Offering the latest news in health care quality and safety, the ISQua blog also features guest posts from the best and brightest in the industry.

By ISQua Wednesday. Jul 15, 2015

A Practical Guide for Large-Scale Improvement Projects Using Ghana’s Project Fives Alive!

by Sodzi Sodzi-Tettey (MD, MPH, FISQua) Senior Technical Director, IHI, Africa / Director, Project Fives Alive!  

If Project Fives Alive! (PFA!), the partnership between the Institute for Healthcare Improvement (US) and the National Catholic Health Service (Ghana), had benefited from a practical and easy-to-read manual eight years ago that systematically documented what works (Key Success Factors), likely pitfalls (Key Challenges), and useful lessons (Recommendations), what difference would it have made?

A whole lot. The truth is that some of those who initially designed PFA! may today hardly  recognize the “machine” that has developed from various adaptations through the years. Initially billed to last five years, PFA! is currently in its eighth and final year. Initially designed as a disease-focused intervention, it quickly adapted a systems approach that enabled a more fundamental approach to tackling both the direct and underlying drivers of under-five deaths. Initially facility- and health-worker-focused, it is currently running 35 collaborative learning networks at scale in seven regions in Ghana with quality improvement teams that incorporate key community stakeholders and patient groups. These teams are running multiple improvement cycles that test and ultimately implement innovative changes developed by the teams and assessed using local data.  

The learning has been truly rich, the experiences diverse, and the impact – by way of measurable improved under-five survival – palpable. What does “adaptive design” entail? How does one achieve effective project management and impact through a relentless focus on results? What is the level of QI capability that is appropriate for different managers and frontline workers of a health system? How does one provide technically effective and inspiring leadership? Reklama: Vadovų ir darbuotojų paieška, mokymai bei personalo atranka What does expert management of complex partner relationships entail? How does one deploy a balanced set of core metrics to answer managers’ and workers’ questions? Finally, how should large-scale improvement projects harness the power of effective communication to drive their success?

Developed through extensive key informant interviews, this practical Guide serves as a roadmap for those also striving to design and execute improvement initiatives to achieve results at scale. Use the content in whatever way best serves you—jump into chapters out of order depending on your current needs, scan for helpful resources, or read it front to back—it is a resource here for you that we hope will sit open on your desk brought to life over time around the world.


Online links to the guide are available at: and


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