Socio-demographic characteristics
A total of 144 health professionals were participated in this study all of them were willing and replied to the interview, giving a response rate of 100%. Majority of the respondent of was 103 (75%) were male. Concerning about the age group the majority which is 79 (54.9 %) were found with the age group of between 22 and 30 years. The table also denotes that 49 (34 %) of the respondents were nurses, 76 (52 %) of have diploma in their education, as showed in the table 1 below.
Table 1:- Socio demographic characteristics of Health professionals working SNNPR, Ethiopia, (N= 144).
Variable
|
Frequency
|
Percent
|
Sex
|
|
|
Male
|
108
|
75
|
Female
|
36
|
25
|
Total
|
144
|
100
|
Age
|
|
|
22-30
|
79
|
54.9
|
31-40
|
49
|
34.0
|
41-50
|
16
|
11.1
|
Total
|
144
|
100.0
|
Profession
|
|
|
Midwife
|
32
|
22.2
|
Nurse
|
49
|
34.0
|
HO
|
32
|
22.2
|
Physician
|
8
|
5.6
|
HIT
|
8
|
5.6
|
Other
|
15
|
10.4
|
Total
|
144
|
100.0
|
Educational level
|
|
|
Diploma
|
76
|
52.8
|
Degree
|
52
|
36.1
|
Post graduate
|
16
|
11.1
|
Total
|
144
|
100.0
|
Working facility
|
|
|
Health center
|
80
|
55.6
|
Hospital
|
44
|
30.6
|
Woreda health office
|
20
|
13.9
|
Total
|
144
|
100.0
|
Implementation status of continuous quality improvement project
Among the 144 respondents 65% said that their respective health facility, whether health center or Hospital, implemented continuous quality improvement project. There rest 35 % did not even start the implementation preliminary process to improve the service delivery related health care.
Leadership factors that contribute for implementations of CQI project
Leadership factors that contribute for continuous quality improvement project implementation assessed by leader’s receptiveness for new idea, use of organization value, creating safe work environment and others. Accordingly, as showed in the table 2 below more that halve of (51.4%) the leaders were not receptive for new ideas moreover, majority of leader were not encouraging learning (62.5%) and not engaged in quality improvement project implementation process (66%).
Table 2: Leadership factors that contribute for implementations of continuous quality improvement project in the health facilities of SNNPR, Ethiopia, 2018
Variable
|
Frequency
|
Percent
|
leaders receptive to new ideas
|
|
|
Yes
|
62
|
43.1
|
No
|
74
|
51.4
|
I don’t know
|
8
|
5.6
|
Total
|
144
|
100.0
|
leader’s uses values of the organization’s to guide health facility activities
|
|
|
Yes
|
46
|
31.9
|
No
|
86
|
59.7
|
I don’t know
|
12
|
8.3
|
Total
|
144
|
100.0
|
leadership created a safe work environment
|
|
|
Safe work environment created
|
36
|
25.0
|
There is initial activities to create safe working environment
|
80
|
55.6
|
Safe working environment not created
|
28
|
19.4
|
Total
|
144
|
100.0
|
leaders share information/ data about health facility service delivery status
|
|
|
Yes
|
97
|
67.4
|
No
|
47
|
32.6
|
Total
|
144
|
100.0
|
leadership encourages learning
|
|
|
Yes
|
44
|
30.6
|
No
|
90
|
62.5
|
I don't Know
|
10
|
6.9
|
Total
|
144
|
100.0
|
leadership asks employees to generate change/innovative ideas
|
|
|
Yes
|
51
|
35.4
|
No
|
93
|
64.6
|
Total
|
144
|
100.0
|
leaders was engaged in quality improvement projects
|
|
|
Yes
|
45
|
31.3
|
No
|
95
|
66.0
|
I don't Know
|
4
|
2.8
|
Total
|
144
|
100.0
|
Customer factors that contribute for implementations of CQI project
To implement quality improvement projects ultimately customer related factor used for identifying quality related problems and implementing the possible solution as a project. Unfortunately, only 50% and 38.4% of respondent said the health facilities has client feedback receiving mechanisms and health facilities measures client satisfaction regularly, respectively, as showed in the table 3 below.
