5 - 5 - Video 4.5 Quality Improvement in EmOC (3 05), Childbirth A Global Perspective
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Assessing quality and establishingquality improvement strategies forEmOC is a critically important partof providing the services thatcomprise this intervention.Quality refers to how correctly andappropriately these services are beingperformed in a particular facility,as compared to accepted standards.Although some of the process indicatorsdiscussed may give some indication ofEmOC quality, they don't directlyassess this aspect of care.Rather than being considereda supplementary study, it might be moreuseful to think of quality evaluation ofEmOC as an essential part of assessment.A number of resources exist forquality improvement in EmOC.The primary resource I will use here, andrefer you to, is Quality Improvement forEmergency Obstetric Care Leadership Manualand Tool, Tool Book, which can,again, be as, accessed with the linkprovided in this week's reading list.At this point, I'd like to brieflyreview a recommended process forquality improvement of EmOC.You'll learn more aboutquality improvement andthe cycle of plan, do, study,act, in week six of this course.But this review will give you an idea,at least, of what's involved.So, the first step involves conductinga quality assessment that involves moredata collection and analysis.In conjunction with the regularEmOC assessment process,a number of evaluations can be performedthat specifically target quality.Criterion-based or performanceaudits can be conducted, by way ofmedical records reviews or observationsto determine whether services beingassessed were performed appropriately andaccording to established protocols.Some of these criterion-based auditsare also available at amddprogram.org.Medical records can be assessed forcompleteness and accuracy.Client andfamily interviews can be performed.These are semi-structured,informal discussions to learn aboutclients' perspectives andexperiences with quality of care.Client flow analysis can be done.This is an assessment of wait timesfrom the arrival at the facility to keypoints in admission,so primarily treatment.Case reviews can also be conducted, wherea team experts review selected cases ofmaternal death or obstetric complicationsto better understand what happened,why and how to avoid it in the future.Once this data is gathered andanalyzed, a team of stakeholders, sofor example, clinical workers healt,regular health workers, supervisors,community members, all of these peoplecome together to identify the problems anddevelop solutions forthe problems of highest priority.These solutions are then implemented,including the tracking of any aspectsthat are measurable or quantifiable.Then using this tracking data, progress isevaluated, changes are made as necessary,and the cycle of implementation andevaluation continues.This concludes our discussion ofEmOC monitoring, assessment andquality improvement.In the next, and final,section of this lecture,I will describe some key challengesto effective implementation anddelivery of EmOC in developingcountries contexts.
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