Sustainability & Real stories on Quality Improvement Mrs Meena Joshi ,Nurse Educator WHO Collaborating Centre for Training and Research in Newborn Care, All India Institute of Medical Sciences, New Delhi, India

Learning Objective You will learn How to embed successful changes into health system to sustain the improvement in quality of care Engage and motivate team to view QI as culture by improvement thus improving work culture across health facility for providing better care 21-11-2018

Hardwiring of QI Project Documenting the flow of the new process Providing training on the new process Teaching people new skills that might be required of them Making changes in job description, policies Addressing supplies and equipment issues Removing any barriers so as to prevent slippage back to old process 21-11-2018

Tinkering VS System Change Problem Tinkering System Change Standardized prescription form sets to minimize need for hand writing Physician orders are illegible, causing medication errors Chastise physicians, tell them to work harder Penalize nurses/sanction nurses who are non compliant Oximeter alarms not set as ordered Modify alarm defaults Breast milk use is low for premature babies Suggest hospital to hire lactation consultants Create process to improve efficient use of breast pumps 21-11-2018

How To Keep Members Involved In QI ? Regularly share run chart/data Reminders on SMS/ what’s app Involve Head of Department and Faculty on floor Share the stories with Nursing Officers / MS 21-11-2018

How To Motivate Team Members ? Give opportunities to team to share experience in physicians and nurses workshops Assigning QI to multiple team leaders who are interconnected Everyone reports to QI leader in joint meetings 21-11-2018

Visual Display of Data Regular sharing of data of QI project Display on board and communicate to others After the project has shown positive results continue on regular epochs with eye on measurement 21-11-2018

Visual Display of Data 21-11-2018

Sustenance Of The Expressed Breast Milk Quantity of milk expressed on Day1 Sustainability of EBM after 2 years, March 2017 Proportion of neonates fed on own mothers milk

Choosing New Problems By Consensus Easy ,simple to solve, within our control Are impactful and are important for improving care No additional resources are needed Ideas emanate from discussions within the unit

Story of Teamwork With Sustenance Involving parents ,nurses & doctors Staff did a QI project in increasing duration of KMC Team consisted of mothers , nurses & doctors The unit implemented changes as per suggestion of team members during weekly meetings Able to sustain the gains with regular feedback and reminders during rounds by faculty

New Problem Arose Breakages of warmer probes while mother were providing KMC to sick babies Despite nurses education and being diligent, probes life still remained short Mother’s education using flip charts in local language resulted in increasing life of probe ! https://www.youtube.com/watch?v=JUMhyWKRkL4

Making Policies for Continuous QI 21-11-2018

Keys To Sustenance There is more ! Celebrate success Team of volunteers and highly motivated participants Recognising champions Positive attitude Inculcating QI as a culture

Key Messages Sustenance often requires system changes ( like ensuring breast pumps for expression ) Changes which lead to less work ( like changing process flow in labor room ) or made life easier for the health workers or regular visual display of data ( run charts for KMC duration) are more sustainable Making policy , so that new recruits are exposed to standards of care Leadership involvement is crucial to success 21-11-2018

THANK YOU 21-11-2018