Table 3: Customer factors that contribute for implementations of continuous quality improvement project in the health facilities of SNNPR, Ethiopia, 2018
Variable
|
Frequency
|
Percent
|
health professionals understand clients need
|
|
|
Yes
|
108
|
75
|
No
|
28
|
19.4
|
I don’t know
|
8
|
5.6
|
Total
|
144
|
100
|
health professionals understand client’s preferences
|
|
|
Yes
|
72
|
50
|
No
|
63
|
43.8
|
I don’t know
|
9
|
6.3
|
Total
|
144
|
100
|
health facility have client feedback receiving mechanism
|
|
|
Yes and reviewed frequently
|
72
|
50
|
Yes but not reviewed
|
52
|
36.1
|
No
|
16
|
11.1
|
I don’t know
|
4
|
2.8
|
Total
|
144
|
100
|
health facility assess client satisfaction level
|
|
|
Yes regularly
|
56
|
38.9
|
Yes but not regular
|
60
|
41.7
|
No
|
28
|
19.4
|
Total
|
144
|
100.0
|
health facility Encourage Clients/ community involvement in decision making
|
|
|
Yes regularly
|
44
|
30.6
|
Yes but not regular
|
72
|
50.0
|
No
|
28
|
19.4
|
Total
|
144
|
100.0
|
Human resource factors that contribute for implementations of CQI project
Only twelve (8.3%) respondent said their respective health facilities staff fully trained on quality improvement project implementation. Majority of respondent (61.1%) mentioned that, staff recognition for the work they performed in the health facilities was available. Quality improvement teams for project implementation were available in the 63.9% in the health facilities were respondent work. Only 27.3% of respondent said that their respective health facilities have enough health staff to implement continuous quality improvement project, as showed in the table 4 below.
Table 4: Distribution of human resource factors that contribute for implementations of continuous quality improvement project in the health facilities of SNNPR, Ethiopia, 2018
Variable
|
Frequency
|
Percent
|
health staff cooperate and work as a team
|
|
|
Yes
|
116
|
80.6
|
No
|
28
|
19.4
|
Total
|
144
|
100.0
|
health staff are recognized for their work
|
|
|
Yes
|
88
|
61.1
|
No
|
56
|
38.9
|
Total
|
144
|
100.0
|
staff have job descriptions
|
|
|
Yes
|
57
|
39.6
|
No
|
87
|
60.4
|
Total
|
144
|
100.0
|
health staff trained on quality improvement
|
|
|
Yes all of the staff
|
12
|
8.3
|
Yes some of the staff
|
120
|
83.3
|
No
|
12
|
8.3
|
Total
|
144
|
100.0
|
Quality improvement committee or team
|
|
|
Yes
|
92
|
63.9
|
No
|
44
|
30.6
|
I don't know
|
8
|
5.6
|
Total
|
144
|
100.0
|
health facility has enough health staff
|
|
|
Yes
|
40
|
27.8
|
No
|
104
|
72.2
|
Total
|
144
|
100.0
|
Determinants of continuous quality improvement project implementation
In order to determine the association of independent variables with continuous quality improvement project implementation both bivariate and multi-variate analysis were used. Variables that showed association with the outcome variables in the bivariate analysis were selected for multivariate analysis. Variables like leaders receptive to new ideas, leaders share information/ data about health facility service delivery status, health facility has a quality improvement project plan, staff know using indicators to tell progress about service delivery, health facility assess client satisfaction level, health staff are recognized for their work, health staffs satisfied with their work, quality improvement project contribute the improvement of work at your Health facility and leadership encourages learning were the independent predictors of CQI project implementation as showed in the table 5 below .
