Quality improvement baseline assessment in the African Neonatal Network
Mots-clés :
Quality Improvement; Needs Assessment; Capacity Building; Infant, Newborn; Infant, Premature; Neonatal Intensive Care Units; Africa South of the Sahara; Global HealthRésumé
Background: Achieving the Sustainable Development Goal target for neonatal mortality reduction requires improved access and quality of services globally. The extent to which neonatal teams in the African Neonatal Network (ANN) have knowledge, experience and capability in quality improvement (QI) is unknown. Methods: ANN team members completed baseline assessments with three standardized QI assessment tools: Beliefs, Attitudes, Skills and Confidence in QI (BASiC-QI), the Institute for Healthcare Improvement (IHI) Improvement Capability Self- Assessment Tool, and the IHI QI Knowledge Application Tool- Revised (QIKAT-R). Team leaders completed a focused assessment on the landscape of neonatal QI within their hospital, region and country.
Results: Ninety percent of ANN team members and 100% of team leaders completed the baseline assessment. 41% of participants reported prior experience in QI. Participants reported strong feelings or beliefs regarding QI on the BASiC-QI, including 72.7% strongly agreeing with ‘Using QI in the real world will make improvements’. The minority of participants agreed or strongly agreed that they were knowledgeable in fundamentals of QI. Just over half of participants reported that their hospital was in the ‘just beginning’ or ‘developing’ stages. The novel neonatal cases for the IHI QIKAT-R showed variation in applied knowledge (case scores: 0 to 9 of possible 9; median total score 11 of possible 27). 35% of teams reported collaboration on QI prior to ANN pilot.
Conclusion: The baseline assessment among ANN pilot sites documented gaps in QI knowledge, skills and their application. As ANN focuses on improving QI capability, learnings may have global relevance.
Références
United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME). Neonatal Mortality [Internet]. New York: UNICEF, March 2025. Available at:https://data.unicef.org/topic/childsurvival/neonatal-mortality/.Accessed March 27, 2025.
United Nations Department of Economic and Social Affairs. Sustainable Development Goals [Internet]. New York: United Nations. Available at: https://sustainabledevelopment.un.org/sdg3. AccessedMarch 27, 2025.
STAGE (Strategic Technical Advisory Group of Experts), Duke T, AlBuhairan FS, et al. World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutrition. Arch Dis Child. 2022;107(7):644 -649. doi:10.1136/archdischild-2021-323102
Committee on Improving the Quality of Health Care Globally, Board on Global Health, Board on Health Care Services, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. Crossing the Global Quality Chasm: Improving Health Care Worldwide. National Academies Press; 2018:25152.doi:10.17226/25152
Ehret DY, Patterson JK, Bose CL. Improving neonatal care: A global perspective. Clin Perinatol. 2017;44(3):567- 582.doi:10.1016/j.clp.2017.05.002
Stevenson AG, Tooke L, Edwards EM, Mangiza M, Horn D, Heys M, Abayneh M, Chimhuya S, Ehret DEY. The use of data in resource limited settings to improve quality of care. Semin Fetal Neonatal Med. 2021;26(1):101204.doi:10.1016/j.siny.2021.101204
Day LT, Sadeq-ur Rahman Q, Ehsanur Rahman A, et al. Assessment of the validity of the measurement of newborn and maternal health-care coverage in hospitals (ENBIRTH): an observational study. Lancet Glob Health. 2021;9(3):e267-e279.doi:10.1016/S2214-09X(20)
-0
Heys M, Kesler E, Sassoon Y, et al. Development and implementation experience of a learning healthcare system for facility based newborn care in low resource settings: The Neotree. Learn Health Syst. 2023;7(1):e10310.doi:10.1002/lrh2.10310
Tuti T, Aluvaala J, Chelangat D, et al. Improving in-patient neonatal data quality as a prerequisite for monitoring and improving quality of care at scale: A multisite retrospective cohort study in Kenya. Asweto CO, ed. PLOS Glob Public Health. 2022;2(10):e0000673. doi:10.1371/journal.pgph.0000673
Cross JH, Bohne C, Ngwala SK, et al. Neonatal inpatient dataset for small and sick newborn care in low- and middleincome countries: systematic development and multi-country operationalisation with NEST360. BMC Pediatr. 2023;23(S2):567. doi:10.1186/s12887-023-04341-2
Diego EK, Ehret DEY, K. C. A, Bose CL. Quality indicators to evaluate essential newborn care in low- and middleincome countries. Pediatrics. 2023;152(3):e2023061527. doi:10.1542/peds.2023-061527
Kc A, Ramaswamy R, Ehret D, Worku B, Kamath-Rayne BD. Recent progress in neonatal global health quality improvement.Clin Perinatol. 2023;50(2):507-529. doi:10.1016/j.clp.2023.02.003
Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care. 2007;16(1):2-3. doi:10.1136/qshc.2006.022046
Horbar JD, Rogowski J, Plsek PE, et al. Collaborative quality improvement for neonatal intensive care. Pediatrics. 2001;107(1):14-22. doi:10.1542/peds.107.1.14
Ellsbury DL, Clark RH. Does quality improvement work in neonatology improve clinical outcomes? Curr OpinPediatr. 2017;29(2):129-134.doi:10.1097/MOP.0000000000000457
Mandu R, Miller L, Namazzi G, et al. Quality improvement collaboratives as part of a quality improvement intervention package for preterm births at sub-national level in East Africa: a multi-method analysis. BMJ Open Qual. 2023;12 (4):e002443. doi:10.1136/bmjoq-2023-002443
Rule ARL, Maina E, Cheruiyot D, Mueri P, Simmons JM, Kamath‐Rayne BD. Using quality improvement to decrease birth asphyxia rates
after ‘Helping Babies Breathe’ training in Kenya. Acta Paediatr. 2017;106(10):1666-1673. doi:10.1111/apa.13940
Tuyisenge D, Byiringiro S, Manirakiza ML, et al. Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda. BMC Pediatr. 2021;21(1):89. doi:10.1186/s12887-021-02544-z
Edwards EM, Ehret DEY, Soll RF, Horbar JD. Vermont Oxford Network: a worldwide learning community. Transl Pediatr. 2019;8(3):182-192.doi:10.21037/tp.2019.07.01
Ehret DEY, Worku B, Demtse A, et al. Remote mentorship to improve continuous positive airway pressure use in the Ethiopian Neonatal Network. Pediatrics. 2025;156 (1):e2024067985.
African Neonatal Association. ANA and VON Partnership. Accessed March 27, 2025. https://africanneonatal.org/ana-partners-with-von-to-form-an-n/
Brown A, Nidumolu A, McConnell M, Hecker K, Grierson L. Development and psychometric evaluation of an instrument to measure knowledge, skills, and attitudes towards quality improvement in health professions education: The Beliefs, Attitudes, Skills, and Confidence in Quality Improvement (BASiC-QI) Scale. Perspect Med Educ. 2019;8(3):167-176.doi:10.1007/s40037-019-0511-8
IHI Improvement Capability Self Assessment Tool. Accessed June 30, 2023. https:// www.ihi.org/knowledge/Pages/Tools/IHI Improvement Capability Self Assessment- Tool.aspx
Singh MK, Ogrinc G, Cox KR, et al. The Quality Improvement Knowledge Application Tool Revised (QIKATR): Acad Med. 2014;89(10):1386-1391. doi:10.1097/ACM.0000000000000456
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