Factors influencing the perpetuation of the quality approach in health care centers of the Medical Prefecture of the city of Fes, Morocco

摘要

The quality approach, which has been implemented since the year 2000 at the pilot sites of the Medical Prefecture of Fes, was aimed to be generalized to all primary health care centers (PHCCs) in the outpatient network. This result is far from being reached at the present time. The objective of this study, performed for the first time in the center of Morocco, was to describe the factors that influenced the implementation and the perpetuation of the quality approach in the PHCCs of the Medical Prefecture of the city of Fes in the center of Morocco. For that, we carried out a survey of the managers of the PHCCs of the Medical Prefecture of Fes. We also had an interview with the quality facilitators and the managers of the Service of the Network of the Health care institutions. We have acquired a percentage of answer to the questionnaire equal to 99%. On the 36 PHCCs touched by the formation, the quality cycle could be initiated only in 17 PHCCs and only in 10 PHCCs could be completed. Currently this approch was given up by all PHCCs. The analysis of the results revealed that there are several factors which impeded the implementation and the perpetuation of the quality approch, in the ambulatory network of the prefecture of Fes. Concerning the factors related to the internal environment, we noted the insufficient commitment of the managers of the central service, the insufficiency in the accompaniment, the follow-up and the communication of the hierarchical managers of all the PHCCs involved in our study. Similarly, the insufficiency of human resources and the overload of work discourage PHCCs managers, to initiate, to complete and to ensure the continuity of the quality improvement cycle. Regarding the functions of support, we found that the supervision, the facilitation, the motivation and the reward are determining factors that have been lacking in the context of this study. As for the organization for quality, this study also revealed an insufficiency of the coordination of the improvements actions of quality between the operational actors and piloting.