Building a culture of quality in maternal and newborn health: experience from the quality, equity and dignity network in Ethiopia.

Background: Building a culture of quality is vital for sustaining high-quality healthcare, emphasising shared values and continuous improvement. The Quality Equity and Dignity (QED) network was a global initiative working toward this objective, focusing on maternal and newborn health. This paper aims to describe how QED influenced five identified attributes of quality culture in Ethiopia: leadership, people-centered interventions, collaboration, rewards, and ownership towards building and sustaining a culture of quality in healthcare establishments.

Methods: This qualitative study, conducted at two points six months apart, incorporated data from key informant interviews, observations, and document reviews. It included 18 national and 22 sub-national key informant interviews, seven facility observations, and one technical working group meeting observation. Data analysis was performed using NVivo 12 software, focusing on identified thematic areas related to quality culture.

Result: Leadership was crucial for building a quality culture in Ethiopia, and the QED network strengthened government leadership structures, although leadership capacity and staff turnover were challenges. QED enhanced people-centered care and data tracking, but the added data focus burdened healthcare workers. Opportunities for collaboration and shared learning were facilitated, although not accessible to all actors. Motivation and rewards encouraged good performance, but addressing intrinsic behavioral change remained a challenge.

Conclusion: Achieving high-quality healthcare involves more than tools and infrastructure; it requires a cultural shift with behavior change consistently demonstrated at various levels. The QED network faced challenges in building a culture of quality but serves as an exemplary initiative for other networks to learn from.