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Title: Quality Improvement: a Key for Health Systems Strengthening
Keywords: Quality
Monitoring and evaluation
Health systems
Country: Germany
Institution: Germany - Heidelberg Institute of Global Health, University of Heidelberg
Course coordinator: PD Dr. med. Svetla Loukanova
About duration and dates: Starts every 01. May till 31.October and 01. November to 30. April. Application deadline: 30. April and 31. October; duration six months submission of the transfer project for assessment is during the last week of the course.
Classification: advanced optional
Mode of delivery: Distance-based
Course location: online
ECTS credit points: 7.5 ECTS credits
SIT: SIT 225 hours:
Student module input hours: 100.5 h, group work 36 h, independent study: 88.5 h
Time distribution in different modules is:
• Modules 1, 4, 5, 6 & 7 are 21 hours each,
• Module 2 & 3 are 14 hours each
Distribution of time for these seven modules is: individual engagement with learning material 60%, chats and discussion 15%, assignments 25%.
• Module 8 is 60 hours.
Distribution of time for this Transfer project module is: On-line individual engagement 20%, chats and discussions 10%, individual assignment investment 70%.
Language: English
Description: At the end of the course participants should be able to:

• Critically analyse the importance of improving quality in health systems
• Analyse strengths and weaknesses of different types of regulatory and other mechanisms that influence quality improvement in the health system.
• Use system thinking in quality improvement activities at all levels of a health care system
• Propose appropriate methods for monitoring and evaluating quality within a specific context
• Formulate patient safety, patient centred care and family/community engagement in QI initiatives within health systems
• Demonstrate how appropriate human resource mechanisms and change interventions contribute towards improving quality
• Interpret how financial mechanisms impact the quality of health systems and services and decision-making of patients and providers
• Develop a QI initiative in current health setting (transfer project)
Assessment Procedures: Assessment of participants’ achievement of the learning objectives will be determined as follows:
• 54 % individual transfer project based on project template and project assessment criteria
• 25% multiple-choice final exam based on all learning objectives
• 21% seven modular assessments

The individual transfer project – due during the last week of the course – is practice based, participants are provided with a project template and are guided through the process of proposal development, prioritization, project selection, project design and implementation, monitoring and evaluation of project outputs and self-identified recommendations for improvements in their efforts. The tutor is available to answer questions at any time through the course platform or in video call.
The deadline for submission is during the last week of the course; the feedback will be available within 2 weeks after the submission.

The multiple-choice questions for the final exam (open-book) cover the overall learning objectives.

Course participants are monitored in their use of the modules through self-assessment questions, assignments, chats and end of module discussions. Discussion forums and chats are mandatory and participation monitored, learners can only progress to the next lesson when they have correctly answered the self-assessment questions. 21 % of the overall course assessment is based on individual assignments (open questions to be answered through the platform) within the individual modules. Assignments are due at the latest two weeks after the participant has finished the respective module. Participants cannot progress to additional modules if assignments are not received according to this schedule.

The students have to submit a signed form with confirmation for each type of assessment, which confirms and guarantees that the product is the student’s personal work.

Participants will be informed of all assessment processes during orientation to the course. Marking guidelines for evaluation of participant transfer projects will be made available to participants. These guidelines are in line with the expected course outcomes.

If students fail the assessment, an opportunity will be offered to them to re-take the test and/or to redo their transfer project. Participant progress in working through the modules will be monitored, participants will not be able to progress to module 4 if they have not completed the first three modules and to module 7 if they have not completed modules 4-6, including assignments.
Content: The course includes the following topics:

Module 1. Why quality matters within a health system/country context, key historical figures and trends in the quality improvement movement, definitions of and defining quality, Deming cycle and Donabedian model, Quality improvement (QI) concepts such as QI, Quality management (QM), Quality assurance (QA) and Quality control (QC), understanding perspectives and roles in quality improvement, key characteristics of QI methods and frameworks, linkages between management, leadership and quality improvement.

Module 2. Key health system factors influencing quality of health care services, international frameworks to strengthen quality improvement strategies, levels and mechanisms regulation and standardization, the role of frameworks and methods such as International Organisation for Standardization (ISO), European Foundation for Quality Management (EFQM), Accreditation and certifications, mechanisms and tools to implement quality management frameworks and methods, country examples.

Module 3. Basic principles of health systems thinking, analysing a quality improvement approach with a system thinking lens, QI Methods and tools commonly used in QI based on the system thinking approach, designing and planning a quality improvement or patient safety initiative using systems thinking principles.

Module 4. Basic concepts of Monitoring & Evaluation (M&E) in QI including their key features, M&E methods and instruments, linkages between M&E and key quality mechanisms such as the Donabedian model, the Plan-Do-Check-Act (PDCA) Cycle, standards and indicators, setting up a M&E system for critical incidents in a health facility.

