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Table 2 Description of CQI tools used in the intervention

From: The MONARCH intervention to enhance the quality of antenatal and postnatal primary health services in rural South Africa: protocol for a stepped-wedge cluster-randomised controlled trial

CQI tool

Description

Process map

A map of clinic processes relating to a specific activity from the time a patient walks into the clinic

A map, including waiting times and waiting site, is created for each activity as there may be differences in the process based on clinical need (e.g. a patient who is HIV-positive with tuberculosis co-infection versus a patient who is HIV-positive without tuberculosis). Mapping identifies areas for improved process efficiency, thereby reducing clinical workload and patient waiting times.

Run chart

A display of real-time data on target indicators

The run chart is the essence of the ‘data-driven’ approach of CQI. Target indicators, or process indicators, are selected during the early stages of CQI implementation, for monitoring throughout the period of CQI activities. Facility staff can observe the results of changed activities using their own data in real-time on the so-called run chart. The run chart facilitates motivation and buy-in.

Fishbone diagram

A diagrammatic representation of factors contributing to a specific clinical endpoint – a ‘cause and effect’ diagram

PDSA cycle [44]

A representation of the process of change

In the Planning stage, facility staff (guided by CRH CQI mentors) plan how to implement change targeting a specific endpoint (Plan). This is followed by actual implementation (Do) and review of progress and challenges (Study). The change becomes embedded in normal practice if implementation was successful, or generates a different method of implementation (Act).

  1. CQI Continuous Quality Improvement, CRH Centre for Rural Health, PDSA Plan-Do-Study-Act