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. 2024 Dec 31;17(1):2433576.
doi: 10.1080/16549716.2024.2433576. Epub 2024 Dec 2.

Building a culture of quality in maternal and newborn health: experience from the quality, equity and dignity network in Ethiopia

Anene Tesfa Berhanu  1 , Asebe Amenu Tufa  1 , Seblewengel Lemma  2 , Geremew Gonfa  1 , Theodros Getachew  1 , Desalegn Bekele  3 , Fitsum Kibret  3 , Nehla Djellouli  4 , Tim Colbourn  4 , Tanya Marchant  2
Affiliations

Building a culture of quality in maternal and newborn health: experience from the quality, equity and dignity network in Ethiopia

Anene Tesfa Berhanu et al. Glob Health Action. .

Abstract

Background: Building a culture of quality is vital for sustaining high-quality healthcare, emphasising shared values and continuous improvement. The Quality Equity and Dignity (QED) network was a global initiative working toward this objective, focusing on maternal and newborn health. This paper aims to describe how QED influenced five identified attributes of quality culture in Ethiopia: leadership, people-centered interventions, collaboration, rewards, and ownership towards building and sustaining a culture of quality in healthcare establishments.

Methods: This qualitative study, conducted at two points six months apart, incorporated data from key informant interviews, observations, and document reviews. It included 18 national and 22 sub-national key informant interviews, seven facility observations, and one technical working group meeting observation. Data analysis was performed using NVivo 12 software, focusing on identified thematic areas related to quality culture.

Result: Leadership was crucial for building a quality culture in Ethiopia, and the QED network strengthened government leadership structures, although leadership capacity and staff turnover were challenges. QED enhanced people-centered care and data tracking, but the added data focus burdened healthcare workers. Opportunities for collaboration and shared learning were facilitated, although not accessible to all actors. Motivation and rewards encouraged good performance, but addressing intrinsic behavioral change remained a challenge.

Conclusion: Achieving high-quality healthcare involves more than tools and infrastructure; it requires a cultural shift with behavior change consistently demonstrated at various levels. The QED network faced challenges in building a culture of quality but serves as an exemplary initiative for other networks to learn from.

Keywords: QED network; leadership; motivation; ownership; people-centered care; quality culture; quality improvement; rewards.

Plain language summary

Main findings: The quality equity dignity network significantly improved leadership, people-centered care, collaboration, rewards, and ownership in Ethiopian healthcare, enhancing maternal and newborn health outcomes.Added knowledge: The study provides empirical evidence of the quality equity dignity network’s effectiveness in promoting a quality culture in low-resource healthcare settings, addressing a gap in the literature.Global health impact for policy and action: The findings advocate for sustainable policies that improve maternal and newborn health globally by presenting the experiences of the quality equity and dignity network, encouraging others to learn and replicate its successes.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
An adapted analytical framework depicting characteristics that foster a quality culture [4,8,18,19].
See this image and copyright information in PMC

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