title: Evaluating the impact of continuous quality improvement methods at hospitals in Tanzania: a cluster-randomized trial.
abstract: OBJECTIVE
  To evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania.
  
  
  METHODS
  Cluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted.
  
  
  METHODS
  Sixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania.
  
  
  METHODS
  Outpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012.
  
  
  METHODS
  Implementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months.
  
  
  METHODS
  Cleanliness, waiting time, patient's experience, patient's satisfaction.
  
  
  RESULTS
  The 5S increased cleanliness in the outpatient department, patients' subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours.
  
  
  CONCLUSIONS
  The 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care.
authors.affiliation: Ryukoku University, Faculty of Economics, Kyoto, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kamiya
authors.affiliation: Fujita Planning Co., Ltd., Tokyo, Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Ishijma
authors.affiliation: Japan International Cooperation Agency, Tokyo, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Hagiwara
authors.affiliation: International Techno Center Co., Ltd, Tokyo, Japan.
authors.forename: Shizu
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Ministry of Health and Social Welfare (retired), Dar Es Salaam, Tanzania.
authors.forename: Henook A M
authors.initials: HAM
authors.lastname: Ngonyani
authors.affiliation: Mbeya Consultant Hospital, Ministry of Health and Social Welfare, Mbeya, Tanzania.
authors.forename: Eleuter
authors.initials: E
authors.lastname: Samky
mesh_terms: D005260:Female; D006797:Housekeeping, Hospital / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D010045:Outpatients / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D058996:Quality Improvement / Q000458:organization & administration*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013636:Tanzania; D013997:Time Factors
keywords: 5S; continuous quality improvement; experimental research; hospital care; patient satisfaction