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Quigley DD, Slaughter ME, Hays RD. Pediatric Inpatient Leaders, Views Changed with COVID-19: A Call to Re-engage in Quality Improvement. Pediatr Qual Saf 2023; 8:e648. [PMID: 38571733 PMCID: PMC10990334 DOI: 10.1097/pq9.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/01/2023] [Indexed: 04/05/2024] Open
Affiliation(s)
| | | | - Ron D. Hays
- University of California Los Angeles, David Geffen School of Medicine
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Wong CI, Henrich N, Barysauskas CM, Conway M, Desrochers MD, Mahan RM, Billett AL. Developing the Key Driver Diagram by Analyzing Home Central Line Caregiver Proficiency Factors. Pediatr Qual Saf 2023; 8:e638. [PMID: 36926216 DOI: 10.1097/pq9.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023] Open
Abstract
Caregivers of pediatric oncology and stem cell transplant patients often care for central lines (CLs) at home. Methods to achieve caregiver CL care proficiency, and interventions designed with caregiver input are lacking. Methods Caregivers of pediatric oncology and stem cell transplant patients patients with an external CL or removed within 2 weeks were eligible for a survey assessing knowledge, the value of training strategies, and comfort. We mapped responses (n = 79) and acceptability/challenges of introducing a pilot caregiver CL teach-back clinic program onto the capability, opportunity, motivation behavioral (COM-B) model of change to identify drivers of caregiver CL care proficiency. A working group, including caregivers, refined and approved a final driver diagram. Results Survey: Ninety-four percent of caregivers answered knowledge questions correctly (capability); 95% considered hands-on training helpful (opportunity); 53% were not very comfortable with CL care (motivation). Teach-back: Seventy-nine percent of caregivers were interested in a teach-back as additional training; 38% participated (opportunity); 20% refused participation due to being overwhelmed/not having time (motivation). Thirty-three percent of participants had a CL proficiency assessment (capability). Drivers of home caregiver CL care proficiency included: support for the caregiver's physical capability to perform CL care; enabling the CL care nurse trainer role; facilitating and increasing training opportunities, and engaging caregivers early and continuously to motivate proficiency development appropriately. Conclusions An approach centered on caregivers as main stakeholders can identify drivers to co-design an intervention for improved home CL care delivery. A standardized process to train and evaluate caregivers with multiple hands-on opportunities might be beneficial.
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Quigley DD, Slaughter ME, Gidengil C, Palimaru A, Lerner C, Hays RD. Usefulness of Child HCAHPS Survey Data for Improving Inpatient Pediatric Care Experiences. Hosp Pediatr 2021; 11:e199-e214. [PMID: 34548390 DOI: 10.1542/hpeds.2020-004283] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Quality improvement (QI) requires data, indicators, and national benchmarks. Knowledge about the usefulness of Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) data are lacking. We examined quality leader and frontline staff perceptions about patient experience measurement and use of Child HCAHPS data for QI. METHODS We surveyed children's hospital leaders and staff about their use of Child HCAHPS for QI, including measures from other studies. We compared scale and item means for leaders and staff and compared means to other studies. RESULTS Almost all leaders, but only one-third of staff, received reports with Child HCAHPS data. Leaders found the data more useful for comparisons to other hospitals than did staff. Both agreed on the validity of Child HCAHPS scores and used these data for improving pediatric care experiences. They agreed the data accurately reflect their hospital's quality of care, provide specific information for QI, and can be used to improve pediatric care experiences. They also agreed on approaches to improve Child HCAHPS scores. Among staff, QI was reported as essential to their daily work and that Child HCAHPS data were integral to QI. CONCLUSIONS As uptake of the Child HCAHPS survey increases, our study of one medium-sized, urban children's hospital revealed that leaders and staff believe Child HCAHPS provides actionable metrics for improvement. Our study fills a gap in research about the use of Child HCAHPS for pediatric QI. A multisite evaluation would provide further information about how the Child HCAHPS survey can improve care.
