There are many ways to improve quality, such as enforcing or revising standards, strengthening supervision, and asking managers or technical experts to redesign a process. The concept of QI, which is grounded in the quality movement in industry (see Chapter 2.2, Understanding CQI and TQM), usually involves a team-based problem-solving approach, however.

In QI groups of staff members at the national, district, or facility level work together to identify and resolve problems that compromise the quality of care. They base their decision-making on data rather than assumptions, use diagnostic and analytic tools, and follow a systematic process. An individual supervisor or manager can take this same approach, but QI seeks to harness the talents and energies of health-care personnel at every level to improve the quality of services—in many cases, with little or no outside help and few new resources (299).

A growing number of health care organizations have adapted the principles of team-based problem-solving (62, 184). While QI initiatives in developing countries are too recent to demonstrate long-term health impact, there is evidence that the team-based approach has helped individual facilities and entire programs use resources more efficiently and improve administration and service delivery.

At the same time, however, experience with QI teams has found that they are difficult to implement, they work slowly, and they may sidestep the most difficult problems. Other management techniques may improve the quality of services more efficiently and at less cost. In Indonesia, for example, staff from the Quality Assurance Project (QAP) gained the impression that about half of the observed quality deficiencies could be corrected by reinforcing standards, while another quarter required small-scale Operations Research to develop solutions that could be widely applied. Only about one-quarter needed team-based problem-solving (345). Quality initiatives in developing countries have relied more heavily on conventional management approaches than on QI teams.