Such accounting infrastructure is consistent with international quality improvement and health policy literature, where, although it is acknowledged to be only the starting point for improvement [ 5], accounting infrastructure is argued to provide the essential preconditions for improvement possibilities.
There was recognition that a consistent approach to quality improvement (QI) for nurses was needed as to avoid creating pockets of excellence that are isolated in one area and to ensure that projects are aligned and not competing for attention.
In keeping with the principles of trialability, reinvention, observability, and risk minimization, we envisioned program implementation as being consistent with continuous quality improvement methodology, specifically including several concepts described by Locock: "Continuous incremental improvement of current processes--repeated testing and evaluation of small scale changes.
This is consistent with the usual quality improvement processes that seek to eliminate the worst offenders first and then look at the other processes subsequently.
Efficiency and Quality of ECD National ECD guidelines and standards for service delivery can facilitate consistent implementation and continuous quality improvement as ECD is scaled up, but better monitoring is needed.
It is also consistent with the evolving quality improvement literature that demonstrates the difficulty in increasing attainment of <7% A1C, especially in patients with starting A1C levels >8%, despite structured interventions in staff model practice settings with electronic health care records (24).
This would be consistent with other research on quality improvement, which suggests that there is no "magic bullet" to improving quality: rather, interventions need to be multifaceted and sustained over time to produce major change.
One of several facets of work improvement programs in JIT management is developing an organization with a focus on constant improvement requiring consistent quality management training as well as cross functional cooperation [50].
However, organizations' top priorities, such as survival, cost containment, and quality improvement, were consistent with patient-centered care.
This feeds into existing approaches for quality improvement research, consistent with the principles of the MRC framework for the development and evaluation of complex interventions [ 28].