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Affiliation(s)
| | | | | | | | - Carlos Lerner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,University of California Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Ron D Hays
- RAND Corporation, Santa Monica, California.,David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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Abstract
CONTEXT Achieving high-quality patient-centered care requires assessing patient and family experiences to identify opportunities for improvement. With the Child Hospital Consumer Assessment of Healthcare Providers and Systems Survey, hospitals can assess performance and make national comparisons of inpatient pediatric experiences. However, using patient and family experience data to improve care remains a challenge. OBJECTIVE We reviewed the literature on best practices for monitoring performance and undertaking activities aimed at improving pediatric patient and family experiences of inpatient care. DATA SOURCES We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychINFO. STUDY SELECTION We included (1) English-language peer-reviewed articles published from January 2000 to April 2019; (2) articles based in the United States, United Kingdom, or Canada; (3) articles focused on pediatric inpatient care; (4) articles describing pediatric patient and family experiences; and (5) articles including content on activities aimed at improving patient and family experiences. Our review included 25 articles. DATA EXTRACTION Two researchers reviewed the full article and abstracted specific information: country, study aims, setting, design, methods, results, Quality Improvement (QI) initiatives performed, internal reporting description, best practices, lessons learned, barriers, facilitators and study implications for clinical practice, patient-experience data collection, and QI activities. We noted themes across samples and care settings. RESULTS We identified 10 themes of best practice. The 4 most common were (1) use evidence-based approaches, (2) maintain an internal system that communicates information and performance on patient and family experiences to staff and hospital leadership, (3) use experience survey data to initiate and/or evaluate QI interventions, and (4) identify optimal times (eg, discharge) and modes (eg, print) for obtaining patient and family feedback. These correspond to adult inpatient best practices. CONCLUSIONS Both pediatric and adult inpatient best practices rely on common principles of culture change (such as evidence-based clinical practice), collaborative learning, multidisciplinary teamwork, and building and/or supporting a QI infrastructure that requires time, money, collaboration, data tracking, and monitoring. QI best practices in both pediatric and adult inpatient settings commonly rely on identifying drivers of overall ratings of care, rewarding staff for successful implementation, and creating easy-to-use and easy-to-access planning and QI tools for staff.
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Affiliation(s)
| | | | - Carlos Lerner
- Division of General Internal Medicine and Health Services Research
- University of California, Los Angeles Mattel Children's Hospital, Los Angeles, California
| | - Ron D Hays
- RAND Corporation, Santa Monica, California
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
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Mitchell SJ, Slowther AM, Coad J, Akhtar S, Hyde E, Khan D, Dale J. Ethics and patient and public involvement with children and young people. Arch Dis Child Educ Pract Ed 2019; 104:195-200. [PMID: 29440127 DOI: 10.1136/archdischild-2017-313480] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/04/2022]
Abstract
Patient and public involvement (PPI) is important both in research and in quality improvement activities related to healthcare services . While PPI activities do not require formal ethical approval, they can raise a number of ethical concerns, through the introduction of complex technical medical concepts, challenging language or sensitive subject areas. There is very little published literature to guide ethical practice in this area. We have been conducting PPI with children and young people throughout a research study in paediatric palliative care. PPI started during the application process and continued to guide and shape the research as it progressed. Ethical issues can arise at any time in PPI work. Although many can be predicted and planned for, the nature of PPI means that researchers can be presented with ideas and concepts they had not previously considered, requiring reflexivity and a reactive approach. This paper describes how we considered and addressed the potential ethical issues of PPI within our research. The approach that emerged provides a framework that can be adapted to a range of contexts and will be of immediate relevance to researchers and clinicians who are conducting PPI to inform their work.
