Continuous quality improvement in a Maltese hospital using logical framework analysis

Sandra C. Buttigieg*, Dorothy Gauci, Prasanta Dey

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: The purpose of this paper is to present the application of logical framework analysis (LFA) for implementing continuous quality improvement (CQI) across multiple settings in a tertiary care hospital.

Design/methodology/approach: This study adopts a multiple case study approach. LFA is implemented within three diverse settings, namely, intensive care unit, surgical ward, and acute in-patient psychiatric ward. First, problem trees are developed in order to determine the root causes of quality issues, specific to the three settings. Second, objective trees are formed suggesting solutions to the quality issues. Third, project plan template using logical framework (LOGFRAME) is created for each setting. Findings: This study shows substantial improvement in quality across the three settings. LFA proved to be effective to analyse quality issues and suggest improvement measures objectively.

Research limitations/implications: This paper applies LFA in specific, albeit, diverse settings in one hospital. For validation purposes, it would be ideal to analyse in other settings within the same hospital, as well as in several hospitals. It also adopts a bottom-up approach when this can be triangulated with other sources of data. Practical implications: LFA enables top management to obtain an integrated view of performance. It also provides a basis for further quantitative research on quality management through the identification of key performance indicators and facilitates the development of a business case for improvement.

Originality/value: LFA is a novel approach for the implementation of CQI programs. Although LFA has been used extensively for project development to source funds from development banks, its application in quality improvement within healthcare projects is scant.

Original languageEnglish
Pages (from-to)1026-1046
Number of pages21
JournalJournal of Health Organization and Management
Issue number7
Early online date4 Oct 2016
Publication statusPublished - 10 Oct 2016


  • continuous improvement
  • continuous quality improvement
  • health services operations
  • logical framework analysis
  • performance management
  • performance measurement
  • quality improvement
  • quality management


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