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Table 2 The elements and process of the CI intervention

From: Opening the ‘black box’ of collaborative improvement: a qualitative evaluation of a pilot intervention to improve quality of malaria surveillance data in public health centres in Uganda

Component Length of component Timing Location Target audience Focus Per diem paid Overall success
In-service training on completing registers Half day, 3–4 h Prior to the start of intervention (4 health centres). During first week of intervention (1 health centre) All 5 health centres All health workers at health facilities How to complete HMIS OPD register, laboratory register, and pharmacy register No Health worker attendance was high (70–100% of health workers from participating health centres attended). In subsequent interviews, this was often described as the most important element in the intervention
Initial workshop Half day, 3–4 h At the start of intervention Kampala hotel District health officials, members of collaborative improvement (CI) team at health centres, intervention team Introduce study and CI methodology to health workers, create district-wide awareness of activities and support for project, present data on current practices 140,000 UGX (US$40) Health worker attendance was high (70–100% of health workers from participating health centres attended). Considerable debate emerged about source of poor quality of data. District officials blamed health workers and poor recording practices. Health workers expressed frustration at overwhelming amount of data that they were asked to collect
Learning sessions 3 sessions each 2 days long At start, at 3 months and at 6 months District hotel (1); Kampala hotel (2) Health workers who were members of the CI teams Formulation of strategies to:
1. Improve data completeness in OPD register (first session)
2. Improving accuracy and concordance between data sources (second session)
3. Improving malaria test and treatment indicators (third session)
140,000 UGX (US$40) Health worker attendance was high (100% of those invited attended or sent a substitute). Health workers agreed to be involved in the project, but did not grasp the methodology sufficiently to be able to describe it by the end of the intervention
Action periods:
Plan, do, study, act (PDSA) cycles
3 action periods of 2–3 months to implement changes from learning sessions Throughout project All 5 health centres Health workers who were members of the CI teams were expected to call meetings to reflect and enact changes, CI mentor who visited health centres to support team members For health workers to implement changes identified at learning sessions, propose and pilot changes to address problems, collect data to document impact of the changes and decide whether to maintain the change. These are known as PDSA cycles. The CI mentor would arrive spontaneously to conduct these sessions 4000 UGX (US$1.10) Whilst health workers were expected to lead these sessions, it was the CI mentor who pushed forward action, helping health workers to reflect on the learning sessions, complete project documentation, identify problems, and prompt them to make decisions about the actions that they should take. Initially, the CI mentor also extracted all the data that was expected to underpin reflection, but health workers undertook this towards the end of the intervention. The CI mentor guided health workers to focus on the root of their problems. No spontaneous meetings were observed, and no health worker was observed completing project forms outside meetings with the mentor. Most activity occurred following second learning session
Harvest meeting 2 days At the end of project Kampala hotel Health workers who were members of CI teams To share lessons learned from the project with participating health workers 140,000 UGX (US$40) Health worker attendance high (100% of those invited attended or sent a substitute). Health workers found presenting the data from their health facility difficult. Few could describe the theory behind CI or the PDSA cycles. The mentor had to support the health workers so that they could evaluate their data, document and rank the importance of changes made