FACILITY QUALITY TEAM/QUALITY

CIRCLE LABOUR WARD AND

MATERNITY OT

Dr R Shankar Shanmugam,PhD,MBA,CCHQ.,
Associate Professor/Reader in Nursing
College of Nursing ,Madras Medical College,
Chennai-3
 LABOUR ROOM QUALITY IMPROVEMENT
INITIATIVE

‘LaQshya’ programme of the Ministry of Health and Family

Welfare aims at improving quality of care in labour room
and maternity Operation Theatre (OT)
 GOAL

Reduce preventable maternal and newborn mortality,

morbidity and stillbirths associated with the care
around delivery in Labour room and Maternity OT
and ensure respectful maternity care.
 OBJECTIVES
 To reduce maternal and newborn mortality & morbidity due to APH,
PPH, retained placenta, preterm, preeclampsia & eclampsia,
obstructed labour, puerperal sepsis, newborn asphyxia, and sepsis, etc.
 To improve Quality of care from conception,during the delivery and
immediate post-partum care, stabilization of complications and ensure
timely referrals, and enable an effective two-way follow-up system.
 To enhance satisfaction of beneficiaries visiting the health facilities and
provide Respectful Maternity Care (RMC) to all pregnant women
attending the public health facility.

THE DRIVERS
 QI TEAM MEMBERS (SUGGESTED)
 Facility in-charge
 Senior Gynaecologist
 Medical Officer/Department IC
 Blood bank MO & Radiologist
 Matron/Nursing In-charge
 OT In-charge
 Support Staff like Housekeeping or security staff.
 Pharmacy / Store keeper
 Senior Lab Technician
 CSSD IC
 ANM & Maternity Asst.
 RESPONSIBILITIES OF THE QI TEAMS
 To work as a cohesive unit working towards specific goals and objectives of each rapid improvement cycle

 Ensuring adherence to Protocols & Clinical guidelines

 To conduct monthly meeting and discuss pertinent issues, monitoring of progress and prioritization of

actions to be taken.
 Assessment of Labour room & operation theatre using the Laqshya Departmental Check-lists and Gap

Analysis.
 Prioritisation and Action planning for closure of gaps as per ‘Maternal and New-born Health Toolkit’ and ‘

Guidelines for Standardisation of Labour Rooms at Delivery Points’

 Collation of data elements, required for monitoring of Indicators.

 Periodic and regular reporting of Indicators. Also analysis of indicators and making efforts to reach the

benchmarks.
 QUALITY CIRCLE

Quality Circle is a small group of 6 to 12 employees doing similar work

who voluntarily meet together on a regular basis to identify
improvements in their respective work areas using various techniques
for analyzing and solving work related problems coming in the way of
achieving and sustaining excellence leading to mutual upliftment of
employees as well as the organization. It is "a way of capturing the
creative and innovative power that lies within the work force“
 QUALITY CIRCLES
 Quality circles are informal groups of the staff in each department that works closely
to improve the QOC there
 These will be the main driver of quality improvement under Laqshya

