance by identifying optimal facility-level contextual factors and implementation processes. We purposively selected 14 facilities of the 21 facilities for a longitudinal qualitative process evaluation. We interviewed 17 team leaders, 47 members, and five QI advisors who provided technical support to the teams. The data were analysed using framework analysis. We choose the Consolidated Framework for Implementation Research as framework given that it explicates contexts and processes that shape programme implementation. Six quality improvement teams were assessed as well-performing, and eight as less well-performing. This research conceptualises a 'life course lens' for setting up and managing a QI team. We identified eight good practices, six related to implementation processes, and two contextual variables that will optimise team performance. The two most impactful practices to improve the performance of a QI team were (i) selecting healthcare workers with quality improvement-specific characteristics, and (ii) appointing advisors whose interpersonal skills match their technical quality improvement competencies.