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Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces
Thesis (PhD)--Stellenbosch University, 2024.
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613995557453824 |
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| access_status_str | Open Access |
| author | Odendaal, Willem Adriaan |
| author2 | Hunt, Xanthe |
| author_browse | Hunt, Xanthe Odendaal, Willem Adriaan |
| author_facet | Hunt, Xanthe Odendaal, Willem Adriaan |
| author_sort | Odendaal, Willem Adriaan |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description |
Thesis (PhD)--Stellenbosch University, 2024. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/131557 |
| institution | Stellenbosch University (South Africa) |
| language | en_ZA |
| last_indexed | 2026-06-10T12:45:00.328Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/131557 Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces Odendaal, Willem Adriaan Hunt, Xanthe Chetty, Terusha Tomlinson, Mark (Mark R.) Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health. Maternal health services -- Evaluation -- South Africa Maternal and infant welfare -- Evaluation -- South Africa Outcome assessment (Medical care) -- South Africa Infants -- Mortality -- Evaluation -- South Africa Medical personnel -- Attutides -- South Africa UCTD Thesis (PhD)--Stellenbosch University, 2024. ENGLISH SUMMARY: Background: Quality improvement (QI) methodologies can reduce avoidable maternal and neonatal deaths and stillbirths, through small scale solutions that address service delivery problems. The methodologies propose healthcare workers organise in QI teams who then develop and implement these changes. Despite inroads, maternal and neonatal mortalities remain high in South Africa. This study evaluated Mphatlalatsane, a National Department of Health QI programme to improve maternal and neonatal healthcare in the country. The programme was implemented in 21 public health facilities across three provinces, seven per participating province, between 2018 and 2022. Aim: This study aimed to explore the perceptions and experiences of the Mphatlalatsane QI team leaders, team members, and advisors (who provided technical support to the teams), of how leaders, members, implementation processes, and facility contexts, shaped variation in QI uptake and team performance across the teams. Methods: This longitudinal, qualitative process evaluation was conducted in 14 purposively selected ‘Mphatlalatsane facilities’. The research comprised interviewing 17 team leaders and 47 team members over three time points; monthly debriefings with the advisors; reviewing programme documentation; and participant observations of the Mphatlalatsane management meetings. All the data were thematically analysed. Results: Paper 1 details that the eight high uptake teams had more training than low uptake teams; advisors who were technically more skilled; leaders with high intrinsic motivation towards QI; better teamwork; and district support. The COVID-19 pandemic resulted in teams introducing major adaptations to the methodology. Paper 2 explains how the intrinsic motivation of the leaders of the six well-performing teams were associated with their aptitude to use routine data and them experiencing how the methodology improved services. The paper also highlights how these leaders nurtured a learning culture in their teams and embedded the methodology in standard care practices. Paper 3 reports that each of the six well-performing teams had a core team with a second-in-charge leader; the members had a good understanding of the methodology; and there was a positive work culture in the existing service teams from whom the core team was recruited. Paper 4 proposes eight good practices to set up and manage a QI team. Conclusion: The performance of a QI team is influenced by configurations of the contextual and implementation process variables identified in this study. However, success starts off with a focus on the ‘hearts and minds’ of healthcare workers by recruiting those who have QI specific attributes as leaders and members. AFRIKAANSE OPSOMMING: Agtergrond: Kwaliteit verbeterings- (KV) metodologiee kan vermybare moeder- en neonatale sterftes en stil geboortes verminder deur middel van kleinskaalse oplossings wat diensleweringsprobleme aanspreek. Die werkswyses stel voor dat gesondheidswerkers in KV-spanne byeenkom wat dan hierdie veranderinge ontwikkel en in werking stel. Desondanks ingrypings, bly moeder- en neonatale sterftes hoog in Suid Afrika. Hierdie navorsingstudie het Mphatlalatsane, ‘n KV-program van die Nasionale Departement van Gesondheid, vir die verbetering