David Meyers, Tiara Forsyth

1. Creating a Culture of Quality Health Care in Resource Limited Clinical and Community Settings; A Necessary Prerequisite to Technological Intervention David Meyers, Tiara Forsyth

2. Introduction • Technological interventions for healthcare don’t always “stick” in resource limited settings • This lack of sustainability can come from a variety of factors: • -lack of resources • -lack of interest • -lack of time • -lack of leadership • Technological Interventions in healthcare stand to learn from the quality improvement movement

3. Bridging the Gap Quality Improvement Global Health Informatics

4. Bridging the Gap

5. At the nexus… • Focus on improving quality • Evaluation and implementation tools and processes • A culture of quality and safety

6. (this is not unique to the developing world… it is an issue everywhere)

7. A Culture of Quality and Safety • Critical component of any health quality improvement initiative • “The (quality and) safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety management. • Organizations with a positive (quality and) safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures.” -Organizingfor Safety: Third Report of the ACSNI (Advisory Committee on the Safety of Nuclear Installations)

8. A Culture of Quality Improving Healthcare Technology • Critical component of any health quality improvement initiative • “The Quality Improving technologyculture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's quality improving technology management. • Organizations with a positive quality improving technology culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of quality improvement, and by confidence in the efficacy of technological measures

9. Methods • Conducted Semi Structured interviews based on expert reviewed questionnaire • Qualitatively Summarized Results • Compiled Several Case Studies

10. Identified Barriers • Lack of staff interest in IT infrastructural improvement • Limited Time • Limited Resources • Limited Demonstration of end results • Lack of leadership engagement in adoption of new technologies • Technical challenges

11. Potential Solutions • Stick/Carrot Approach • PhilHealth System • Financial Incentives • Story/Statistics • Possible Health • Top-down/Bottom-up • Government wide policies • Push from clinicians or community

12. Further Research This is only the beginning… Larger studies should be conducted to assess the extent of quality culture barriers to the adoption of Health IT. • More studies on efficacy of QI approaches in health IT should be conducted

13. Key Takeaways • Quality improvement concepts can be applied to the adoption of global health informatics systems • A culture of quality and safety not only a prerequisite for QI approaches but is also vital for adoption of health technology • Health informatics requires a multi-disciplined approach

14. Acknowledgements • Tiara Forsyth • Interview Participants • Leo Celi and Vipan Nikore • Entire Possible Health Team • Tufts University