Adam Mary B, Makobu Naomi Wambui, Mate Kedar, Newman Tod, Donelson Angela Joy
Head of Research AIC Kijabe Hospital, Kijabe, Kenya
Africa Consortium for Quality Improvement Research in Frontline Healthcare (ACQUIRE), Nairobi, Kenya.
BMJ Open Qual. 2025 May 28;14(2):e003330. doi: 10.1136/bmjoq-2025-003330.
Trust is fundamental to the effective functioning of healthcare systems, influencing access, utilisation and adherence to evidence-based practices. While quality improvement (QI) processes are widely recognised for addressing technical challenges, their role in fostering trust and relationships within health systems remains underexplored. This study examines the relationship dynamics in QI teams and how trust-building frameworks align with adaptive processes in healthcare settings. We conducted a qualitative study involving 30 healthcare workers from six African countries, recruited through the Africa Consortium for Quality Improvement in Frontline Healthcare. Data were collected through semistructured interviews, transcribed and analysed using both inductive and deductive methods. Deductive analysis was guided by a published trust-building framework, while insights from a large language model were incorporated in addition to a traditional analysis to provide an unbiased perspective. Results identified three theoretically described dimensions of trust-building within QI teams: common goals, self-interest and gratitude/indebtedness. Common goals fostered teamwork, multidisciplinary collaboration and effective communication, while self-interest motivated personal and professional growth. Gratitude and recognition reinforced team cohesion and sustained motivation. Participants highlighted the importance of trust in achieving project success, noting that robust relationships within teams correlated with improved outcomes. The study underscores the dual nature of QI processes, which simultaneously address technical improvements and adaptive challenges, including trust and relationship-building. Trust-building, framed as an iterative process of aligning common goals, recognising contributions and addressing individual interests, complements technical QI methodologies like Plan-Do-Study-Act cycles. These findings support expanding QI frameworks to emphasise relational dynamics, contributing to more sustainable and impactful healthcare improvements. Further research should continue to explore the adaptive dimensions of QI, integrating recent research on culturally relevant frameworks prioritising kindness in healthcare systems, to enhance trust and collaboration within healthcare systems.
信任是医疗保健系统有效运作的基础，影响着医疗服务的可及性、利用率以及对循证实践的依从性。虽然质量改进（QI）流程在应对技术挑战方面得到了广泛认可，但其在促进卫生系统内的信任和关系方面的作用仍未得到充分探索。本研究考察了QI团队中的关系动态，以及信任建立框架如何与医疗环境中的适应性流程相契合。我们进行了一项定性研究，涉及来自六个非洲国家的30名医护人员，通过非洲一线医疗保健质量改进联盟招募而来。数据通过半结构化访谈收集，转录后使用归纳法和演绎法进行分析。演绎分析以已发表的信任建立框架为指导，除了传统分析外，还纳入了大语言模型的见解，以提供无偏见的观点。结果确定了QI团队中理论上描述的信任建立的三个维度：共同目标、自身利益和感恩/亏欠感。共同目标促进了团队合作、多学科协作和有效沟通，而自身利益激发了个人和职业成长。感恩和认可增强了团队凝聚力并维持了动力。参与者强调了信任对项目成功的重要性，指出团队内部稳固的关系与更好的结果相关。该研究强调了QI流程的双重性质，即同时解决技术改进和适应性挑战，包括信任和关系建立。信任建立被构建为一个使共同目标保持一致、认可贡献并解决个人利益的迭代过程，它补充了诸如计划-执行-研究-行动循环等技术QI方法。这些发现支持扩展QI框架以强调关系动态，为更可持续和更有影响力的医疗保健改进做出贡献。进一步的研究应继续探索QI的适应性维度，整合近期关于优先考虑医疗保健系统中友善的文化相关框架的研究，以增强医疗保健系统内的信任和协作。
