Gains from Quality Improvement Initiatives – Experience from a Tertiary-care Institute in India

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Quality improvement (QI) is defined as the combined and unceasing efforts of everyone involved in healthcare including providers, patients and their families, researchers, planners and administrators to make changes that will lead to better patient outcomes, better health system performance and better professional development. Better quality of care (QoC) ensures that the healthcare provided is safe (avoids harm), effective (evidence-based best practices), patient centred (care that respects patients and their preferences), timely (avoids unnecessary delays), efficient (avoiding wastage) and equitable. QI also helps one to translate best clinical and scientific evidences into clinical practice. The key ingredient of any QI initiative is the ‘change’ (context specific improvement) that is proposed and the ‘methodology’ by which the change is introduced. QI initiatives in low- and middle- income countries (LMIC) targeting small and sick neonates have shown benefits in the form of reduction in neonatal mortality and morbidity. However, overburdened staff and lack of sufficient equipment were identified as the most common barriers during implementation.

While a number of approaches can be used for QI initiatives, some general principles hold true for all of them. These include a thorough understanding of the problem to be addressed, the system and processes that prevail within the unit, appropriate data collection, choosing suitable changes, executing them, and finally evaluating and measuring the impact of such changes. All these can be accomplished only with good leadership support, staff engagement, motivation and team work. In this article, we share a number of QI initiatives undertaken in the neonatal unit of our institute and elaborate our learning from them.

This special issue of Indian Pediatrics (September 2018; Volume 55: Number 9) highlights mechanisms that can support health care providers in using various quality improvement (QI) approaches and showcases some of the improvement projects undertaken in India by different teams.

The USAID ASSIST Project started working in India in September 2013; initially working directly with districts and facilities to help them learn how to use QI approaches to save lives. This work went well and the staff in these facilities were able to reduce perinatal mortality by 15% over 18 months. During this time, we met great partners from important organizations and institutions across India.

These institutions are now leading a growing movement to help more people apply QI methods to deliver care that prevents harm, improves outcomes, and meets the needs of the people receiving it through their own networks using domestic funding; continuing these lifesaving efforts after ASSIST technical support has ended.

The supplement shows important results of the ongoing QI work in these networks and shows how domestic QI networks, earlier supported by ASSIST, are now independently supporting and spreading the use of QI methods to provide better care.

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