Module 5. Patient safety and its importance as a core element of quality health care, historical development of patient safety, types of medical errors, theory and practice of patient-centeredness, strategies, mechanisms and tools to improve patient safety and ensure quality health care and better outcomes, roles of legislation and regulations in patient safety.

Module 6. Health human resource (HHR) management and its importance in ensuring quality health care, function and tasks of strategic human resources management for quality improvement, meaning and significance of performance management in quality health care, change management as an instrument to improve HHR functions and practices, HR mechanisms to strategically influence successful change management processes and develop competent health human resources.

Module 7. Quality and related financial concepts such as efficiency and cost-effectiveness, financing strategies and mechanisms including collection of funds, pooling of funds, purchasing, insurance, purchaser provider split, private / governmental / mixed health service provision, linking funding to QI mechanisms such as Licensing/ Certification/ Accreditation, country examples linking health financing strategies and mechanisms with QI mechanisms and outcomes.

Module 8: Transfer project. Developing a QI initiative in the participants current health setting with the following specific objectives: (i) undertaking a QI Initiative in the participants own healthcare setting provides the bridge between the learning and the doing; (ii) the participants will have identified a priority quality issue, started work with a team on the issue and are moving towards assessing the results and next steps. (iii) The participants use the course material to provide their direction and content for the project.
Methods: The course is divided into 8 modules, each module follows a set of standardized elements based on the overall didactic setup and course structure: Content of the modules are framed through the elements of an introduction, overview of content and objectives, 3-4 lessons based on learning objectives, summary of the module, self-assessment questions and modular assignments.

The main learning methods applied are:

• Self-directed learning where students make use of the materials into the lectures to meet the learning objectives of the course. Each module consists of several online lessons (in accordance with the module’s curriculum). Every two or three weeks, a new module will be available for the learners. The schedule and specific elements for each module have been designed in accordance with the module’s curriculum and learning objectives and vary slightly from module to module. The modules will be delivered one after the other, following a given course schedule. As soon as one module is accessible, it will be open until the end of the course. However, the course’s focus will shift to the subsequent module after 3 weeks (after 2 weeks for Module 2 and Module 3)
Learning materials include:
• Reading materials both obligatory and recommended
• Short videos
• A leading case study introduced in module 1 and then used in each module to illustrate the modular contents,
• Glossaries, both an overall glossary and modular specific glossaries.
• All required readings, videos, the case-study and glossary are available as either internet or pdfs links
• There is one chat per lesson, which will be scheduled in the final week of the lesson. The chat will assist participants to engage with the contents of the module reflection questions and guided topics and examples.
• One or more module-related forum discussions will take place on the discussion board. The forum will include questions for reflection and discussion in order to guide the directed learning. Students can initiate discussion topics as well. Tutors will monitor the discussions and give feedback on key points. Both discussion forum and chat room will enable students to exchange research experiences, ask questions and give peer feedback.
• Each module will have one or two assignments, group work and/or an individual assignment. Assignments are due at the latest two weeks after the respective course-module (1-7) ends.
• Module 8, which is the transfer project, is introduced starting in module 3 and is aligned with each module concluding with an individual project covering the course learning material.
Prerequisites: The course is open to public health professionals, quality managers, medical and paramedical staff, tropEd students, global health consultants, Ministries, development partners.; English Toefl: Computer based >237; Paper based >580; Internet based >90; IELTS > 6.5. (Or as requested at respective English taught home institute = tropEd enrollment sufficient); Regular access to a computer with access to internet, email identification.
Attendance: The max number of participants (including tropEd students) is limited to 30
Selection: first come, first served
2.000- EUR
None available
Major changes since initial accreditation: Closer monitoring and support during the transfer project period.
Student evaluation: Very positive feedback on the transfer project at the end. This enables the participants to apply their knowledge in practice.
Lessons learned: Few more introductory sessions needed at the beginning and support during the work on the transfer project has been adapted.
tropEd accreditation:
Accredited in November 2017 and in February 2023. This accreditation is valid until February 2028.
Email Address:
Date Of Record Creation: 2017-11-26 09:01:16 (W3C-DTF)
Date Of Record Release: 2017-11-26 14:17:07 (W3C-DTF)
Date Record Checked: 2017-11-26 (W3C-DTF)
Date Last Modified: 2023-03-20 15:05:09 (W3C-DTF)

Fifteen years of the tropEd Masters in International Health programme: what has it delivered? Results of an alumni survey of masters students in international health

L. Gerstel1, P. A. C. Zwanikken1, A. Hoffman2, C. Diederichs3, M. Borchert3 and B. Peterhans2

1 Royal Tropical Institute, Amsterdam, The Netherlands
2 Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
3 Institute of Tropical Medicine and International Health, Charite – Universit€atsmedizin Berlin, Berlin, Germany