Implementation of a nationwide Quality Management System

In many countries, governments are concerned about the quality of care which is provided to the people. Reforms to improve the quality are very high on national agendas (Black/Gruen 2005, 12). There are various theories and models which offer theoretical support for the successful development and implementation of strategies or programms, like the implementation of a nationwide quality management system. Following two of these models are being introduced.

Public Health Action Cycle

The Public Health Action Cycle was derived from the political science Policy Cycle and transferred to public health projects and processes (Rosenbrock/Hartung 2011). The cycle is applicable as an individual action program for implementing a health-related measure or project. But it can also be used for enforcing health interventions, programs and policies at the micro, meso and macro levels. For example, on a national health policy (macro level), it provokes questions like:

·         What is the problem (hazards and diseases) which should and can be addressed by health policy?

·         What are the formulated objectives? Which stakeholders and instruments are needed to achieve them?

·         How can the application of intervention tools be ensured?

·         What health-related and other effects can be identified by health policy?

The Public Health Action Cycle breaks down intervention in four phases:

1. Problem Assessment: identifying and defining the problem

2. Policy Development: formulating a suitable strategy or action to solve the problem

3. Implementation: carrying out the defined actions

4. Evaluation: reviewing the effects achieved

When the identified problem is solved, the cycle starts all over again with identifying a new problem.

The Public Health Action Cycle represents an ideal type of implementing health-related interventions. But it is very important to note, that the often very crucial question or phase of setting a topic on the agenda must take place before the first step of the Public Health Action Cycle is being done. Moreover, the phases of the Public Health Action Cycle do not necessarily correspond chronologically successive with the phases of the policy process. Also, interests and power constellations can influence the selection of a health problem and the attribution of causes.

Capacity Building

“Capacity building” is a term used in many different fields, organizations and individuals. It generally addresses specialized management issues, like organization management or integration of a program, depending on the interest of the capacity builders (Howitt 1986, 9). Therefore there are many different existing definitions. For example, Robert Hawking defines capacity building at an institutional level (Howitt 1986, 11): “Capacity building is a concept that encompasses a broad range of activities that are aimed to increasing the ability of citizens and their governments to produce more responsive and efficient public goods and services. At its core capacity building is concerned with the selection and development of instructional arrangements, both political and administrative.

The United Nations Development Programme (UNDP) (www.undp.org) supports capacity development and has designed a Capacity Measure Framework (see illustration below). In this model the availability of resources, e.g. human or financial and capacities build the fundamental input. The output is represented by four “levers of change”, which create the core issues/responses for capacity building. These are:

·         Institutional arrangements, e.g. processes, definition of roles and responsibility or a coordination system à organizational development of required organizations, roles

·         Leadership, e.g. defined vision or communication standards à policy and community development

·         Knowledge. e.g. knowledge sharing and gaining management à Development of the required human resources

·         Accountability, e.g. audit, stakeholder feedback or participatory planning approach à development of monitoring system

The outcome stands for the change in institutional performance, stability and adaptability, which have an impact on national development goals.