The forum showcased a continent-wide perspective on patient safety and quality improvement. You can watch a LIVE RECORDING of the session and read more about ACQUIRE here.
On 18th-19th July, healthcare professionals, policymakers, and quality improvement specialists from 9 African countries gathered for the ACQUIRE QI Leadership Forum in Nairobi, Kenya. The forum discussed the latest developments in healthcare quality and patient safety, highlighting ongoing challenges and the need for systems-based approaches to improving healthcare outcomes. The opening session of the event focused on the Status of Quality and Safety Globally, and began with a keynote address delivered by Dr. Irungu Kamau, emphasizing Kenya’s constitutional mandate to deliver people-centered, timely, and equitable healthcare services.
Global Status of Quality and Safety: What Can Africa Do?
Ms. Lauren de Kok, Quality Improvement Specialist and Regional Director for QI and Training at Aurum Institute, delivered a compelling presentation on the global status of healthcare quality and safety. The statistics she shared painted a sobering picture: between 5.7 and 8.4 million deaths annually in low- and middle-income countries (LMICs) are caused by poor-quality care, representing up to 15% of overall deaths in these regions.
Referencing the Lancet Global Health Commission on High-Quality Health Systems, Ms. Laureen de Kok emphasized that 60% of preventable deaths from conditions requiring healthcare in LMICs result from inadequate care, which imposes a heavy economic burden, with up to $1.6 trillion in lost productivity annually. These findings demonstrated the fragility of health systems, particularly in resource-limited settings. 1 in 8 healthcare facilities globally lack water services, while 1 in 5 lack sanitation—both essential for maintaining safety in care provision. As Ms. Laureen De Kok remarked, “Every system is perfectly designed to get the results it gets,” reminding attendees that the current design of health systems is failing to meet the needs of populations more so in the LMIC.
The Call for a System View in Healthcare
A key point raised by Ms Laureen de Kok was that health systems are not viewed as systems but rather as fragmented programs. This siloed approach results in confusion and inefficiency, with quality improvement efforts often isolated. Ms. Laureen de Kok urged African nations to take a system-wide view of healthcare to address the crisis of poor quality care..
She reinforced the idea that quality improvement (QI) cannot be outsourced. Healthcare workers and managers must take ownership of QI initiatives rather than relying on donor-driven programs that often focus on short-term goals. “Healthcare will not realize its full potential unless change-making becomes an intrinsic part of everyone’s job, every day, in all parts of the system,” she noted, quoting Paul B. Batalden and Frank Davidoff.
Redesigning Healthcare Systems for Success
Ms. Laureen de Kok also highlighted the misuse of data in healthcare systems, where it is often collected for reporting rather than for driving improvement. Additionally, she pointed out that management support is audit-driven, focusing on meeting standards rather than fostering a culture of continuous improvement. She called for a shift in how healthcare systems are designed and how quality improvement is implemented, emphasizing the following areas:
- Systems Thinking: Healthcare must be viewed as an interconnected system rather than a collection of siloed programs.
- Data for Improvement: Data should be used not only for reporting but as a tool for decision-making towards continuous improvements.
- Management Support: Leadership should focus on creating an enabling environment to support continuous learning. Reflection on performance should be supported at all levels of the organisation and should drive feedback loops for learning and improvement. Only then can a learning health system be attained.
- Workforce Engagement: Healthcare workers have invaluable insights, yet their voices often go unheard, leading to disengagement and frustration. The frontline healthcare worker understands the system vulnerabilities and the potential for better care.
Ms. Laureen de Kok introduced the South African 4A Approach (Assess, Act, Analyze, Anchor) to quality improvement, a methodology that encourages continuous assessment and action, followed by analysis and the anchoring of improvements into the system.
Panel Discussion: Implementing National Frameworks for Quality Improvement
The session concluded with a panel discussion featuring insights from healthcare leaders, including Dr. Olabisi Ogunbase (Nigeria), Dr. Tumi Dvine (Cameroon), Dr. Sabelile Tenza (South Africa), and Dr. Elon Otchi (Ghana). The speakers emphasized the importance of national frameworks and strategies for guiding quality improvement efforts. These frameworks provide guidelines for healthcare facilities, ensuring the health system inputs are effectively translated into processes that will deliver desired outcomes.
The panelists agreed that while accreditation is important, it is not the ultimate measure of quality improvement. Most health institutions encountered quality through the eyes of audits and compliance checklists. This has not sufficiently moved to the realm of using the audits as an enabler to start the improvement journey; rather, it’s used for regulatory requirements and accreditation compliance.
The patient experience should be at the centre of all health system efforts. Drawing on examples from Botswana, Ghana, Cameroon, South Africa, and Nigeria, the panellists demonstrated how different countries are improving patient experiences and healthcare quality.
Closing Thoughts: A Call for Systems-Based Quality Improvement
The conference’s opening session sent a clear message: quality improvement in healthcare must be owned by those within the system, and it must be approached with a systems-thinking mindset. Ms. Laureen de Kok’s presentation and the panel discussion emphasized that Africa’s healthcare systems must evolve by integrating quality improvement into everyday practice. With national frameworks guiding these efforts and a commitment to patient-centered care, African nations can begin to close the gap in health outcomes and elevate the standard of care across the continent.
As Ms. Laureen de Kok concluded, “We must start seeing ourselves as a health system” if we are to build resilient and equitable healthcare infrastructures for Africa’s populations.
