High Quality Health Systems: Assessing Performance and Improving at Scale

The course will review the conceptual frameworks of health systems and quality of care and discuss how these can be used to organize measurement and performance assessment.  It will review measures of health system quality, suggest where to focus measurement and provide examples of innovative tools for measuring quality, including in settings without extensive data.  The course will critically review past and current approaches to quality improvement and suggest structural levers for improving health systems at scale, including for settings with substantial decentralization and large private sectors.   

Participants will apply the concepts from the course to prepare their final presentations using the cases and challenges from their own organizations and countries.  

The course is informed by concepts and recommendations from the Lancet Global Health Commission on High Quality Health Systems and the QuEST Network. 

• Identify the key concepts underpinning health system quality, such as care and system competence, user experience, and user confidence.
• Describe and compare legacy and novel approaches to measure quality
• Critically assess effectiveness of past and current strategies for quality improvement using the lens of complex adaptive systems
• Identify strategies to evaluate large-scale health system improvement and discuss how these can be applied in the local context
• Discuss best practices and innovations in the measurement of health system quality
• Identify data sources for quality measures.

The curriculum of the course includes the following: 

• Overview of high quality health systems 
• Measurement of quality impacts, processes, and equity 
• Understanding the customer
• Strategic management and planning for quality
• Structural quality improvement opportunities: governance, new training models involving the user, service delivery redesign, financing & payment, and management
• Politics of health system improvement.

This interactive in-person course offers a blend of theory and practice geared to an audience focused on implementation. The course consists of lectures, group work sessions, case studies, problem sets, and the preparation of group and individual case presentations. Facilitated discussion among participants is expected throughout the course. Participants are encouraged to have on hand their own country’s materials and resources on health systems related to quality performance and management.

This week long course is designed for individuals working in either the public or private sectors who are committed to improving the quality of health services in resource-constrained environments, including both policymakers and senior health care managers.

This course will be useful for country or regional leaders engaged in health sector reforms, especially those contracting for health services with private or quasi-governmental institutions.   Managers with strategic authority at health care institutions are appropriate. Researchers and global multilateral partners working in the area of health system quality will benefit.  Additionally, we encourage participation by teams of participants who can work together in the course to develop draft strategic plans for their own organizations or countries.

Dr. Margaret E. Kruk is Professor of Health Systems at the Harvard T.H. Chan School of Public Health.  Dr. Kruk’s research generates evidence on how health systems can improve health for people living in low-income countries.  Working with colleagues in Ethiopia, Kenya, South Africa, India, and countries in Latin America among others, she develops novel measures of health system quality and studies the links between quality and population demand for health care, health outcomes, and confidence in the system.  Dr. Kruk and her team use implementation science and econometric methods to evaluate large-scale health system reforms.

Dr. Kruk is Director of the QuEST Centers and Network: a multi-country collaboration to produce a global evidence base for improving health systems. The QuEST Network responds to the findings of  the Lancet Global Health Commission on High Quality Health Systems in the SDG Era (HQSS Commission).  QuEST will develop new instruments to assess health system quality, test structural and policy solutions to systemic quality deficits, and support expansion of high-impact health systems research in partner countries.

Dr. Diana Bowser serves as course director for all training programs within the International Health Systems Program of the Harvard T. H. Chan School of Public Health. She is also is the Associate Dean for Research and Integrated Science at the Connell School of Nursing. Bowser has 20 years of experience in health system analysis related to health economics, health policy, and using econometric methods and costing techniques to evaluate health system changes in Latin America, Africa, and the United States. She is especially interested in health system issues and research related to health financing, cost impacts on efficiency and effectiveness, catastrophic health payments, evaluation, income inequality, quality improvement, workforce, decentralization, and resource allocation in the health sector, and health and economic growth. She has worked at both the global and federal level on several research projects focusing on specific populations such as women and children and migrants and topics related to behavioral health and substance use. She has provided technical assistance and conducted research with grants and funding from USAID, DFID, WHO, the Global Fund, Save the Children, Bill and Melinda Gates Foundation, IADB and the World Bank. She has worked closely with the following governments on these policy issues: Nigeria, Rwanda, Ethiopia, Ghana, Namibia, Swaziland, El Salvador, Nicaragua, Honduras, Colombia, Chile, Belize, Saint Lucia, Dominica, Ukraine, Kosovo, Bangladesh, Malaysia, Haiti, Egypt, Oman and Kuwait. Dr. Bowser earned her BA from Harvard College, her MPH from Yale School of Public Health and her Doctor of Science (Sc.D.) in health economics from the Harvard School of Public Health. She is fluent in Spanish and has lived and worked in Latin America.