title: Quality of health care and the need for assessment.
abstract: OBJECTIVE
  In many hospitals of developing countries quality of care is below the expected standard to maintain patient safety. In 2006, health care experts from Tanzania and Germany collaborated on a set of indicators to be used as a hospital performance assessment tool. The aim of this study was to introduce this tool and check its feasibility for use in a Tanzanian regional hospital.
  
  
  METHODS
  Within the hospital, independent observers assessed quantitatively structural quality and the performance of health care encounter using an itemized scale from 0 (0%) to 2 (100%) for each defined item. Outcome parameters were taken from the annual hospital report. In addition, semi-qualitative interviews with staff and patients were held to a) assess staff knowledge of the treatment guidelines published by the Tanzanian Ministry of Health and Social Welfare (MoHSW), b) assess attitudes and user motivation and c) authenticate the quantitative findings in a mixed-method triangulation approach.
  
  
  RESULTS
  Structural quality in maternity was at 75% of the expected standard, while process quality ranged from 36% (Care of the newborn with APGAR score < 4) to 47% (normal delivery procedure). Staff knowledge ranged between 64% and 87% with low motivation and commitment given as contributing factors. Outcome (maternal mortality) was 481/100,000 live births with an infant mortality rate of 10%.
  
  
  CONCLUSIONS
  The tool appeared to be feasible and effective in judging care quality. It provides a model for continuous quality improvement. Motivation of health care workers, a strong determinant of care process quality, might be improved by strengthening internal factors in health facilities. For conclusive validation, further studies using the tool must be conducted with larger numbers of institutions.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte, Charité, Universitätsmedizin Berlin. goetz.bosse@charite.de
authors.forename: G
authors.initials: G
authors.lastname: Bosse
authors.forename: B
authors.initials: B
authors.lastname: Ngoli
authors.forename: M T
authors.initials: MT
authors.lastname: Leshabari
authors.forename: R
authors.initials: R
authors.lastname: Külker
authors.forename: T
authors.initials: T
authors.lastname: Dämmrich
authors.forename: W
authors.initials: W
authors.lastname: Abels
authors.forename: J P
authors.initials: JP
authors.lastname: Breuer
authors.forename: R
authors.initials: R
authors.lastname: Kersten
authors.forename: C
authors.initials: C
authors.lastname: Spies
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006282:Health Personnel; D006771:Hospitals, Maternity; D006779:Hospitals, Public; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008428:Maternal Mortality; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011247:Pregnancy; D011256:Pregnancy Outcome; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results; D012449:Safety; D011795:Surveys and Questionnaires / Q000592:standards*; D013636:Tanzania