While the prefabs of the 1940 homes were often a byword for poor quality, improvements in technology mean that such concerns are no longer an issue.
Overall, there were a number of issues that were highlighted which included chronic underfunding of services; lack of discipline-specific training and access to training for rural community nurses; poor-quality improvement and pastoral care systems; and workforce supply problems, encompassed by poor recruitment, staff relief systems and inadequate orientation of new staff.
Incorporating user, providers, and community perspectives in studies to further understand the factors underlying poor quality and inform quality improvement could be useful.
18 21 Others highlight the literature focus on the difficulties of the managers' role and the negative results of poor leadership on quality improvement (QI) rather than considering actions that managers presently undertake on quality and safety.
For example, one programme theory hypothesises that the use of PROMs as an indicator of hospital quality will improve patient care by refocusing provider organisational priorities on areas of poor performance and initiating quality improvement activities.
Presence of poor referral and transport systems, poor quality of KMC delivery and weak quality improvement measures were also reported (Table 1).
Monitoring results showing poor hand hygiene compliance in a major, busy emergency department prompted a quality improvement initiative to improve hand hygiene compliance.
Absence of outcome data is a barrier to quality improvement in resource poor settings.
A recent district-level participatory quality improvement intervention in South Africa to improve PMTCT coverage [ 17] identified poor supervision systems as a limitation to quality improvement and compensated by employing an external facilitator.
Under this system, a care home with a poor quality rating (QR) would need to provide an improvement plan.
Despite their popularity, the fidelity and quality of reporting of PDSA cycles remain problematic, 59 and the quality of measurement and interpretation of data in quality improvement projects is often strikingly poor.
