The whole is greater than the sum of the parts: insights into resilient, well performing, quality improvement teams for maternal and neonatal health care in South Africa before, during, and after the COVID-19 pandemic

Aim This evaluation identifies the factors that shaped the performance of quality improvement teams for maternal and neonatal health, before, during, and after the COVID-19 pandemic. Method A longitudinal, qualitative evaluation of a National Department of Health quality improvement (QI) programme called Mphatlalatsane was undertaken. The programme adopts a plan-do-study-act cycle to identify and implement change ideas that support QI, through QI teams comprising existing facility staff. Mphatlalatsane was implemented in 21 facilities across three provinces, between 2018–2022. Fifteen teams were purposively selected for this evaluation, ranging from primary health care clinics to regional hospitals. The evaluation comprised of interviews with QI team leaders and members undertaken at three time points, monthly debriefings with the technical advisors, review of programme documentation, and observing Mphatlalatsane management meetings. Data were thematically analysed. Findings The COVID-19 pandemic resulted in teams introducing major, yet effective, adaptations to the QI methodology. Six teams were assessed as performing well in conducting activities to improve service delivery. Those teams had advisors who were technically skilled, leaders and members with an aptitude for QI methods, and support from facility management. Team performance was shaped by the interplay between advisor, leader, members, and prevailing work culture in the existing facility service teams. Conclusion Healthcare workers in well performing teams successfully implemented and sustained QI, despite the COVID-19 pandemic challenges. Supporting a QI team to enthusiastically and sustainably use the methodology, requires acknowledging that the advisor, leader, and members create a microsystem that becomes more than the sum of its parts. QI success lies in the interplay among elements in this microsystem, and not in the absence or presence of individual elements.