 Dedicated Quality Circles has to be formed at Labour Room & Maternity OT

 Routine Meetings of Quality Circles

 Whoever works in the department. Eg. Labour room QC would involve of

Gynaecologist, Paediatrician, Matrons and Nursing Staff & Support Staff.
 Quality Team at facility level will facilitate and support
10 STEPS TO WARD LAQSHYA
OPERATIONALISE QUALITY CIRCLES- STEP 1
WHAT
WHO
 Quality circles are informal
 Whoever works in the
groups of the staff in each
department. Eg. Labor room
department that works closely
QC would involve of
to improve the QOC there
Gynecologist, Pediatrician,
 These will be the main driver of Matrons and Nursing Staff &
quality improvement under Support Staff.
Laqshya  Quality Team at facility level
 Dedicated Quality Circles has to will facilitate and support
be formed at Labor Room &
Maternity OT
 Routine Meetings of Quality
Circles
 BASELINE ASSESSMENT & REPORTING-STEP 2
WHAT
WHO
• Baseline Assessment of LR &
• Laqshya Internal Assessment –
Maternity OT using LaQshya
Quality Circle supported by
checklist
Quality Team
• Baseline Competence
• Laqshya Peer Assessment –
assessment of Labour Room
Coaching Team
staff using OSCE
• OSCE – Trained nursing
• Baseline Measurement facility
mentors/ Clinicians
level Indicators (Annexure C)
• Indicator – Measurement by
• Reporting of Laqshya, OSCE and
Quality Circle , verified by
Indicators to state
coaching team
ACTION PLANNING & PRIORITIZATION – STEP 3
WHAT
WHO
• Listing gaps identified in
Quality circles with support of
assessment process
coaching teams and facility level
• Categorizing gaps into local and quality teams
those requires external support
– facility level, district, state
• Reporting of HR and structural
requirements to state
• Action planning and
prioritization of actions
• Tracking of gap closure
 ORIENTATION & TRAINING- STEP 4
WHAT WHO
• Orientation on LaQshya • Orientation – Coaching teams /
program State Mentoring Group
• Training on clinical skills – • Dakshta - Skill Labs, Senior
Dakshta Nursing Staff/ Tutors
• Training on quality • Quality Improvement & RMC–
improvement – Assessment, Coaching Teams / QA units
PDCA, Quality Tools, Process
Improvement
• Training on Respectful
Maternal Care
 LABOUR ROOM STANDARDIZATION -STEP 5
WHAT
WHO
• Rearranging labor room in LDR
• Quality Circle with support of
format
hospital administration / Quality
• In space constrained facility teams
conventional LR should be as LR • HR and structural support to
standardization guidelines
provided
• Demarcation of triage and
assessment area
• Process redesigning
 CLIENT SATISFACTION SURVEYS-STEP 6
WHAT
WHO
• Exit feedback of Clients used
• Designated staff from Labour
Labour room & Ot services
room/ maternity Wards
• Mera Aspatal platform can be
• Analysis and corrective action
used
by quality circle supported by
• All clients should be contacted coaching team and hospital
for feedback administration
• Monthly collation & Analysis
• Corrective action on weak areas
of satisfaction
 STANDARD OPERATING PROCEDURES -STEP 7
WHAT
WHO
• Standard Operating Procedures
• Labour Room and OT incharges
for core and support processes
• Quality Circles, Quality Teams
• Documenting and standardizing
and Coaching Teams
the reorganized processes
• SOPs developed in participation
of process owners
• Sensitization of users and
insure availability
 RAPID IMPROVEMENT CYCLES (6) -STEP 8
WHAT WHO
• 6 focused quality improvement cycles
each for two months
• Quality Circles supported by
• First month for improvement followed by coaching teams
second month for sustaining improvement
• Improvement using PDCA approach and
quality tools
• Each cycle supported by onsite coaching
team visits
• Supported by resource package for each
cycle
• Onsite training and monitoring by coaches
• Documentation of improvement activities
 PERIODIC REVIEWS & AUDITS -STEP 9
WHAT WHO WHEN
• Maternal Death Audits • Facility Based
• Neonatal Death Audits Maternal Death •Audits -
Periodic Reviews & Audits
• Medical audit Review Committee Monthly Basis
• •Internal
• C-Section Audits New born Death
Review Committee Assessment –
• Referral Audits At least
• • Referral Audit
Near Miss Audits Quarterly
• Committee
Internal Assessment
• C-Section audit
(LaQshya)
committee
 CERTIFICATION, INCENTIVES, BRANDING -STEP 10
WHAT WHO WHEN

• External Assessment • Quality Circles •Once facility is confident

and Certification • Quality Team and of achieving the targets
against Laqshya and certification
Hospital
• Financial incentives for • Maximum 16 Months.
Administration
certification and But earlier is better
meeting the targets
• Branding of Labor room
as Gold , Silver and
Bronze