Themes (No. studies) | Evidence synthesis | Quality of Evidence [ref.] | ||||
---|---|---|---|---|---|---|
Description of relationship QIC component–mechanism–outcome | Contextual enablers of mechanism (or barriers) | Quantitative and mixed methods | Qualitative and review | |||
QIC component | Mechanism of change | Outcome | ||||
Health professionals -knowledge, skills & problem solving (N = 4) | Use of continuous quality improvement approach | • Refreshed knowledge • Reinforced confidence and skills in improvement topic area • Facilitated a problem-solving approach | Change in clinical practice enabled | • Quality and appropriateness (mix of clinical and quality improvement expertise) of mentoring • Leadership and work culture open to bottom up discussion and reflection • Health workers participating in quality improvement interventions have adequate clinical competences (or a complementary clinical skills training programme is accessible) | Medium [46] | |
Health professionals engagement, attitude and motivation (N = 8) | Formulating shared goals Alignment with national priorities and fit with existing practices Use of run-charts to visualise progress Dissemination of success stories Credibility of change package | • Increased motivation, by reframing improvement topic as desirable, urgent and achievable • Removed resistance to use of data • Increased Commitment to change | Increased engagement in QIC—may lead to increased success | • Intensity of mentoring to increase data literacy and use for decision-making, particularly in LMICs • Supportive leadership • Barrier: competing programmes and initiatives. | ||
Organisational climate (N = 4) | General QIC approach | • Facilitated teamwork and multi-professional collaboration within and across departments • Facilitated bottom up dialogue and discussion |  | • Quality and intensity of mentoring • Wider use of improvement tools beyond unit of focus | High [60] | |
Leadership (N = 2) | General QIC approach | • Enhanced leadership engagement • Decentralised/shared leadership promoted through encouraging bottom up problem solving | Staff morale boosted | • Previous success with quality improvement • Alignment with institutional responsibilities and participatory working culture |  | |
Organisational structures, processes and systems (N = 5) | Process mapping | • Definition of standard care processes facilitated | New expectations on performance generated | • Previous success with quality improvement • Alignment with institutional responsibilities and priorities • Complementary approach (beyond QIC activities) to institutionalise new ways of working e.g. incorporation in induction or staff training; performance management frameworks for accountability at the level of health workers and/or organisation |  | |
Organisational culture (N = 3) | General QIC approach | • Development of habits for improvement facilitated | Normalisation of new practices | • Leadership open to new practices • Health system enabling decentralised innovation |  |