Title: Quality Management in International Health
Keywords: Quality
Health systems
Health facilities
Country: Germany
Institution: Germany - Heidelberg Institute of Global Health, University of Heidelberg
Course coordinator: Peter Campbell
Date start: 2024-05-21
Date end: 2024-05-31
About duration and dates: 2 weeks on-site 4 days preparation
Classification: advanced optional
Mode of delivery: Face to face
Course location: Institute of Global Health
Im Neuenheimer Feld 365, Room 007
D-69120 Heidelberg, Germany
ECTS credit points: 4 ECTS credits
SIT: 120 SIT:
• Pre-Course Preparation including Case Study: 40 hours
• Lectures/Discussion: 50 hours
• Group work including Case Study Assessment: 16 hours
• Supervised Study for Essay: 14 hours
Language: English
Description: By the end of the module the participants should be able to:
• Explain the history and development of Quality Management for health, including the concept of Total Quality Management.
• Appraise recent developments and challenges in assuring healthcare quality in low- and middle-income countries (LMIC).
• Critically evaluate international healthcare quality management and patient safety mechanisms and their global transferability especially in the context of LMICs.
• Develop a strategy for strengthening healthcare quality in a country or region familiar to the participant (preferably an LMIC) using key Quality Management principles and tools).
• Differentiate roles and priorities of stakeholders in managing healthcare quality improvement initiatives and activities.
Assessment Procedures: Participants’ achievement of the learning objectives will be assessed at the end of the course on:
• 30%: Individual completion of the Health Facility Assessment Case Study to identify and improve a low resource facility, including completion of the assessment form for selected standards (this is clearly explained in the instructions and requires no prior knowledge/experience) with grades and rationale.
This is expected to be completed as part of the pre-course preparation (SIT 32 hours)
• 70%: Essay on lessons learned from Quality Management course, description of examples to illustrate this, and implementation steps to establish or improve healthcare in a setting (preferably an LMIC) known to the participant (minimum 1500 words with no maximum limit).
The essay is to be handed in on the final day of the course (SIT 14 hours).
If the student fails to reach the pass grade of 60% (average from both assessments), s/he will be required to do an individual written assignment (1500 words essay on a healthcare quality management topic negotiated between the student and the coordinator) to be submitted not later than 2 weeks after receiving the failing mark.
Content: Pre-Course preparation involves the following:
Reading the Health Facility Assessment Case Study to identify and improve an LMIC health facility, including completion of the assessment form for selected standards with grades and rationale (32 SIT hours)
Background reading including understanding key actors and their contributions in the history and development of Quality Management

The initial week of the course mainly focuses on current well-accepted Quality Management mechanisms and tools used in healthcare systems internationally. Topics covered include:
• Major steps and trends in the healthcare quality and patient safety movements (including participant inputs from pre-course reading) (Lectures)
• Quality management and patient safety principles, mechanisms and tools and their contextual relevance (Lectures)
• Healthcare quality evaluation mechanisms including in low- and middle-income contexts
• Quality management Case Study set in a low/middle-income country and assessment tool to critically evaluate quality (Short lectures followed by group work)
• Team leadership and implementing healthcare quality tools (e.g., root cause analysis, flow and Pareto charts) (lectures and group work)
• If feasible, a guided exercise and field trip to critically analyse quality management mechanisms in German healthcare facilities (supervised field trip)
A key output of this first week is the Case Study self- and group-work exercise, and critical understanding of the role of such assessments, standards and use of Quality Management tools.

The second week of the course mainly focuses on the principles of Total Quality Management (seeing the system as a whole, coordinating and harmonizing all inputs and activities towards a central goal). Topics include the following:
• The use of target-setting to improve quality of healthcare, and alternatives (lectures and participative discussions)
• Setting various types of indicators (input, process, result) for monitoring of project/programme achievements (lectures and individual exercises)
• Financial implications of Total Quality Management strategies (lectures and participative discussions)
• Improvement of procurement mechanisms (e.g., for equipment, construction, technical support) using principles of Total Quality Management (lectures and participative discussions)
• Designing and sustaining a healthcare quality management framework in a low- or middle-income country or regional context(Supervised self-study with essay writing)
• Case study presentations by the volunteering participants to highlight key aspects of actual Quality Management projects with which they are familiar (lectures and participative discussions)
A key output of the second week is the essay, in which participants reflect from lessons learned during the course with respect to their own experience, in order to design a Quality Management approach in a setting with which they are familiar.
Methods: A total of 40 SIT hours individual self-study time needs to be invested prior to the start of the course in Heidelberg. All information and materials will be made available 3 weeks before course starts. Pre-course work includes:
• Individual exercise including readings and analysis of Nanda Devi Case Study and completion of quality assessment tool which requires no prior knowledge or experience of the topic (32 SIT hours)
• Self-directed research on definitions of Quality Management, and healthcare quality management history based on key readings (8 SIT hours)

