From May to September 2024, the PIECEs research team in Pakistan conducted a series of Quality Improvement (QI) training workshops with 14 participants from four local hospitals in Karachi (one public and three private). These workshops aimed to support the broader implementation of DIALOG+, an app-mediated intervention designed to improve patient outcomes through structured, personalized conversations while addressing challenges in its adoption and use.

The QI workshops focused on empowering healthcare professionals with practical tools to drive small but impactful changes in their facilities. Over a total of five sessions, each lasting three hours, participants explored QI methodologies and their real-world applications.

A Step-by-Step Approach to Quality Improvement

The initial sessions introduced participants to the basics of QI, including the ELFT sequence and the Model for Improvement. During these workshops, participants:

  • Identified specific problems in DIALOG+ implementation.
  • Selected measurable outcomes, such as the number of completed DIALOG+ sessions.
  • Applied analytical tools like the 5 Whys and Fishbone Diagram to uncover the root causes of challenges.

Building on these foundations, participants worked in seven groups to develop their own QI projects. Each group was tasked with defining a SMART aim and creating a stakeholder team at their respective facilities. These teams met fortnightly to refine their projects based on feedback and progress.

Practical Applications: Tools for Change

To deepen their understanding, participants engaged in practical exercises like process mapping, flow charts, and Pareto charts, which helped them visualize challenges and prioritize solutions. By the end of the training, healthcare professionals from Karwan-e-Hayat, Jinnah Postgraduate Medical Centre (JPMC), Lady Dufferin Hospital, and Karachi Psychiatric Hospital had developed tailored QI projects, each targeting key areas for improvement as follows:

  • Workplace Improvement Initiatives: 4 QI projects aimed to enhance job satisfaction among healthcare staff and students by leveraging DIALOG+ sessions to address workplace stressors and improve the “job satisfaction domain.”
  • Psychiatric Care: Two QI projects aimed to enhance mental health outcomes for patients and caregivers by using DIALOG+ sessions to improve ratings in the mental health domain. Another project focused on reducing average counselling time during follow-ups, particularly in high-volume community settings/psychiatric camps.

A Collaborative Path Forward

The collaborative efforts of local hospitals and the PIECEs research team underscore the potential of QI training to overcome DIALOG+ implementation challenges at health facilities. By equipping healthcare workers with the skills to analyze problems and implement targeted solutions, these initiatives are paving the way for more effective and sustainable use of DIALOG+ in Pakistan.

This journey demonstrates the power of small, consistent changes to drive significant improvements in mental health care delivery, offering a model that can be replicated across similar contexts.

Here are some key moments from QI workshops captured below:

QI participants from 3 private facilities, analyzing root causes using the “5 Whys” exercise

QI participants brainstorming sources of improvement ideas

PIECEs team demonstrating Fishbone exercise in a QI session

QI participants conducted a Fishbone exercise

QI Huddle with Project Stakeholders (Caregivers and Psychiatric Ward Staff)

Participants from the public hospital completing the QI workshops