Barriers associated with the use of the Kenya quality model in St. Francis Community Hospital Kasarani and Igegania sub-district hospital in Nairobi and Kiambu counties in Kenya

Abstract

Background: The Kenya Quality Model (KQM) was designed by the Department of Standards Research and Regulatory Services under Ministry of Health (MoH) in Kenya to provide a conceptual framework for quality improvement in health care. This model has been used by the National Hospital Insurance Fund (NHIF) to improve quality in NHIF accredited hospitals. NHIF and MoH have trained health workers on the use of the KQM. Despite encouraging results after using the Kenya Quality Model, this document has been poorly adopted by many health facilities. Barriers associated with the use of the KQM have not been documented locally. Objective: To determine the barriers associated with the use of the Kenya Quality Model in St. Francis Community Hospital Kasarani and Igegania Sub-district hospital. Methodology: A cross sectional study was done at St. Francis Community Hospital and Igegania Sub District Hospital which have hospital staff trained on using the Kenya Quality Model. A total of 155 interviews were conducted using questionnaires with health workers in all departments. A Focus Group Discussion was conducted with quality improvement team members within the hospital, quality staff from the Department of Standards Research and Regulatory Services, NHIF quality experts and other key players in the health sector. Results: Among the respondents 69% were female and 31% male. Majority (80%) of the respondents had background medical training. The mean number of years worked in the health sector was 4.75 ±3.814. Lack of awareness emerged as a barrier to the use of KQM with 14.8% of respondents aware of the existence of the KQM. Only 10.3% members of staff had been trained. The use of KQM was low with 89.7% of the respondents reporting none-use. About 37.9% of respondents mentioned that not all members of the quality improvement team understood the KQM. Other barriers include that the KQM is too detailed 20.7% and a lack of clear understanding of the KQM 17.2%. Methods identified by the respondents of increasing awareness on the existence of the KQM include training 58.3%, facility improvement support 12.5% and recognition as a centre of excellence 8.3%. Conclusion: The level of awareness of the Kenya Quality Model is low. In order to improve the utilization of the Kenya Quality Model awareness level should be increased and the barriers associated with the use of the Kenya Quality Model addressed. Recommendation: The Ministry of Health should aim at scaling-up promotion of KQM as a tool for quality improvement and assessment among health facilities in Kenya. More health workers need to be trained on the use of the Kenya Quality Model.