IntroductionDepuis une quinzaine d'années en Afrique, cercles de qualité, audits cliniques, c... more IntroductionDepuis une quinzaine d'années en Afrique, cercles de qualité, audits cliniques, cycles de résolution de problèmes et autres 'projets qualité' ont été mis en oeuvre dans les services publics de santé pour améliorer la qualité des soins. Ces projets ont souvent mis l'accent sur des approches participatives, la résolution locale de problèmes et le changement, bousculant les pratiques managériales traditionnelles. A court terme, les évaluations montrent l'amélioration des résultats de programmes ou d'activités. Mais la pérennité de la dynamique reste largement à prouver. Le véritable aboutissement d'un programme d'assurance qualité devrait être apprécié à l'aune de sa capacité à mettre la préoccupation pour la qualité au cœur du management et du fonctionnement du système, et ce de façon continue. C'est en effet la vision moderne de l'assurance qualité déclinée dans les approches du management de la qualité totale, de l'améliora...
Improving quality in health care means implementing change. Public health services in most Africa... more Improving quality in health care means implementing change. Public health services in most African countries are hierarchical and rule-ba sed organisations close to the machine type of bureaucracy according to Mintzberg's typology. How can a conformity- based culture of stability accommodate the innovati ve culture of change promoted by quality management? We present a case study from a health district of Z imbabwe, which runs an action- research programme for quality improvement. Since 1992, the district management team implements problem solving cycles. In 2002, we conducted in-depth interviews with district health professionals. The objective was to investigate the process of management of change and its underlying dynamics. Our analysis identifies the coping strategies devel oped by the management team to overcome organisational rigidity and to unfreeze th e rules. It also reveals how stakeholders call upon different sub-culture paradi gms to promote or oppose change. The t...
Quality and quality management in health services are high on the agenda in Africa. On the basis ... more Quality and quality management in health services are high on the agenda in Africa. On the basis of three case studies conducted in Niger, Zimbabwe and Guinea, we review past experience with quality management in African health systems. We have identified four main issues. First, the vertical implementation of these quality management approaches, taking the shape of projects or programmes,
The International Journal of Health Planning and Management, 2004
The quality movement is gaining momentum worldwide in the field of health care. Initiated in indu... more The quality movement is gaining momentum worldwide in the field of health care. Initiated in industrialized countries, it steadily grows in Africa. However, there is no evidence that approaches designed to address issues in a given organizational context have the same effect in another one where issues present differently. Along the epistemological paradigm of realistic evaluation proposed by Pawson and Tilley, we use Mintzberg's organizational models to compare the configurations of European and African health care organizations and the trends followed by the quality management movement in both contexts. We illustrate how European health systems traditionally emphasize professional autonomy while African health systems are structured as command and control hierarchical systems. We illustrate how the quality movement in Europe emphasizes standardization of procedures, a characteristic of a mechanistic organization, while excessive standardization is part of the quality problem in Africa. We suggest that instilling professionalism may be a way forward for the quality movement in Africa to improve patient focus and responsiveness of responsible professionals. We also suggest that our interpretation of broad trends and contrasts may be used as a useful departure point to study the wide contextual diversity of the African experience with quality management.
IntroductionDepuis une quinzaine d'années en Afrique, cercles de qualité, audits cliniques, c... more IntroductionDepuis une quinzaine d'années en Afrique, cercles de qualité, audits cliniques, cycles de résolution de problèmes et autres 'projets qualité' ont été mis en oeuvre dans les services publics de santé pour améliorer la qualité des soins. Ces projets ont souvent mis l'accent sur des approches participatives, la résolution locale de problèmes et le changement, bousculant les pratiques managériales traditionnelles. A court terme, les évaluations montrent l'amélioration des résultats de programmes ou d'activités. Mais la pérennité de la dynamique reste largement à prouver. Le véritable aboutissement d'un programme d'assurance qualité devrait être apprécié à l'aune de sa capacité à mettre la préoccupation pour la qualité au cœur du management et du fonctionnement du système, et ce de façon continue. C'est en effet la vision moderne de l'assurance qualité déclinée dans les approches du management de la qualité totale, de l'améliora...
Improving quality in health care means implementing change. Public health services in most Africa... more Improving quality in health care means implementing change. Public health services in most African countries are hierarchical and rule-ba sed organisations close to the machine type of bureaucracy according to Mintzberg's typology. How can a conformity- based culture of stability accommodate the innovati ve culture of change promoted by quality management? We present a case study from a health district of Z imbabwe, which runs an action- research programme for quality improvement. Since 1992, the district management team implements problem solving cycles. In 2002, we conducted in-depth interviews with district health professionals. The objective was to investigate the process of management of change and its underlying dynamics. Our analysis identifies the coping strategies devel oped by the management team to overcome organisational rigidity and to unfreeze th e rules. It also reveals how stakeholders call upon different sub-culture paradi gms to promote or oppose change. The t...
Quality and quality management in health services are high on the agenda in Africa. On the basis ... more Quality and quality management in health services are high on the agenda in Africa. On the basis of three case studies conducted in Niger, Zimbabwe and Guinea, we review past experience with quality management in African health systems. We have identified four main issues. First, the vertical implementation of these quality management approaches, taking the shape of projects or programmes,
The International Journal of Health Planning and Management, 2004
The quality movement is gaining momentum worldwide in the field of health care. Initiated in indu... more The quality movement is gaining momentum worldwide in the field of health care. Initiated in industrialized countries, it steadily grows in Africa. However, there is no evidence that approaches designed to address issues in a given organizational context have the same effect in another one where issues present differently. Along the epistemological paradigm of realistic evaluation proposed by Pawson and Tilley, we use Mintzberg's organizational models to compare the configurations of European and African health care organizations and the trends followed by the quality management movement in both contexts. We illustrate how European health systems traditionally emphasize professional autonomy while African health systems are structured as command and control hierarchical systems. We illustrate how the quality movement in Europe emphasizes standardization of procedures, a characteristic of a mechanistic organization, while excessive standardization is part of the quality problem in Africa. We suggest that instilling professionalism may be a way forward for the quality movement in Africa to improve patient focus and responsiveness of responsible professionals. We also suggest that our interpretation of broad trends and contrasts may be used as a useful departure point to study the wide contextual diversity of the African experience with quality management.
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Papers by Pierre Blaise