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Affiliation(s)
| | | | - Jane Coad
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Shazaan Akhtar
- Birmingham Children's Hospital Young Persons Advisory Group, Birmingham Children's Hospital, Birmingham, UK
| | | | - Dena Khan
- NIHR CRN Young People's Steering Group, Stafford, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
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Cai RA, Chaplin H, Livermore P, Lee M, Sen D, Wedderburn LR, Wilkinson N, Jeffery R, Kempa A, Norton I, Tattersall R, Ioannou Y, Eleftheriou D. Development of a benchmarking toolkit for adolescent and young adult rheumatology services (BeTAR). Pediatr Rheumatol Online J 2019; 17:23. [PMID: 31113443 PMCID: PMC6528251 DOI: 10.1186/s12969-019-0323-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Young people (YP; 12-24 years old) with rheumatic diseases face many challenges associated with chronic illness in addition to the physiological and psychosocial changes of adolescence. Timely access to developmentally appropriate multidisciplinary care is key to successfully managing rheumatic diseases, but gaps in the care of this vulnerable age group still exist. This study aimed to develop a benchmarking toolkit to enable comparative evaluation of YP rheumatology services in order to promote best practice and reduce variations in service delivery. METHODS A staged and consultative method was used across a broad group of stakeholders in the UK (YP, parents/other carers, and healthcare professionals, HCPs) to develop this toolkit, with reference to pre-existing standards of YP-friendly healthcare. Eighty-seven YP (median age 19 years, range 12-24 years) and 26 rheumatology HCPs with 1-34 years of experience caring for YP have participated. RESULTS Thirty quality criteria were identified, which were grouped into four main domains: assessment and treatment, information and involvement, accessibility and environment, and continuity of care. Two toolkit versions, one to be completed by HCPs and one to be completed by patients, were developed. These were further refined by relevant groups and face validity was confirmed. CONCLUSIONS A toolkit has been developed to systematically evaluate and benchmark YP rheumatology services, which is key in setting standards of care, identifying targets for improvement and facilitating research. Engagement from YP, clinical teams, and commissioners with this tool should facilitate investigation of variability in levels of care and drive quality improvement.
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Affiliation(s)
- Ran A. Cai
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Hema Chaplin
- 0000 0001 2322 6764grid.13097.3cHealth Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Polly Livermore
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK ,0000 0004 5902 9895grid.424537.3Paediatric Rheumatology Department, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK ,0000000121901201grid.83440.3bUCL GOS Institute of Child Health, University College London, London, UK
| | - Martin Lee
- 0000 0004 0444 2244grid.420004.2Rheumatology Department, Newcastle Upon Tyne Hospitals, Newcastle, UK
| | - Debajit Sen
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK ,0000 0004 0612 2754grid.439749.4Rheumatology, University College London Hospitals, London, UK
| | - Lucy R. Wedderburn
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK ,0000000121901201grid.83440.3bUCL GOS Institute of Child Health, University College London, London, UK ,0000 0001 2116 3923grid.451056.3NIHR Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Nick Wilkinson
- 0000 0004 5345 7223grid.483570.dPaediatric Rheumatology Department, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, UK
| | - Rachel Jeffery
- grid.500651.7Rheumatology, Northampton General Hospital NHS Trust, Northampton, UK
| | - Andrea Kempa
- grid.500651.7Rheumatology, Northampton General Hospital NHS Trust, Northampton, UK
| | - Imogen Norton
- grid.500651.7Rheumatology, Northampton General Hospital NHS Trust, Northampton, UK
| | - Rachel Tattersall
- 0000 0004 0641 6031grid.416126.6Rheumatology Department, Royal Hallamshire Hospital, Sheffield, UK and Sheffield Children’s Hospital, Sheffield, UK
| | - Yiannis Ioannou
- 0000 0004 0612 2754grid.439749.4Rheumatology, University College London Hospitals, London, UK
| | - Despina Eleftheriou
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK ,0000000121901201grid.83440.3bUCL GOS Institute of Child Health, University College London, London, UK ,0000 0001 2116 3923grid.451056.3NIHR Biomedical Research Centre, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Walters SJ, Stern C, Robertson-Malt S. The measurement of collaboration within healthcare settings: a systematic review of measurement properties of instruments. ACTA ACUST UNITED AC 2018; 14:138-97. [PMID: 27532315 DOI: 10.11124/jbisrir-2016-2159] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND There is a growing call by consumers and governments for healthcare to adopt systems and approaches to care to improve patient safety. Collaboration within healthcare settings is an important factor for improving systems of care. By using validated measurement instruments a standardized approach to assessing collaboration is possible, otherwise it is only an assumption that collaboration is occurring in any healthcare setting. OBJECTIVES The objective of this review was to evaluate and compare measurement properties of instruments that measure collaboration within healthcare settings, specifically those which have been psychometrically tested and validated. INCLUSION CRITERIA, TYPES OF PARTICIPANTS Participants could be healthcare professionals, the patient or any non-professional who contributes to a patient's care, for example, family members, chaplains or orderlies. The term participant type means the designation of any one participant; for example 'nurse', 'social worker' or 'administrator'. More than two participant types was mandatory. