Developing a conceptual and practical framework for outcomes measurement to support a quality improvement project in Rwanda: an observational study

Authors

Elisabeth DRiviello, Brigham and Women's Hospital, USA
Samuel lFinlayson, Brigham and Women's Hospital, USA
Woon ChoKim, Emory University Medical School, USA
Theoneste Mwumvaneza, University Hospital of Kigali, Rwanda
Willy Kiviri, Aga Khan UniversityFollow
Sophie Reshamwalla, Lifebox Foundation, UK
William Berry, Harvard School of Public Health, USA
Georges Ntakiyiruta, Department of Surgery, University Hospital of Kigali, Rwanda
Patrick Kyamanywa, University Hospital of Butare, Rwanda
Edmond Ntaganda, University Hospital of Kigali, Rwanda
Theogene Twagirumugabe, University Hospital of Butare, Rwanda

Document Type

Article

Department

Anaesthesiology (East Africa)

Abstract

Background

A landmark study in 2009 demonstrated that a WHO surgical safety checklist decreased mortality and complications in surgical patients. Attempts to replicate this in the developing world have been mixed. We piloted the implementation of a surgical safety checklist with outcomes measurement in one district hospital in Rwanda, with the goal of creating a scalable model to use in all public hospitals in the country.

Methods

We sought to develop a conceptual and practical framework for ongoing outcomes measurement that can be applied to quality improvement projects in resource-poor settings. We accomplished this through interviews with global checklist implementation teams and Rwandan hospital staff, as well as observation.

Findings

We developed the following framework with specific examples from our experience. (1) Define the elements of data collection and who will perform each. In particular, the data audit function must be carefully outlined. (2) Understand the potential motivators for each participant in data collection and align incentives; these may be financial or non-financial. (3) Choose a data collection training method including initiation, maintenance, and troubleshooting. (4) Select a database software considering the following: availability of consistent or intermittent internet access, user interface complexity, flexibility of software for Mac and PC operating systems, need for mobile access, initial and ongoing costs, and technical support. Based on these criteria, we chose to pilot a new offline version of REDCap, which may have important implications for global health projects in settings without consistent internet access. (5) Be flexible. The framework provides a best first guess at the methods that will work for high-quality data collection, but a willingness to change course is critical.

Comments

This work was published before the author joined Aga Khan University.

Publication (Name of Journal)

The Lancent

Recommended Citation

Riviello, E. D., Finlayson, S., Kim, W. C., Mwumvaneza, T., Kiviri, W., Reshamwalla, S., ... & Twagirumugabe, T. (2013). Developing a conceptual and practical framework for outcomes measurement to support a quality improvement project in Rwanda: an observational study. The Lancet, 381, S125.