van moeder- en neonatale gesondheidsorg in die land geevalueer. Die program is tussen 2018 en 2022 in 21 openbare gesondheidsfasiliteite oor drie provinsies, sewe per deelnemende provinsie, geimplementeer. Doel: Hierdie navorsing het ten doel gehad om die persepsies en ervarings van die Mphatlalatsane KV-spanleiers, spanlede en raadgewers (wat tegniese ondersteuning aan die spanne verleen het) te ondersoek en hoe die leiers, lede , die implementeringsprosesse en fasiliteitskontekste, variasie in die opneem van KV en spanprestasies beinvloed het. Metodes: Hierdie longitudinale kwalitatiewe proses-evaluering is in 14 spesifiek-geselekteerde ‘Mphatlalatsane gesondheids-fasiliteite’ uitgevoer. Die navorsing het bestaan uit onderhoude met 17 spanleiers en 47 spanlede oor die bestek van drie tydpunte; maandelikse rapporterings van die raadgewers; oorsig van program dokumentasie; en deelnemer-waarnemings van die Mphatlalatsane bestuursvergaderings. Alle data is tematies ontleed. Resultate: Artikel 1 bevind dat die agt hoe-opneem spanne meer opleiding as die lae-opneem spanne gehad het; raadgewers was tegnies meer vaardig; die leiers het meer intrinsieke motivering ten opsigte van KV gehad; en daar was beter spanwerk en ondersteuning in die distrik. Die COVID-19 pandemie het tot gevolg gehad dat spanne groot aanpassings aan metodologie moes maak. Artikel 2 verduidelik hoe die intrinsieke motivering van die leiers van die ses goed-presterende spanne geassosieer is met hulle vaardigheid om roetine-data te gebruik en hulle ervarings van hoe die metodologie dienste verbeter het. Die artikel belig ook hoe die leiers ‘n leer-kultuur onder hulle spanne aangemoedig het en die metode geintegreer het in standaard-sorg praktyke. Artikel 3 rapporteer dat elk van die ses goed-presterende spanne ‘n kernspan met ‘n tweede-in-bevel leier gehad het; die lede het ‘n goeie begrip van die metodologie gehad; en daar was ‘n positiewe werkskultuur onder die bestaande diensspanne waaruit die kernspan gewerf is. Artikel 4 stel agt goeie praktyke voor vir die saamstel l en bestuur van ‘n KV-span. Gevolgtrekking: Die werkverrigting van ‘n KV-span word beinvloed deur die konfigurasie van kontekstuele en implementeringsproses veranderlikes wat in hierdie studie geidentifiseer is. Nietemin, sukses begin met ‘n fokus op die ‘harte en gedagtes’ van gesondheidswerkers sodat die gesondheidswerkers met spesifieke KV eienskappe as leiers en lede gewerf word. Sleutel woorde: COVID-19 pandemie, Gesondheidsorg werkers, Kontekste en implementerings- prosesse, Kwaliteit verbetering, Longitudinale kwalitatiewe proses evaluering, Moeder en neonatale gesondheid, Plan- Doen-Bestudeer-Aksie siklus. Doctoral 2025-01-27T06:59:00Z 2025-01-27T06:59:00Z 2024-12 Thesis https://scholar.sun.ac.za/handle/10019.1/131557 en_ZA Stellenbosch University 305 pages : illustrations, maps, includes annexures application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Maternal health services -- Evaluation -- South Africa Maternal and infant welfare -- Evaluation -- South Africa Outcome assessment (Medical care) -- South Africa Infants -- Mortality -- Evaluation -- South Africa Medical personnel -- Attutides -- South Africa UCTD Odendaal, Willem Adriaan Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces |
| title | Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces |
| title_full | Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces |
| title_fullStr | Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces |
| title_full_unstemmed | Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces |
| title_short | Health workers’ perceptions and experiences of the role that teams, leadership, and health facility context play in the implementation of a quality improvement programme for maternal, neonatal and child health in three South African provinces |
| title_sort | health workers perceptions and experiences of the role that teams leadership and health facility context play in the implementation of a quality improvement programme for maternal neonatal and child health in three south african provinces |
| topic | Maternal health services -- Evaluation -- South Africa Maternal and infant welfare -- Evaluation -- South Africa Outcome assessment (Medical care) -- South Africa Infants -- Mortality -- Evaluation -- South Africa Medical personnel -- Attutides -- South Africa UCTD |
| url | https://scholar.sun.ac.za/handle/10019.1/131557 |
| work_keys_str_mv | AT odendaalwillemadriaan healthworkersperceptionsandexperiencesoftherolethatteamsleadershipandhealthfacilitycontextplayintheimplementationofaqualityimprovementprogrammeformaternalneonatalandchildhealthinthreesouthafricanprovinces |