Academic journal article Bulletin of the World Health Organization

Adaptation and Implementation of Local Maternity Dashboards in a Zimbabwean Hospital to Drive Clinical improvement/Adaptation et Mise En Oeuvre De Tableaux De Bord De Maternite Locaux Dans Un Hopital Du Zimbabwe Pour Stimuler Les Ameliorations cliniques/Adaptacion Y Aplicacion De Paneles De Maternidad Locales En Un Hospital De Zimbabwe Para Impulsar Una Mejora Clinica

Academic journal article Bulletin of the World Health Organization

Adaptation and Implementation of Local Maternity Dashboards in a Zimbabwean Hospital to Drive Clinical improvement/Adaptation et Mise En Oeuvre De Tableaux De Bord De Maternite Locaux Dans Un Hopital Du Zimbabwe Pour Stimuler Les Ameliorations cliniques/Adaptacion Y Aplicacion De Paneles De Maternidad Locales En Un Hospital De Zimbabwe Para Impulsar Una Mejora Clinica

Article excerpt

Introduction

Global efforts to improve maternal and perinatal health continue. However, quality improvement demands quality measurement: we can only improve things we can measure. Moreover, if we wish to make rapid improvements in quality, we must make measurement easier, more timely and more understandable. (1) The relevant information must be available to those who need it. (2)

In many countries, national maternal and perinatal mortality data are already collected locally in a variety of formats and are submitted to national and international bodies. (3) This process often produces summary data that cover a long period of time. However, lengthy time lags are inevitable and make it difficult for both front-line staff and managers to identify and deal with local problems quickly enough to prevent further harm. This, we believe, is one of the crucial failings of otherwise commendable attempts to improve maternal and perinatal outcomes around the world. The Commission on Information and Accountability for Women's and Children's Health of the World Health Organization (WHO) has recognized that, in resource-poor settings, health outcome data are often out of date and of questionable quality and are "therefore, not timely enough for practical use by health planners and administrators". (4)

In high-income countries, health-care quality is increasingly being monitored in local settings using performance score cards, such as "clinical dashboards". (5) In the United Kingdom of Great Britain and Northern Ireland, for example, the Royal College of Obstetricians and Gynaecologists has recommended the use of a maternity dashboard for all maternity units. (2) The dashboard graphically presents changes over time in performance statistics and quality indicators by using a red-amber-green, traffic-light coding system to alert users to changes in the frequency of selected parameters. In high-income countries, maternity dashboards have been shown to be a feasible way of prospectively and continuously monitoring clinical outcomes. On one occasion, a maternity dashboard enabled an otherwise unrecognized adverse trend in a perinatal outcome to be detected. This trend was addressed by a training intervention that led to improvements in care and outcomes. (6) Nonetheless, since 99% of maternal deaths occur in the developing world, the use of data for improving outcomes should not be restricted to high-income countries.

Local setting

The aim of this project was to assess the feasibility of adapting maternity dashboards for, and introducing them into, the Mpilo Central Hospital in Bulawayo, Zimbabwe, which is a public, tertiary referral hospital that handles around 10 000 births each year. In common with all Zimbabwean hospitals, Mpilo Central Hospital submits paper-based, quarterly maternity outcome statistics to the Ministry of Health and Child Welfare. The data, which are collated by "reproductive health officers", include the numbers of births, caesarean sections, maternal deaths, admissions to special care baby units, stillbirths and neonatal deaths. However, as occurs in many other similar systems, the data are not readily available or accessible to local practitioners in a suitable form. Even if the data were available, however, reports are compiled only four times a year and it would still be at least 3 months--a period during which 2500 births would have taken place at Mpilo Central Hospital--before any adverse trends were apparent. Would it be feasible to review the data more frequently, perhaps at monthly intervals?

In November 2011, the Mpilo Central Hospital began running one-day, interdisciplinary, practical obstetric multiprofessional training (PROMPT) courses for all maternity staff on the labour ward. In addition, several tools were provided to improve the local work environment, including emergency boxes containing management protocols and the equipment required for managing emergencies. …

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