Increasing compliance with maternal and child care quality standards in Ecuador.

OBJECTIVE To determine the effects of hospital quality assurance interventions on compliance with clinical standards, availability of essential drugs, client satisfaction, and utilization. DESIGN Quasi-experimental, prospective study with four intervention hospitals and four control hospitals. All eight facilities were purposively selected and of comparable complexity. SETTING Ministry of Health secondary care facilities in Ecuador. INTERVENTIONS Facility-based quality improvement teams, job clarification, standards communication, refresher training, strengthening hospital pharmacy committees, monthly monitoring of compliance indicators, and formation of users' committees. MEASURES Compliance with input and process standards, utilization of services, and patient satisfaction were measured monthly in both groups through review of clinical and administrative records, exit interviews, and patient satisfaction surveys. RESULTS After 12 months, the quality assurance interventions produced rapid increases in compliance with clinical standards in the intervention hospitals as compared with the control group. These improvements appeared as early as 2 months after the onset of the interventions. No differences were found between intervention and control groups in terms of trends in utilization patterns or client satisfaction. CONCLUSION Quality assurance interventions made a difference in technical quality of care. Patient satisfaction and utilization do not appear to be directly associated with short-term improvements in compliance with clinical standards. Quality improvement interventions may require longer periods and a specific aim at clients' needs to demonstrate effects on utilization and satisfaction outcome variables.