This document discusses how creating a culture of quality healthcare in resource-limited settings is necessary for successful technological interventions. It notes that lack of resources, interest, time, and leadership can hinder sustainability. The document suggests that quality improvement concepts from other industries can help bridge this gap. Specifically, focusing on quality, using evaluation and implementation tools, and fostering a culture of quality and safety are critical. Interviews identified barriers like limited staff interest, time, resources and leadership engagement. Potential solutions discussed include incentives, leadership demonstration, and policies to encourage adoption from both the top-down and bottom-up. Further research on a larger scale is still needed to fully understand quality culture barriers and test approaches.

1. Creatinga Culture of QualityHealthCarein
ResourceLimitedClinical andCommunitySettings;
A NecessaryPrerequisite 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
Global Health
Informatics
Quality
Improvement

4. Bridging the Gap
Quality
Improvement
Global Health
Informatics

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.” -Organizing for 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 technology 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
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