The guide is informed by UMB’s and Ciheb’s collective CQI implementation experience over a nearly 15 year period across six low-resource countries and has been adapted to the Botswana context. Stakeholder engagement has been emphasized throughout the application of our CQI approach to ensure buy-in to the assessment, implementation process, monitoring of CQI initiatives, and sustainability for maintenance.

Below, we share evidence-based resources developed to support the implementation of quality improvement projects. Included in the materials are valuable external resources that our teams have utilized for successful implementation of CQI.  We also recommend the Aurum Institute's How to Guide for Quality Improvement, which is an easy-to-read guide and provides examples and methods for administering quality improvement.

Step 1: Conducting a rapid assessment of the facility through review of data and process mapping

Activity 1: Engage leadership within an organization for support and buy-in.
Tools: CQI Plan Template

Activity 2: Conduct joint rapid assessment of services and review the findings.
Tools: Organizational Assessment Tool

Activity 3: Develop QI skills for the team.
Tools: Knowledge and Skills Assessment Tool

Step 2: Capacity building tools

Activity 4: Conduct capacity building of CQI teams to implement CQI.

Step 3: Identifying opportunities for improvement

Activity 5: Identify a CQI team to drive planning and processes.
Tools: Quality Improvement Plan, Botswana PDSA Worksheet

Activity 6: Conduct a root cause analysis to identify the problem.
Tools: Fishbone Diagram, Example of Fishbone Diagram, Example of Five Whys

Activity 7: Develop a quality improvement model.

Step 4: Planning and prioritizing

Activity 8: Use priority methodology, e.g., CQI prioritization matrix.
Tools: Prioritization Matrix

Activity 9: Prioritize interventions depending on gap and other contextual factors to determine the change package.
Tools: Driver Diagram Example, Driver Template

Step 5: Data interrogation for data gaps and corrective measures

Activity 10: Scrutinize data to identify gaps in implementation.

Activity 11: Stepwise approaches for bridging implementation gaps.
Tools: Missed Appointment Tool