Use of a participatory quality assessment and improvement tool for maternal and neonatal hospital care. Part 2: Review of the results of quality cycles and of factors influencing change
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TAMBURLINI, Giorgio; BACCI, Alberta; DANIELE, Marina A.S.; HODOROGEA, Stelian; JECKAITE, Dalia; MACIULEVICIUS, Audrius; VALENTE, Emanuelle Pessa; SIUPSINSKAS, Gelmius; STILLO, Paola; UXA, Fabio; VEZZINI, Francesca ; LINCETTO, Ornella; BUCAGU, Maurice. Use of a participatory quality assessment and improvement tool for maternal and neonatal hospital care. Part 2: Review of the results of quality cycles and of factors influencing change. In: Journal of Global Health. 2020, nr. 2(10), pp. 1-10. ISSN 2049-2986.
10.7189/jogh.10.020433
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Journal of Global Health
Numărul 2(10) / 2020 / ISSN 2049-2986 /ISSNe 2049-2986

Use of a participatory quality assessment and improvement tool for maternal and neonatal hospital care. Part 2: Review of the results of quality cycles and of factors influencing change


DOI: 10.7189/jogh.10.020433
Pag. 1-10

Tamburlini Giorgio1, Bacci Alberta2, Daniele Marina A.S.3, Hodorogea Stelian4, Jeckaite Dalia5, Maciulevicius Audrius6, Valente Emanuelle Pessa7, Siupsinskas Gelmius8, Stillo Paola9, Uxa Fabio10, Vezzini Francesca 7, Lincetto Ornella11, Bucagu Maurice11
 
1 Center for Child Health, Trieste,
2 IRCCS San Raffaele Scientific Institute, Milan,
3 King's College London,
4 ”Nicolae Testemițanu” State University of Medicine and Pharmacy,
5 International midwifery and perinatal care consultant, Panevezys,
6 Lithuanian University of Health Sciences, Kaunas,
7 Instituto de Medicina Integral Fernando Figueira, Recife,
8 International perinatal consultant, Geneva,
9 Meyer University Hospital, Florence,
10 WHO Collaborating Centre for Maternal and Child Health, Trieste,
11 Adolescent Health and Ageing, Newborn, Geneva
 
Disponibil în IBN: 26 ianuarie 2021


Rezumat

Background Information about the use of the findings of quality assessments in maternal and neonatal (MN) care is lacking and the development of tools capable to effectively address quality gaps is a key priority. Furthermore, little is known about factors that act as barriers or facilitators to change at facility level. Based on the extensive experience made with the WHO Quality Assessment and Improvement MN (QA/QI MN) tool, an overview is provided of the improvements in quality of care (QoC) which were obtained over time and of the factors influencing change. Methods All documented reports on the implementation of the WHO QA/QI MN tool were searched and screened for inclusion. Reports were considered if bringing evidence from both the baseline assessment and the reassessment. Changes were considered in four domains: maternal care, neonatal care, infrastructure and policies, with reference made to WHO maternal and neonatal care standards. The observed improvements were categorized according to intensity and extent across the sample of health facilities. Factors influencing change were categorized into internal and external and further classified as barriers or facilitators. Results. Changes were documented after an average period of 1.2 years from first assessment in 27 facilities belonging to 9 different countries in Central and Eastern Europe (3), Central Asia (3), sub-Saharan Africa (2) and Latin America (1). Improvements were observed in all areas of care but were greater and more frequently observed in areas related to appropriate case management and respectful care for both mothers and newborns. Although widespread across most facilities and countries, the observed improvements were not covering all the quality gaps observed at the baseline assessment nor were always sufficient to achieve standard care. Factors facilitating change as well as barriers were mainly related to the capacity of the managers and head of units to involve and motivate their staff members. Conclusions The use of WHO QA/QI MN tool proved effective in promoting significant changes in quality of care. The review of observed improvements and of factors influencing change at facility level shows that participatory assessment tools that promote a constructive dialogue with hospital managers and staff and support them in acquiring capacity in this role are crucial to implement effective quality cycles.



Cuvinte-cheie
Africa south of the Sahara, article, Asia, case management, Eastern Europe, female, health care facility, health care quality, hospital care, human, manager, maternal care, mother, newborn, newborn care, respect, South and Central America