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The focus of this review was the validity of tools used to measure collaboration within healthcare settings. TYPES OF STUDIES The types of studies considered for inclusion were validation studies, but quantitative study designs such as randomized controlled trials, controlled trials and case studies were also eligible for inclusion. Studies that focused on Interprofessional Education, were published as an abstract only, contained patient self-reporting only or were not about care delivery were excluded. OUTCOMES The outcome of interest was validation and interpretability of the instrument being assessed and included content validity, construct validity and reliability. Interpretability is characterized by statistics such as mean and standard deviation which can be translated to a qualitative meaning. SEARCH STRATEGY The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. The databases searched included PubMed, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Emerald Fulltext, MD Consult Australia, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Informit Health Databases, Scopus, UpToDate and Web of Science. The search for unpublished studies included EThOS (Electronic Thesis Online Service), Index to Theses and ProQuest- Dissertations and Theses. METHODOLOGICAL QUALITY The assessment of methodological quality of the included studies was undertaken using the COSMIN checklist which is a validated tool that assesses the process of design and validation of healthcare measurement instruments. DATA COLLECTION An Excel spreadsheet version of COSMIN was developed for data collection which included a worksheet for extracting participant characteristics and interpretability data. DATA SYNTHESIS Statistical pooling of data was not possible for this review. Therefore, the findings are presented in a narrative form including tables and figures to aid in data presentation. To make a synthesis of the assessments of methodological quality of the different studies, each instrument was rated by accounting for the number of studies performed with an instrument, the appraisal of methodological quality and the consistency of results between studies. RESULTS Twenty-one studies of 12 instruments were included in the review. The studies were diverse in their theoretical underpinnings, target population/setting and measurement objectives. Measurement objectives included: investigating beliefs, behaviors, attitudes, perceptions and relationships associated with collaboration; measuring collaboration between different levels of care or within a multi-rater/target group; assessing collaboration across teams; or assessing internal participation of both teams and patients.Studies produced validity or interpretability data but none of the studies assessed all validity and reliability properties. However, most of the included studies produced a factor structure or referred to prior factor analysis. A narrative synthesis of the individual study factor structures was generated consisting of nine headings: organizational settings, support structures, purpose and goals; communication; reflection on process; cooperation; coordination; role interdependence and partnership; relationships; newly created professional activities; and professional flexibility. CONCLUSIONS Among the many instruments that measure collaboration within healthcare settings, the quality of each instrument varies; instruments are designed for specific populations and purposes, and are validated in various settings. Selecting an instrument requires careful consideration of the qualities of each. Therefore, referring to systematic reviews of measurement properties of instruments may be helpful to clinicians or researchers in instrument selection. IMPLICATIONS FOR PRACTICE Systematic reviews of measurement properties of instruments are valuable in aiding in instrument selection. This systematic review may be useful in instrument selection for the measurement of collaboration within healthcare settings with a complex mix of participant types. Evaluating collaboration provides important information on the strengths and limitations of different healthcare settings and the opportunities for continuous improvement via any remedial actions initiated. IMPLICATIONS FOR RESEARCH Development of a tool that can be used to measure collaboration within teams of healthcare professionals and non-professionals is important for practice. The use of different statistical modelling techniques, such as Item Response Theory modelling and the translation of models into Computer Adaptive Tests, may prove useful. Measurement equivalence is an important consideration for future instrument development and validation. Further development of the COSMIN tool should include appraisal for measurement equivalence. Researchers developing and validating measurement tools should consider multi-method research designs.
