Factors Hindering the Implementation of Quality Improvement at the MoH-Gaza.

Mahmoud Mohammed Radwan
محمود محمد رضوان
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Al-Quds University
Quality has been identified as one of the key drivers of improved health outcomes and greater efficiency in health service delivery in developing countries. In a fragmented and inefficient health system like the Palestinian one, where resources are scarce and health problems are complex, the need for implementation of Quality Improvement (QI) is even more crucial than elsewhere. Little is known about the most influencing factors for impeding the implementation of QI at the Ministry of Health (MoH). This study aims to investigate the most perceived barrier factors to the successful implementation of QI at the MoH facilities. The study employed a descriptive, analytical cross sectional design with a triangulated approach (quantitative and qualitative). Self-administered questionnaires and key informant interviews were used for data collection. A randomized multi stage stratified sampling was used to select the eligible healthcare providers working at the MoH in two medical complexes (Shifa in Gaza and Nasser in Khanyounis) and five PHC centers (level 4). The calculated sample size was 450, out of them, 397 responded and completed the questionnaires, with a response rate of 88.2%. The overall reliability coefficient for the study instrument was acceptable 0.787. Semi structured, face to face, audiotaped in-depth interviews were conducted with eight key informants as a second data collection instrument. Findings revealed that the most perceived barrier factors to the implementation of QI were top management commitment (Mean=2.17), followed by organizational culture (Mean=2.29), leadership (Mean=2.33), health information system (Mean=2.48), human resources management (Mean=2.49), staff training (Mean=2.53), and staff engagement (Mean=2.57). Although the most common obstacle for the implementation of QI, mentioned by all key informants, was the lack of a strategic plan, majority of them reported the same obstacles elicited from quantitative data. However, the perception of healthcare providers reflected a limited implementation of QI with percentage of (25.1%). Such perception was widely concurred by the key informants. Participants working at hospitals and PHC centers revealed similar perception towards the barrier factors affecting the implementation of QI with statistically insignificant differences (P˃0.05). The findings showed variation in the perceived barriers to the implementation of QI in reference to gender, specialties, and job positions (P˂0.05). Pearson test showed a weak positive correlation between the implementation of QI and top management commitment, structure, leadership, human resource management, monitoring & supervision, staff engagement and training, health information system, financial support, and material resources. The researcher recommends prioritizing the QI in the strategic plan as an approach to improve the performance and the provided healthcare services at the MoH facilities; in addition, strengthening the role of management and leadership through dissemination of quality culture, ensuring the resources, and investment in the training.