Factors that Influence the Implementation of Quality Improvement Programs.

Introduction: Access to poor-quality care has adverse effects in terms of morbidity and mortality. Hence, the need to find strategies to improve processes and systems to satisfy patients and enable access to good-quality care. In Haiti, the Ministry of Public Health and Population, donors, and technical and financial partners emphasize quality improvement programs such as the HEALTHQUAL program. It has become an essential approach in the Haitian health system. While quality improvement programs are relatively new to Haiti, little data is available on the factors that can facilitate or hinder their implementation.

Methodology: An evaluative research (implementation analysis) using a multiple case study design was conducted with a qualitative approach. Thirty-eight semi-structured interviews were conducted, observations were made, and documents were analysed. Data analysis was performed using the constant comparative method and a synthetic analysis framework with predefined categories (program components, facilitating factors, inhibiting factors, mechanisms, consequences, and interactions between model elements). Subsequently, these categories were analysed using Atlas.ti software, with additional codes emerging and being incorporated into the predefined categories. Memos and a research journal were used during data collection and analysis.

Results: The main facilitating factors include collaboration between the institutional and community levels, leadership, coordination and collaboration within a multidisciplinary team, external pressures, the characteristics of the networks, team ownership of the process, and quality infrastructure.The main inhibiting factors comprise the socio-political context, organisational culture, the influence of previous decisions (policy legacy), provider perceptions of HEALTHQUAL, the lack of accountability mechanisms, an unsuitable health information system, and resource unavailability.

Conclusion: Based on these observations, leaders and decision-makers are encouraged to consider these contextual factors when planning and implementing the HEALTHQUAL program in Haiti. It is important to consider a range of contextual variables to understand implementation at any given time.