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Affiliation(s)
- Stephen John Walters
- 1The Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia 2University of Adelaide, Australia
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Salgado M, Wendland M, Rodriguez D, Bohren MA, Oladapo OT, Ojelade OA, Mugerwa K, Fawole B. A service concept and tools to improve maternal and newborn health in Nigeria and Uganda. Int J Gynaecol Obstet 2017; 139 Suppl 1:67-73. [DOI: 10.1002/ijgo.12382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - Olufemi T. Oladapo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research Development and Research Training in Human Reproduction Department of Reproductive Health and Research WHO Geneva Switzerland
| | - Olubunmi A. Ojelade
- Department of Health Promotion and Education Faculty of Public Health College of Medicine University of Ibadan Ibadan Nigeria
| | - Kidza Mugerwa
- Department of Obstetrics and Gynecology College of Medicine University of Ibadan Ibadan Nigeria
| | - Bukola Fawole
- Department of Obstetrics and Gynecology Makerere University Kampala Uganda
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Affiliation(s)
| | - Claire Lemer
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Elspeth Webb
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dougal S Hargreaves
- Department of Population, Policy & Practice Programme, UCL Institute of Child Health, London, UK
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Abstract
Purpose
– The purpose of this paper is to review how patient and public involvement (PPI) can contribute to quality improvement functions and describe the levels of PPI in quality improvement functions at hospital and departmental level in a sample of European hospitals.
Design/methodology/approach
– Literature review and cross-sectional study.
Findings
– PPI takes multiple forms in health care and there is not a single strategy or method that can be considered to reflect best practice. The literature reveals that PPI can serve important functions to support quality improvement efforts. In contrast, the assessment of actual PPI in quality improvement shows that PPI is low.
Research limitations/implications
– Findings are not representative of hospitals in the EU.
Practical implications
– A diverse set of methods and tools that can be employed to realize PPI. Service providers should consider PPI at all stages, in particular in setting quality standards and criteria and in evaluating the results.
Originality/value
– Contextualization of empirical findings with case studies from the literature that inform further practice and research on PPI.
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Oladapo OT, Souza JP, Bohren MA, Tunçalp Ö, Vogel JP, Fawole B, Mugerwa K, Gülmezoglu AM. WHO Better Outcomes in Labour Difficulty (BOLD) project: innovating to improve quality of care around the time of childbirth. Reprod Health 2015; 12:48. [PMID: 26006170 PMCID: PMC4456059 DOI: 10.1186/s12978-015-0027-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 04/14/2015] [Indexed: 01/08/2023] Open
Abstract
As most pregnancy-related deaths and morbidities are clustered around the time of childbirth, quality of care during this period is critical to the survival of pregnant women and their babies. Despite the wide acceptance of partograph as the central tool to optimize labour outcomes for over 40 years, its use has not successfully improved outcomes in many settings for several reasons. There are also increasing questions about the validity and applicability of its central feature – “the alert line” – to all women regardless of their labour characteristics. Apart from the known deficiencies in labour care, attempts to improve quality of care in low resource settings have also failed to address and integrate women’s birth experience into quality improvement processes. It was against this background that the World Health Organization (WHO) embarked on the Better Outcomes in Labour Difficulty (BOLD) project to improve the quality of intrapartum care in low- and middle-income countries. The main goal of the BOLD project is to reduce intrapartum-related stillbirths, maternal and newborn mortalities and morbidities by addressing the critical barriers to the process of good quality intrapartum care and enhancing the connection between health systems and communities. The project seeks to achieve this goal by (1) developing an evidence-based, easy to use, labour monitoring-to-action decision-support tool (currently termed Simplified, Effective, Labour Monitoring-to-Action – SELMA); and (2) by developing innovative service prototypes/tools, co-designed with users of health services (women, their families and communities) and health providers, to promote access to respectful, dignified and emotionally supportive care for pregnant women and their companions at the time of birth (“Passport to Safer Birth”). This two-pronged approach is expected to positively impact on important domains of quality of care relating to both provision and experience of care. In this paper, we briefly describe the rationale for innovative thinking in relation to improving quality of care around the time of childbirth and introduce WHO current plans to improve care through research, design and implementation of innovative tools and services in the post-2015 era. Please see related articles ‘http://dx.doi.org/10.1186/s12978-015-0029-4’ and ‘http://dx.doi.org/10.1186/s12978-015-0028-5’.
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Affiliation(s)
- Olufemi T Oladapo
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, Geneva, 1201, Switzerland.
| | - João Paulo Souza
- Department of Social Medicine, Ribeirao Preto School of Medicine, University of São Paulo, Ribeirao Preto, São Paulo, 14010, Brazil.
| | - Meghan A Bohren
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, Geneva, 1201, Switzerland. .,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, Geneva, 1201, Switzerland.
| | - Joshua P Vogel
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, Geneva, 1201, Switzerland.
