Reference no: EM132942648

Case: Using Teams to Achieve Millennium Development Goals

Childhood mortality continues to be a major health problem in developing countries. A child born in a developing country is over 13 times more likely to die within the first five years of life than a child born in an industrialized country. Sub-Saharan African countries account for about half the deaths of children under five in the developing world. Between 1990 and 2006, about 27 countries-the large majority in sub-Saharan Africa-made no progress in reducing childhood deaths.

The country of Ghana had set a goal of decreasing childhood mortality from 110 per 1,000 live births to 20 per 1,000 live births by 2015. The most common causes of death among children under age five in Ghana are malaria and neonatal diseases, primarily asphyxia, sepsis, and prematurity. Tragically, most of these deaths are preventable. Among other initiatives, Project Fives-Alive! was established to reduce childhood mortality in Ghana. The approach taken by this nationwide project was guided by the IHI Breakthrough Series Improvement Collaborative Network. Through this multi-year project, teams of frontline health providers and their managers met periodically in learning sessions where they acquired quality improvement knowledge and skills. Teams tested system improvement changes and learned from each other. This is one of the first applications of IHI improvement initiatives in Africa. When the project was fully scaled up, hundreds of teams in Ghana participated in this improvement effort.

Among the most important factors associated with under-five mortality is the underutilization of health services. For example, many women do not receive antenatal care, preventive measures (such as neonatal tetanus protection and folate/iron supplements) are inconsistently provided, and many women lack knowledge about oral rehydration therapy and other life-saving procedures.

Why the focus on teams? The answer is that frontline provider are often in the best position to understand the obstacles that women face in accessing services-and to suggest and test potential solutions. As with quality improvement initiatives elsewhere, teams need training, knowledge, and skills, as well as a framework for applying quality improvement methods. Throughout the country, teams were trained in quality improvement methods: setting measurable goals, implementing tests of change, identifying best practices, and-perhaps of greatest significance from a country development perspective-sharing their experiences with other teams and disseminating this knowledge to the larger global health community.

Results are encouraging. Teams enthusiastically shared their knowledge through collaborative meetings, and evidence emerged of improvements in the processes of care and, hopefully, in health outcomes. Even more encouraging is evidence that teams learned how to function as teams and to apply a systems improvement perspective to other health system problems. The development of well-functioning and highly trained teams could be a key part of achieving important global health goals.

Questions

1. One feature of the teams in this case is frequent turnover among team members. How might turnover among team members affect team performance? What approaches can team leaders take to minimize potential negative impacts of turnover and gain advantages, if any?

2. Consumers or patients are sometimes involved in quality improvement teams, but in this role, they may feel that their voices are unimportant, or that their participation is symbolic rather than substantive. Do you think that consumers should be involved in the improvement teams in this case? Why or why not? If consumers are involved, how can team leaders and members most effectively utilize their knowledge and insights?

3. Even when team improvement efforts achieve change, the sustainability of change remains a pervasive challenge. In fact, the sustainability of the teams themselves may be problematic. What are the particular obstacles to sustaining the improvements achieved by teams in this case? Similarly, what factors might lead to the dissolution of the improvement teams over time? As a team leader, what strategies might be used to sustain change and to uphold the vitality of the team over time?