Week Seven Assignment – Written Assignment
Case Analysis: Improving Care in Rural Rwanda
• (ImprovingCareInRuralRwandaPart1)
Download Participant Version Here:
• Participant_Improving Care in Rural Rwanda.pdf – PDF Document (455.0 KB)
Use the following outline to complete an in-depth case analysis.
Setting the Stage for Improvement
1. Imagine you are a staff member at a hospital or clinic in a resource-poor setting (this might be anywhere from Kirehe, Rwanda to Chicago, Illinois). A team arrives and offers to help improve the quality of care. You are initially skeptical as prior quality improvement efforts have taken up considerable staff time and attention but have not resulted in sustained change.
• How could this new team earn your confidence and collaboration?
• What factors might convince you this team has a good understanding of your hospital/clinic and its underlying economic and sociopolitical context?
Assuming Leadership (I’m the leadership as a nurse practitioner in the clinic)
2. Imagine again that you are the leader of the Quality Improvement team in the previous scenario. Your team would like to improve quality of care across the board and sustain those gains. Whatever specific targets you choose to measure and focus on, your ultimate aim is to raise staff morale, set a new higher standard of excellence, and empower staff members to “see a problem, fix a problem” in their daily work.
• How would you go about assessing the local needs and setting appropriate quality goals?
• Who would be your most important allies? What qualities would you look for in selecting effective local leaders for this new program?
• How would you frame this intervention, especially in light of the previous Quality Improvement efforts at this site? What would you say to the staff on day one?
Rallying Resources
3. Substantial resource inputs are essential to successful improvement work in resource-poor settings. At Kirehe, for example, nurses in the outpatient department were initially doing more than fifty patient consultations per day and had no time to talk with patients about their diagnoses. We had two major resource gaps here: not enough nurses, and not enough consultation rooms.
• In your own experience, how have you seen resource inputs play a critical role in improvement efforts in resource-poor settings?
• Can you think of at least one instance where missing resources also hindered improvement efforts in a resource-rich setting?
Setting Priorities
4. Imagine you are a successful Quality Improvement program director who has led several high impact interventions from startup through independence in developing settings. Several proposals for Quality Improvement interventions cross your desk and you have the option of funding only one of them.
• How would you decide which proposal to fund?
• What advice might you offer this new Quality Improvement team as they get started
