1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. Visual Display of Data

9. 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

10. 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

11. 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

12. 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 !

13. Making Policies for Continuous QI

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

15. 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

16. THANK YOU