Table 5: Factor associated with continuous quality improvement project implementation in the health facilities of SNNPR, Ethiopia, 2018
Variables
|
Implemented
|
Not implemented
|
COR (95% C.I.)
|
AOR (95% C.I.)
|
Leaders receptive to new ideas
|
|
|
|
|
No
|
10(20%)
|
64(68.1%)
|
0.156 (0.034-0.727)*
|
0.572 (0.097-3.37)
|
Yes
|
36(72%)
|
26(27.7%)
|
1.385 (0.317-6.051)
|
4.535 (0.765 -26.895)
|
I don’t know
|
4 (8%)
|
4(4.3%)
|
1
|
1
|
Leaders share information/ data about health
|
|
|
|
|
No
|
9(18%)
|
38(40.4%)
|
0.323 (0.141 -0.742)*
|
0.976 (0.171 -5.57)
|
Yes
|
41(82%)
|
56(59.6%)
|
1
|
1
|
Health facility has a quality improvement project plan
|
|
|
|
|
No
|
5(10%)
|
27(28.7%)
|
0.276 (0.099 -0.769)*
|
0.138 (0.029 -0.652)*
|
Yes
|
45(90%)
|
67(71.3%)
|
1
|
1
|
Staff know using indicators to tell progress
|
|
|
|
|
No, they can’t
|
7(14%)
|
27(28.7%)
|
1.815 (0.332 -9.923)
|
2.3 (0.19 -27.905)
|
Yes, they able to report calculate indicators
|
22(44%)
|
20(21.3)
|
7.7 (1.554 -38.16)*
|
5.627 (0.481 -65.888)
|
Yes, they able to report progress figure
|
19(38%)
|
33(35.1%)
|
4.03 (0.826 -19.674)
|
5.274 (0.47 -59.156)
|
I don’t know
|
2(4%)
|
14(14.9%)
|
1
|
1
|
Health facility assess client satisfaction level
|
|
|
|
|
No
|
3(6%)
|
25(26.6%)
|
0.137 (0.037 -0.503)*
|
0.101 (0.019 -0.522)*
|
Yes regularly
|
19(38%)
|
37(39.4%)
|
0.587 (0.277 -1.243)
|
0.19 (0.06 -0.6)*
|
Yes but not regular
|
28(56%)
|
32(34%)
|
1
|
1
|
Health staff are recognized for their work
|
|
|
|
|
No
|
11(22%)
|
45(47.9%)
|
0.307 (0.141 -0.671)*
|
0.233 (0.076 -0.721)*
|
Yes
|
39(78%)
|
49(52.1%)
|
1
|
1
|
Health staffs satisfied with their work
|
|
|
|
|
Not satisfied
|
22(44%)
|
58(61.7%)
|
1.043 (0.3 -3.623)
|
3.308 (0.535 -20.448)
|
Yes, Satisfied
|
|
|
2.64 (0.738 -9.439)
|
6.349 (0.993 - 40.588)*
|
I don’t know
|
4(8%)
|
11(11.7%)
|
1
|
1
|
Quality improvement project contribute the improvement of work at your Health facility
|
|
|
|
|
No
|
5(10%)
|
29(30.9)
|
0.249 (0.09 -0.692)*
|
0.181 (0.047 -0.696)*
|
Yes
|
45(90%)
|
65(69.1%)
|
1
|
1
|
leadership encourages learning
|
|
|
|
|
No
|
27(54%)
|
73(77.7%)
|
0.338 (0.161 -0.706)*
|
2.148 (0.664 -6.948)
|
Yes
|
23(46%)
|
21(22.3%)
|
1
|
1
|
Significantly associated with P- Value of <0.05.
According to the multivariate logistic regression analysis if the health facility has strategic quality improvement project plan, 84% of the health facility will implement continuous quality improvement project (AOR=0.138 (0.029 -0.652)). Similarly, if the health facility assess client satisfaction, even if the assessment is not regular, 90% (AOR=0.101 (0.019 -0.522)) of the health facility will implement continuous quality improvement project as compared to health facilities couldn’t able to assess the satisfaction level of clients. Moreover, if the health facilities staff believe that quality improvement project contribute the improvement of work at their respective health facility, 80% (AOR=0.181 (0.047 -0.696)) of the health facilities more likely implement continuous quality improvement project as compared to those health facilities with staff not believe CQI project has contribution for their work.