Browsing by Author "Odendaal, Willem Adriaan"

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    Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces
    (Stellenbosch : Stellenbosch University , 2024-12) Odendaal, Willem Adriaan; Hunt, Xanthe; Chetty, Terusha; Tomlinson, Mark (Mark R.); Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: Background: Quality improvement (QI) methodologies can reduce avoidable maternal and neonatal deaths and stillbirths, through small scale solutions that address service delivery problems. The methodologies propose healthcare workers organise in QI teams who then develop and implement these changes. Despite inroads, maternal and neonatal mortalities remain high in South Africa. This study evaluated Mphatlalatsane, a National Department of Health QI programme to improve maternal and neonatal healthcare in the country. The programme was implemented in 21 public health facilities across three provinces, seven per participating province, between 2018 and 2022. Aim: This study aimed to explore the perceptions and experiences of the Mphatlalatsane QI team leaders, team members, and advisors (who provided technical support to the teams), of how leaders, members, implementation processes, and facility contexts, shaped variation in QI uptake and team performance across the teams. Methods: This longitudinal, qualitative process evaluation was conducted in 14 purposively selected ‘Mphatlalatsane facilities’. The research comprised interviewing 17 team leaders and 47 team members over three time points; monthly debriefings with the advisors; reviewing programme documentation; and participant observations of the Mphatlalatsane management meetings. All the data were thematically analysed. Results: Paper 1 details that the eight high uptake teams had more training than low uptake teams; advisors who were technically more skilled; leaders with high intrinsic motivation towards QI; better teamwork; and district support. The COVID-19 pandemic resulted in teams introducing major adaptations to the methodology. Paper 2 explains how the intrinsic motivation of the leaders of the six well-performing teams were associated with their aptitude to use routine data and them experiencing how the methodology improved services. The paper also highlights how these leaders nurtured a learning culture in their teams and embedded the methodology in standard care practices. Paper 3 reports that each of the six well-performing teams had a core team with a second-in-charge leader; the members had a good understanding of the methodology; and there was a positive work culture in the existing service teams from whom the core team was recruited. Paper 4 proposes eight good practices to set up and manage a QI team. Conclusion: The performance of a QI team is influenced by configurations of the contextual and implementation process variables identified in this study. However, success starts off with a focus on the ‘hearts and minds’ of healthcare workers by recruiting those who have QI specific attributes as leaders and members.