The first week of the course comprises:
• Lectures to introduce the topic and cover other key topics of current QM practice (20 SIT hours)
• There is also a Groupwork exercise to work on the Quality management Case Study (16 SIT hours)
• If feasible, a visit to a German health facility can be arranged (4 SIT hours). If this is not possible, a session on aspects of QM in German hospitals will be held using examples of findings from previous years.

The second week of the course comprises:
• Lectures provided in a highly participative way (e.g. including Question and Answer sessions) to explain the concepts of Total Quality Management (24 SIT hours)
• At least 1 Case Study of actual QM practice is presented by a volunteering participant(s) followed by a Q&A session (2-4 SIT hours)
• Supervised Self-Study for development of individual essays (12-14 SIT hours)

Course participants are expected to participate actively in discussions and group assignments: their presence is monitored and absence of 20% of the teaching time is permitted.
Prerequisites: English TOEFL: Computer based >237; Paper based >580; Internet based >90; IELTS > 6.5. (Or as requested at respective English taught home institute = tropEd enrolment sufficient.
Attendance: Maximum number of students (including tropEd students):30
first come, first serve
Fees: 1000 EUR (for tropEd students, others have to pay EUR 1.500)
Scholarships: None
Major changes since initial accreditation: Changes to participatory mechanisms in Case Study and assessment tool with more interactive small group discussions based and individual soft-board presentations.
The course is now divided into 2 main parts, with an initial focus on current well-accepted Quality Management mechanisms and tools, followed by a focus on Total Quality Management and its implications for progress monitoring, health financing and procurement.
The assessment of students has had to change because of pandemic restrictions on visiting German health facilities. An essay question became the core component and was well accepted, and this will be accompanied by a formal evaluation of the pre-course Case Study assessment.
Student evaluation: The course continues to gain excellent evaluations. The introduction of additional topics on Total Quality Management - to mitigate the lack of a facility visit due to pandemic restrictions - has been appreciated.
Lessons learned: The Case Study remains a core feature combined with the pre-course preparation.
The pandemic showed it was possible to run the course online, and replacement of the field trip (that could no longer be organized due to visiting restrictions) with additional Quality Management topics (origin and basics of Quality Management, economics etc) has proved successful.
tropEd accreditation:
Accredited in London, 2000 (3 ECTS), reaccredited in Stockholm, 2002 (4 ECTS), in Barcelona, May 2007, in EC TelCo, Sep 2012 (4.5 ECTS), in EC TelCo, April 2018, and in Barcelona, September 2023. This accreditation is valid until September 2028.
Remarks: Key readings include:
• Smits, Helen L. Leatherman Sheila & Berwick, D. M. Editorial: Quality Improvement in the Developing World. IJQHC 2002; 14:439-440 Available at https://academic.oup.com/intqhc/article/14/6/439/1902641?login=false
• Leatherman Sheila et. al. The role of quality improvement in strengthening health systems in developing countries. IJQHC 2010; 22:4, 237-243
• Mate KS, et al. Accreditation as a path to achieving universal quality health coverage. Global Health. 2014 Oct 17; 10:68. Available at www.ncbi.nlm.nih.gov/pubmed/23118095/
• Mansour W, Boyd A, Walshe K. The development of hospital accreditation in low- and middle-income countries: a literature review. Health Policy Plan. 2020 Jul 1;35(6):684-700. doi: 10.1093/heapol/czaa011. Available at https://pubmed.ncbi.nlm.nih.gov/32268354/
• Aguayo R. 1990. Dr. Deming, the American who taught the Japanese about quality. Touchstone. ISBN-13: 978-0671746216
• Deming W.E.1980. Out of the Crisis. MIT Center for Advanced Engineering Study. ISBN-13: 978-0911379013
Email Address: anne-kathrin.fabricius@uni-heidelberg.de
Date Of Record Creation: 2012-01-09 20:44:56 (W3C-DTF)
Date Of Record Release: 2012-01-10 03:49:58 (W3C-DTF)
Date Record Checked: 2018-06-10 (W3C-DTF)
Date Last Modified: 2023-11-29 15:33:03 (W3C-DTF)