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Gamification & coaching : team commitment in and with Quality Management: Case study of “Concours Qualité” in Burundi

par Fromont, Anne
Référence Symposium on Economy and Social Development (FATA- GIZ) (10-14/09/2018: Bad Neuenahr)
Publication Non publié, 2018-09-11

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Gamification & coaching : team commitment in and with Quality Management - case study of “Concours Qualité” in Burundi Hypothesis In a context with strong constraints and poor autonomy (exogenous standards and requirement, predefined indicators, control, low income, low skill and competence level…), the introduction of game elements (gamification) in a light approach (“simple” model of QM, soft indicators and requirement…), allows field actors to engage, progress and be rewarded in a quality improvement process. Aims- Encourage the commitment and empowerment of teams (based on fun, confidence, autonomy, recognition and team building) in and with QI.- Introduce QM in HC by using “simple” model (Deming wheel), to start thinking QM.- Support capacity building of teams - Use synergies with existing: PBF, felt needs... The intervention highlights the perception that QI is not something extra but, on the contrary, a way, an answer to existing needs.Intervention- “Concours Qualité”: ranking based on process (respect on Deming wheel), team commitment and on progression realized during the period (especially, changes on work process). Awards were for HC (non-financial) and recognition of efforts was highlighted. Each HC was rewarded. o Phase 1 (2013-15): 68 HC (5 health districts) in 2x2 groups during 2x9 months, 2 coaches (doctors employed by the project) supported HCo Phase 2 (2016-18): 72 HC (5 health districts), 12 months, 2 coaches (doctors, employed by the project) supported 15 supervisors who supported HC team (integration of the intervention).- Dimensions of QI were limited: 2 axes (reception and hygiene) in phase 1, 5 axes (reception, hygiene and 3 axes on reproduction health) in phase 2.- Criteria were inspired by PBF indicators. - Based on an initial auto-evaluation and identification of challenges, teams were free to choose and plan the changes to meet the criteria. - Role of coaches was to help teams to: work together (team spirit), understand criteria and QI process, go through each step (auto-evaluation, challenge identification, plan and implementation of QI).Learned lessons• Achievement- Introduction of QM in the Health Center is a challenge. Teams need to be accompanied during this journey. A close coaching creates close relationship based on mutual confidence and respect of specific needs and progress.- Team and professional knowledges were compartmentalized. The intervention contributed to develop dialogue between occupational categories and strengthen the team spirit.- Reception and hygiene were culturally meaningful and make the team commitment easier. The meaningfulness is an “obvious” way to introduce a “complicated” change (as the QM is).- The synergies with PBF were very helpful: (1) CQ allows teams to understand indicators and to have better performance and financing; (2) PBF allows HC to invest in changes for CQ.- CQ help supervisors to start and change their supervision style through the coaching (phase 2).• Challenges and questions- In a medium term, obvious and easy changes will be achieved. The teams will need support to remain engaged in QI despite their difficulties. - In a long term, there is a risk of wearing off the positive effect of competition, especially for the low ranking. The gamification strategy needs to diversify to keep its attractiveness.- Changes in work processes and habits (in HC but also in leadership and supervision style) are long and difficult. These changes need a strong support that is not easy to implement on a large scale.- Synergy with PBF was a strong lever. What changes may be possible without any financing (and extrinsic motivation) in HC?- Fragility and political crisis have led the intervention to focus on operational level. That does not facilitate the integration of the strategy and does not help to strengthen the health system.