National learning forums in Lao PDR show rising participation in healthcare quality improvement

A descriptive case study published in BMC Health Services Research examined collaborative learning platforms run through a Japan International Cooperation Agency (JICA) project in Lao PDR, and found that participation grew dramatically while the topics discussed matured from basic methods to hospital governance and patient safety. Over four years, attendance at the national forums rose from 65 to 234 participants, and the number of institutions represented climbed from 14 to 97.

The share of attendees who paid their own way to participate rose from 7.7 percent to 52.1 percent over the study period. Participant enthusiasm was also reflected in survey responses: 89.0 percent of respondents said they would be willing to recommend a forum to their colleagues. These figures come from an analysis of existing documentation covering four dimensions of the forums: participant engagement, the learning environment, quality improvement readiness, and the role of international cooperation.

The content of the discussions evolved over time. Early sessions focused on policy implementation and quality improvement methods, but the agenda broadened to include hospital governance, patient safety, and crisis response. The researchers classified quality improvement activities using a Japanese typology with four categories: problem solving, task achievement, countermeasure implementation, and prevention.

Problem solving dominated the portfolio of quality improvement work presented at the forums, followed by task achievement, countermeasure implementation, and finally prevention. The study also identified a significant bottleneck. Nearly one in five quality improvement efforts, 19.5 percent, remained at the situational assessment stage, meaning teams had analyzed their circumstances but had not yet progressed further, and this stall was especially evident in work on patient and staff satisfaction.

The authors conclude that a structured collective learning platform can enhance quality improvement readiness in low-resource settings by fostering shared understanding and promoting iterative learning. In health systems where stakeholders arrive with widely varying levels of readiness, collective learning helps bridge organizational gaps that often fragment quality and safety initiatives in low- and middle-income countries.

The findings come with important caveats about how such platforms should be run. The researchers emphasize that success depends on cultivating local ownership, engaging leadership at multiple levels, and creating culturally aligned learning environments that empower local actors. They argue that these environments should not rely on rigid tools or externally led solutions, but instead enable teams to explore and adapt approaches to their own context.

The role of international cooperation also emerged as a key lesson. The authors suggest that external partners may need to provide substantial support at the outset but should gradually shift toward facilitation, a transition they note is particularly relevant in centralized governance systems such as Laos. Sustaining quality improvement efforts, they argue, depends on local adaptation and long-term integration into the health system rather than perpetual external direction.

Methodologically, the study applied inductive qualitative analysis to extract key lessons and deductive analysis using a framework for knowledge transfer readiness to assess quality improvement readiness. As a descriptive case study based on documentation from a single national program, the analysis cannot establish causal effects or generalize to all low-resource settings, and the reported participation and survey figures describe this specific forum series rather than outcomes for patients.

Subject of Research: Collaborative learning forums for healthcare quality improvement in Lao PDR

Article Title: Implementing collaborative learning platforms for healthcare quality improvement in Lao PDR: a case study of national forums

Article References: Murai, S., Saysanasongkham, B., Nishimoto, G., Thounsavath, S., Jimbo, S., Hansen, S., Kanda, M., Hashizume, A., Rattana, S., Duangphachanh, S., Phanthanalay, V., Sisoulath, A., & Kounnavong, S. (2026). Implementing collaborative learning platforms for healthcare quality improvement in Lao PDR: a case study of national forums. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15424-y

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15424-y

Keywords: Lao PDR, healthcare quality improvement, collaborative learning, JICA, health systems, patient safety, low- and middle-income countries, capacity building, case study, hospital governance, knowledge transfer, BMC Health Services Research