Quality improvement has become a global priority as more countries become interested in systemic strategies, particularly that of the Quality Improvement Support Agency (QISA). This study sets out to identify and document contextual factors that facilitate or hinder the perceived effects of QISAs. A study of two critical and paradigmatic cases consisting of the QISAs HAS and INESSS was carried out through interviews, a focus group discussion, a non-participatory observation session, and the use of secondary data from in-depth documentary research. All data were recorded and processed using the QDA Miner 6.0.2 software in an inductive approach in two coding cycles and were validated by the participants. The results showed that the contextual factors at the level of the internal environment included: leadership of agency actors; dissemination and support strategy for their productions and support for their implementation; availability and nature of human, informational, and material resources; organizational culture; training of actors; and coordination, coherence, and complementarity of the various activities of an agency. At the level of the external environment, the factors included: crises; institutional collaborations and partnerships at the national and international levels; collaborations and partnerships with system actors; public policy, governance, and leadership; legal provisions; health information system and data accessibility; and funding. These results, the first to be produced on this topic, complement the literature on QISAs and may thus inspire other jurisdictions in developed and developing countries to implement more efficient, sustainable, and self-potentiating quality improvement strategies.