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kidza Mugerwa
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, Geneva, 1201, Switzerland.
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Bohren MA, Oladapo OT, Tunçalp Ö, Wendland M, Vogel JP, Tikkanen M, Fawole B, Mugerwa K, Souza JP, Bahl R, Gülmezoglu AM. Formative research and development of innovative tools for "Better Outcomes in Labour Difficulty" (BOLD): study protocol. Reprod Health 2015; 12:50. [PMID: 26006320 PMCID: PMC4464989 DOI: 10.1186/s12978-015-0028-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background Most complications during labour and childbirth could be averted with timely interventions by skilled healthcare providers. Yet, the quality and outcomes of childbirth care remains suboptimal in many health facilities in low-resource settings. To accelerate the reduction of childbirth-related maternal, fetal and newborn mortality and morbidity, the World Health Organization has initiated the “Better Outcomes in Labour Difficulty” (BOLD) project to address weaknesses in labour care processes and better connect health systems and communities. The project seeks to develop a “Simplified, Effective, Labour Monitoring-to-Action” tool (SELMA) to assist healthcare providers to monitor labour and take decisive actions more efficiently; and by developing an innovative set of service prototypes and/or tools termed “Passport to Safer Birth”, designed with communities and healthcare providers, to promote access to quality care for women during childbirth. This protocol describes the formative research activities to support the development of these tools. Methods/Design We will employ qualitative research and service design methodologies in eight health facilities and their catchment communities in Nigeria and Uganda. In the health facilities, focus group discussions (FGD) and in-depth interviews (IDI) will be conducted among different cadres of healthcare providers and facility administrators. In the communities, FGDs and IDIs will be conducted among women who have delivered in a health facility. We will use service design methods to explore women’s journey to access and receive childbirth care in order to innovate and design services around the needs and expectations of women, within the context of the health system. Discussion This formative research will serve several roles. First, it will provide an in-depth understanding of healthcare providers and health system issues to be accounted for in the final design and implementation of SELMA. Second, it will help to identify key moments (“touch points”) where women’s experiences of childbirth care are shaped, and where the overall experience of quality care could be improved. The synthesis of findings from the qualitative and service design activities will help identify potential areas for behaviour change related to the provision and experience of childbirth care, and serve as the basis for the development of Passport to Safer Birth. Please see related articles ‘http://dx.doi.org/10.1186/s12978-015-0027-6’ and ‘http://dx.doi.org/10.1186/s12978-015-0029-4’.
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Affiliation(s)
- Meghan A Bohren
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. .,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA.
| | - Olufemi T Oladapo
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Melanie Wendland
- M4ID - Leveraging new communication technology for development and health, Snellmaninkatu 15, 00170, Helsinki, Finland.
| | - Joshua P Vogel
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Mari Tikkanen
- M4ID - Leveraging new communication technology for development and health, Snellmaninkatu 15, 00170, Helsinki, Finland.
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Kidza Mugerwa
- Department of Obstetrics and Gynaecology, Makerere University, Kampala, Uganda.
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Brazil Av. Bandeirantes, 3900, Ribeirão Preto, SP, Brazil.
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
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Abstract
The involvement of all user groups, including children, young people (CYP) and their parents, encourages people to take responsibility for healthier lifestyle behaviours, improves treatment compliance and leads to more appropriate use of healthcare resources. Initiatives to engage CYP in the UK are gathering momentum, but significant improvements are still needed. There is a national drive from the department of health (DH) and NHS England, strategic clinical networks, operational delivery networks (including newborn networks), charities, parent groups and a number of other bodies to embed CYP involvement in service design and delivery. User engagement and patient choice, is underpinned by the NHS outcomes framework, and a myriad of other DH and NHS England policies and practice frameworks. It is now everybody's business.
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Affiliation(s)
- A R Bedford Russell
- Neonatal Intensive Care Unit (NICU), Birmingham Women's NICU, Birmingham, UK
| | - M Passant
- West Midlands Strategic Clinical Networks, NHS England, UK
| | - H Kitt
- Queens University Medical School Belfast, Belfast, UK
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