Improving compliance with health care service delivery guidelines through quality improvement processes

Bolivia has a relatively well developed system of service delivery guidelines (norms) for different programs and levels of care. One of the major problems in Bolivia is the quality of health care services including the compliance with norms. During 2007, the Health Quality and Management Project tested a quality improvement model to increase compliance with norms.

In this pilot test, staff at four rural hospitals was assisted in comparing hospital practices with national norms. After conducting this self-evaluation staff developed action plans to increase the number and percent of procedures performed according to service delivery norms. Each month thereafter the teams met to assess progress implementing their action plans and the effect of the actions on the quality of care and compliance with service delivery norms.

Among the noticeable results, it was observed that the compliance with the norms to maintain the cold chain increased from 63% to 98% four months after the intervention and the percent of prescriptions which were properly filled increased from 37% to 86%. In addition, the percent of children whose caretakers reported participating in nutrition counseling sessions increased from 0% to 47%.

The results from this pilot test clearly show the impact that the quality improvement model can have on increasing compliance with health service delivery norms. Since the provider evaluates his/her own service delivery and diagnoses the problems, utilization of findings and motivation to improve the service delivery is high.