Lessons from building the capacity of programme managers on leadership and management skills using quality improvement PDSA (plan do study act) cycles.

BACKGROUND: Effective implementation of tuberculosis (TB) control programmes requires programme managers to possess leadership and management competencies in addition to technical expertise. To strengthen these competencies among District TB Officers (DTOs) in India, a six-month Program Manager's Executive Course (PMEC) incorporating leadership training and workplace-based Plan-Do-Study-Act (PDSA) projects was implemented. This study evaluated participants' experiences and the characteristics of the PDSA projects undertaken during the course. METHODS: A mixed-methods implementation assessment was conducted across seven PMEC batches. Qualitative interviews were completed with 143 DTOs selected through convenience sampling to explore participants' perceptions of the training, application of PDSA, and recommendations for programme improvement. In addition, 377 eligible PDSA worksheets were reviewed to describe the programme areas addressed, implementation level, and duration of the quality improvement initiatives. RESULTS: Participants reported perceived improvements in communication, team leadership, delegation, and data-informed decision-making following the course. The structured PDSA approach was perceived as useful for systematic problem-solving and team coordination, while mentorship provided by Quality Improvement Consultants (QIC)s was identified as a key facilitator of implementation. Of the 377 PDSA projects analysed, 203 (53.8%) focused on strengthening TB notification, and most were implemented over two to three months at treatment unit or block level. Continued use of formal PDSA cycles after course completion was limited by competing programme responsibilities, time constraints, and the lack of ongoing mentorship. CONCLUSION: A structured leadership and management programme combined with workplace-based quality improvement projects is a feasible approach to strengthening managerial competencies among TB programme managers. Integrating leadership development and quality improvement methods into routine programme capacity-building may support sustained improvements in programme implementation.