Title: Improving the quality of healthcare services in resource limited settings
Keywords: Team-work (incl. interdisciplinary, inter-professional)
Quality (incl. accessibility)
Health facilities (hospitals)
Health systems
Country: Germany
Institution: Germany - Institute of Public Health, University of Heidelberg
Course coordinator: Sylvia Sax
Date start: 2018-02-19
Date end: 2018-03-02
About duration and dates: 2 weeks
Classification: advanced optional
Mode of delivery: Face to face
Course location:
Institute of Public Health, University of Heidelberg
ECTS credit points: 3 ECTS credits
SIT:
90 hours
Lectures: 28 hours, Group work and presentations: 30 hours, Independent study: 32 hours
Language: English
Description:
By the end of this course participants will be able to:
• Defend the importance of improving quality in health services
• Describe common mechanisms to improve quality of health services in resource limited settings
• Critically analyze the use of quality improvement principles and mechanisms in resource limited settings
• Describe current human and other resource challenges to improve health service qualityDemonstrate individual and team skills in using quality improvement tools and mechanisms
Assessment Procedures:
Participants’ achievement of the learning objectives will be assessed on:
• 60%: Individual written assignment (approx. 2000 words); essay based on case studies from low-and middle-income countries; case studies about quality improvement in various settings will be chosen by participants in consultation with the course coordinator. The essay must be delivered on the last day of the course.
• 40%: Presentation of a group project (20 min presentation) on case studies on assessment of quality in health facilities provided by the coordinator

If the student fails to reach the passing grade of 60% (average from both assessments), s/he will be able to re-submit the individual written assignment not later than 2 weeks after receiving coordinator’s comments.
Content:
• Prioritizing quality improvement: rationale, methods and examples
• Overview of quality and safety terminology and concepts
• Harmonizing quality improvement with local and international health system strengthening initiatives
• Developing and implementing standards, guidelines and indicators in a healthcare service
• Designing and implementing quality assessments using audit, accreditation and supervision
• Personal skills development for managing teams in improving quality
• Designing and managing quality improvement teams including quality circles, clinical guideline working groups, clinical audit, and quality improvement committees
• Quality improvement tools such as checklists, affinity analysis, flow chart, mind mapping, fish-bone diagram, force-field analysis, prioritisation matrix, Gantt chart, control chart, and radar chart
• Case studies of quality improvement in low and middle-income countries
Methods:
• Searching the internet and internet resources for health services quality improvement publications and grey literature
• Use quality improvement literature critically to inform individual and team exercises
• Two x 60 minute interactive lectures to introduce key subjects of trends in healthcare quality and patient safety movements with two group exercises on these subjects
• 60 minute interactive lecture to introduce key quality improvement principles and two x 2 hour guided team exercises on using principles in different contexts
• 45 minute interactive lecture and two exercises on quality, patient safety and evidence based practice and their relevance in a resource limited setting
• Three x 30 minute lecture on teams and five x 30 to 45 minute individual and group exercises on team building and using quality improvement tools and mechanisms
• 45 minute lectures and 1.5 hour group exercise to analyze two case studies on introducing and/or improving health services quality
• Two day (16 hours) healthcare surveyor training using case-study, interactive lectures, individual and group exercises
• 1.5 day (14 hour) interactive field visit to a healthcare service including design and use of a healthcare quality assessment tool, analysis of findings, role play and debate
• Four hour exploration of patient rights and responsibilities in healthcare, culture and ethical aspects of quality and safety using short lectures, role plays and design of patient charter
• 20 hour assignment on an agreed topic in health services quality improvement in a resource limited setting with optional presentation and defense of their approach.
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): 25
Selection: first come, first serve
Fees: tropEd students: 1.000 EUR
General admission: 1.500 EUR
Scholarships: None available
Major changes since initial accreditation:
The title has changed from resource poor settings to resource limited settings based on participant feedback. The assessment methods now include both individual and group assessments. We have increased learning on multi-disciplinary teams and included a session on cultural diversity with a session on ethics in quality.
Student evaluation:
The course continues to receive very positive feedback and consistent high ratings from students. Frequent comments are on the value of the participant presentations with their critical analyses of local quality improvement initiatives course, the use of the field trip to German hospitals using tools and methods covered in the course and the interactive and open communication methods. The practical nature of the two-day surveyor training was generally rated high though some found working in teams for two days a challenge.
Lessons learned:
Cultural perceptions of quality and teams vary widely. Knowledge on the topic of ethics is weak.
tropEd accreditation:
Accredited in Bordeaux 2007. Re-accredited in September 2012 and in October 2017. This accreditation is valid until October 2022.
Remarks:
This course focuses on practical tools and methods to improve healthcare services in low- and middle-income countries. It introduces participants to major steps and trends in healthcare quality and patient safety movements with a focus on challenges to improving quality in resource limited settings.
Course participants learn how to adapt quality improvement tools, methods, and techniques to national and local settings with a special emphasis on managing and motivating people and designing sustainable health improvement programmes.
A two-day skills development workshop strengthens individual and team skills in evaluating the quality of health care services.
Email Address: grys@uni-heidelberg.de
Date Of Record Creation: 2012-01-10 02:37:22 (W3C-DTF)
Date Of Record Release: 2012-01-10 08:49:44 (W3C-DTF)
Date Record Checked: 2017-10-09 (W3C-DTF)
Date Last Modified: 2017-10-10 04:47:03 (W3C-DTF)

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