“Health care workers have changed their bad language”: When the patient's voice is heard
Background: Elizabeth Glaser Pediatric AIDS Foundation, in collaboration with facility-based
and district quality improvement teams (QIT), introduced the Patient''s Voice
program to solicit community-level feedback on clinical services in Kilimanjaro
Tanzania.
Methods: : Two high-volume hospitals providing HIV
treatment services, who utilize community resource persons (CORPS), and QITs, introduced
quarterly assessments, including patient satisfaction exit surveys
(PSS) administered by district-level
QIT members to about 25 patients, and Community Dialogues attended by up to 50 community members, led by the CORPs. For transparent data review and action
planning, the program incorporated consumer representation on the facility QIT. These teams were then responsible for implementing
improvement projects in response to the issues identified.
Results: Since 2013, each site completed four
rounds of assessments resulting in 363 community participants and seven
completed QIT meetings. The PSS and dialogues
revealed different issues at each round and in each facility. In one facility, the main finding from the
first round was long waiting time at various service delivery points. Mean waiting time reported on PSS was
significantly reduced in subsequent rounds (R1=3.8 hrs, R2=2.4, R3=2.6, R4=3.0;
p=.005) after the QIT implemented the following changes: appointment time
blocks, two additional drug dispensing windows/stations, and a clock placed in
the staff meeting room to encourage timeliness of meetings and breaks. The other facility''s dialogue highlighted
poor quality of care at the labor ward, namely that women were required to wash
hospital linens after delivery and staff spoke rudely. The district management addressed the issue
with hospital staff, and patients reported in the next round an improvement: “Health care workers have changed their bad language.” Later rounds showed both sites reporting
issues related to misperceptions of medical care costs or triage/referral
policies. Action points focused on
community sensitization and posting information about eligibility for free
medical care and other policies at the facility.
Conclusions: Involving patients in a collaborative QI approach using both qualitative
and quantitative assessment approaches can reveal quality gaps that providers are
either not aware of, or are not actively addressing, and positively engage
community members, providers and local government leaders in holding public
services accountable.
G. Mbita1, T. Kiwale2, R. Ally2, E. Mshana3, A. Shirima4, C. Kimario5, J. Macha6, A.B. Ntogwisangu7, T. Mtambalike8, G. Antelman1, R. Van den Ven8
1Elizabeth Glaser Pediatric AIDS Foundation, Public Health Evaluation, Dar es Salaam, Tanzania, United Republic of, 2Elizabeth Glaser Pediatric AIDS Foundation, Quality Improvement, Dar es Salaam, Tanzania, United Republic of, 3Moshi District Council Health Management Team Kilimanjaro, CHMT Member, Moshi, Tanzania, United Republic of, 4Hai District Council Health Management Team Kilimanjaro, CHMT, Moshi, Tanzania, United Republic of, 5Kibosho Hospital, CHMT, Moshi, Tanzania, United Republic of, 6Hai District Hospital, CHMT, Moshi, Tanzania, United Republic of, 7Elizabeth Glaser Pediatric AIDS Foundation, Program, Moshi, Tanzania, United Republic of, 8Elizabeth Glaser Pediatric AIDS Foundation, Program, Dar es Salaam, Tanzania, United Republic of