QUIC: using data to drive improvements in quality of care
Quality of Institutional Care (QuIC) is a fast and low-cost telephone-based approach to assessing the quality of health services. It collects, analyses and feeds back data quickly, using easy-to-interpret scorecard formats. Options' experts developed QuIC as part of our Evidence for Action (E4A) programme, which promotes maternal survival through a combined focus on evidence, advocacy and accountability.
Monitoring all aspects of quality of care is challenging, expensive and time-consuming. Most comprehensive approaches do not provide immediate feedback, preventing timely responses to service challenges. QuIC is a locally appropriate solution that collects relevant and timely evidence about health facility readiness. It compliments existing routine data collection, providing health staff, health planners and patients with the evidence they need to demand and deliver improved quality of care.
The QuIC approach is being implemented in five countries – Ghana, Malawi, Tanzania, Sierra Leone and Nigeria – where we monitor the readiness of facilities to provide emergency obstetric care services for women experiencing difficulties in labour. Do facilities have the drugs and equipment required? Are referral systems working? Are qualified staff available to provide timely and appropriate care? In Sierra Leone we adapted QuIC to gather information on the ability of facilities to provide health services safely during the Ebola outbreak.
How does QuIC work?
The QuIC approach can be applied in different contexts, with or without digital or mobile technology. We work in conjunction with local government staff to ensure that questions reflect national priorities, and that the questionnaire meets the following criteria:
- Quick implementation – the interviewer can collect the data in a 20-minute telephone call per facility.
- Quick for the facility staff and stakeholders – minimal preparation or personal knowledge is required, and, in most cases, data are entered directly into a mobile-phone-based application.
- Quick feedback to facility staff and stakeholders – scorecards are generated automatically on completion of data entry and rapidly shared with facilities and decision-makers at all levels.
Using data to drive improvements in service delivery is central to the QuIC approach. Scorecards and dashboards use a visually engaging traffic light system to highlight good quality services and where there are gaps. The rapid and easy-to-interpret information prompts action from government decision-makers and facility staff to address the identified issues. It also gives patients and their communities the tools they need to hold decision-makers to account for providing timely and good quality health care services.
Results to date
Our work has shown the power of effective data:
- Managers in Mara Region in Tanzania found that QuIC provides a transparent approach to gathering the data they need for policy formulation, planning and decision-making. “Now we are able to know at facility and district level how we are performing and we have identified areas for improvement…it really helped in making decisions with robust reasoning. It has come at the right time as we are striving to implement our Mara strategy to reduce maternal and newborn death.”
- In Sierra Leone, QuIC has been successfully used alongside the more resource-intensive Facility Improvement Team assessments to provide rapid, low-cost information to generate action to improve services at a fraction of the cost.
- In Malawi and Nigeria, QuIC has encouraged transparency about the availability of good quality maternal and newborn health services, and engaged government staff, facilities, communities, community-based organisations and development partners in debate around service quality.