International Journal for Quality in Health Care Advance Access originally published online on June 15, 2007
International Journal for Quality in Health Care 2007 19(4):237-243; doi:10.1093/intqhc/mzm021
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Introduction of a quality improvement program in a children's hospital in Tehran: design, implementation, evaluation and lessons learned
1 Tehran University of Medical Sciences and Health Services, Center for Academic and Health Policy
2 Tehran University of Medical Sciences and Health Services, Eye Research Center
3 Oregon Health and Science University, School of Medicine, Department of Emergency Medicine
4 Management Sciences for Health
Background and Objective. Reports addressing continuous quality improvement (CQI) methods in developing countries are scant and there are questions about the applicability of quality improvement methods in such settings. The structure and output of a formal quality improvement program implemented in a teaching hospital affiliated with the Tehran University of Medical Sciences is presented.
Objective Method. During a nine-month period, a multi-stage quality improvement program was implemented. It comprised: (i) training workshops; (ii) a steering committee; (iii) weekly consultation and facilitation of improvement projects; and (iv) a day-long demonstration and recognition meeting. Four cycles of workshops were held in which 132 employees were trained in the basics of CQI.
Results. Thirty improvement projects were initiated. Twenty-five of the projects were completed. In an evaluation survey more than 70% of respondents assessed a ‘positive impact’ on organizational culture, work efficiency and quality of services. More than 90% believed that the changes were sustained, and more than 60% reported that they have implemented additional improvement projects.
Conclusion. Our quality improvement package supported rapid implementation of multiple projects. The underlying ‘change structure’ comprised the improvement teams, top management and the university's quality improvement office; it integrated project management, support and facilitation functions by the respective participant. Organization-wide change was more limited than anticipated. To institutionalize the program and ensure sustainability, a local structure for change should be organized, management coaching should be sustained, local facilitators should be developed, incentives should be established and physician involvement should be emphasized.
Keywords: change in behavior, continuous quality improvement, hospital, structure for change
Address reprint requests to: S. Mehrdad Mohammadi, Center for Academic and Health Policy, Tehran University of Medical Sciences and Health Services, 12 Nosrat, Postal code: 1417965173, Tehran, Iran. Tel: (+9821) 6649 5859; Fax: (+9821) 6641 9537; E-mail: mmohamadi{at}tums.ac.ir
Accepted for publication March 21, 2007.