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- Title
Culture's Place in Quality of Care in a Resource-Constrained Health System: Comparison Between Three Malawi Districts.
- Authors
Patterson, Patrick B.; Mumtaz, Zubia; Chirwa, Ellen; Mambulasa, Janet; Kachale, Fannie; Nyagero, Josephat
- Abstract
Public health scholars describe "culture of quality" in terms of desired values, attitudes, and practices, but this literature rarely includes explicitly stated theories of culture formation. In this article, we apply Fredrik Barth's transactional model to demonstrate how taking a theory-centered approach can help to identify what would be necessary to foster "cultures of quality" outlined in the public health literature. We draw on data from a study of the Republic of Malawi's Performance and Quality Improvement for Reproductive Health initiative. These data were generated in 2017–2018 through a 6-month organizational ethnography in three facilities selected to represent a range of districts with differing social and economic contexts. Our analysis revealed facility-level organizational cultures in which staff valued providing care, but responded to structural constraints by normalizing divergence from quality-of-care protocols. These findings indicate that sustaining a quality-oriented organizational culture requires addressing underlying conditions that generate routine experiences and practices.
- Subjects
MALAWI; MEDICAL quality control; RESEARCH methodology; MATHEMATICAL models; MEDICAL care; INTERVIEWING; PUBLIC health; ETHNOLOGY research; SOCIOECONOMIC factors; MEDICAL protocols; RESEARCH funding; QUALITY assurance; THEORY; CORPORATE culture; MEDICAL coding; REPRODUCTIVE health; HEALTH promotion
- Publication
Qualitative Health Research, 2021, Vol 31, Issue 13, p2528
- ISSN
1049-7323
- Publication type
Article
- DOI
10.1177/10497323211037636