Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul;10(Suppl 1):e001449.
doi: 10.1136/bmjoq-2021-001449.

Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons

Vikram Datta  1   2 , Sushil Srivastava  3 , Rahul Garde  4 , Rajesh Mehta  5 , Nigel Livesley  6 , Kedar Sawleshwarkar  7 , Harish Pemde  8 , Suprabha K Patnaik  9 , Ankur Sooden  10   11 , Mahtab Singh  12 , Susy Sarah John  13 , Jeena Pradeep  14 , Anupa Vig  15   16 , Achala Kumar  14 , Vivek Singh  17 , Vandana Bhatia  18 , Bishan Singh Garg  19 , Dinesh Baswal  20
Affiliations

Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons

Vikram Datta et al. BMJ Open Qual. 2021 Jul.

Abstract

Background: Inadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point of care quality improvement (POCQI) method has been developed. This paper describes developing a dynamic framework for the implementation of POCQI across India from 2015 to 2020.

Methods: A total of 10 intervention strategies were designed as per the needs of the local health settings. These strategies were implemented across 10 states of India, using a modification of the 'translating research in practice' framework. Healthcare professionals and administrators were trained in POCQI using a combination of onsite and online training methods followed by coaching and mentoring support. The implementation strategy changed to a fully digital community of practice platform during the active phase of the COVID-19 pandemic. Dashboard process, outcome indicators and crude cost of implementation were collected and analysed across the implementation sites.

Results: Three implementation frameworks were evolved over the study period. The combined population benefitting from these interventions was 103 million. A pool of QI teams from 131 facilities successfully undertook 165 QI projects supported by a pool of 240 mentors over the study period. A total of 21 QI resources and 6 publications in peer-reviewed journals were also developed. The average cost of implementing POCQI initiatives for a target population of one million was US$ 3219. A total of 100 online activities were conducted over 6 months by the digital community of practice. The framework has recently extended digitally across the South-East Asian region.

Conclusion: The development of an implementation framework for POCQI is an essential requirement for the initiative's successful country-wide scale. The implementation plan should be flexible to the healthcare system's needs, target population and the implementing agency's capacity and amenable to multiple iterative changes.

Keywords: health services research; healthcare quality improvement; implementation science.

PubMed Disclaimer

Conflict of interest statement

Competing interests: RM is employed with the WHO-SEAR Office. He was responsible for the release of funds for some of the implementing strategies described in the paper. VS, VB are employed by UNICEF India and Madhya Pradesh field offices respectively, they were responsible for the release of funds for some of the implementing strategies described in the paper.The funding agencies had no bearing on methodology, data collection, data analysis and results reported in this paper. The opinions expressed herein are those of the authors and do not necessarily represent the official views of the WHO or UNICEF.

Figures

Figure 1
Figure 1
Adapted TRIP framework for implementing Point Of Care Quality Improvement (POCQI) method.
Figure 2
Figure 2
Factors influencing the development of implementation framework for QI initiatives. QI, quality improvement.
Figure 3
Figure 3
Evolution of Implementation framework—2015–17.
Figure 4
Figure 4
Evolution of Implementation framework—2017–18.
Figure 5
Figure 5
Evolution of Implementation framework—2018–20.
See this image and copyright information in PMC

References

    1. Horton R, Beaglehole R, Bonita R, et al. . From public to planetary health: a manifesto. Lancet 2014;383:847. 10.1016/S0140-6736(14)60409-8 - DOI - PubMed
    1. Kruk ME, Gage AD, Arsenault C, et al. . High-Quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health 2018;6:e1196–252. 10.1016/S2214-109X(18)30386-3 - DOI - PMC - PubMed
    1. Morton S, Pencheon D, Squires N. Sustainable development goals (SDGs), and their implementation: a national global framework for health, development and equity needs a systems approach at every level. Br Med Bull 2017;124:81–90. 10.1093/bmb/ldx031 - DOI - PubMed
    1. Sankar MJ, Neogi SB, Sharma J, et al. . State of newborn health in India. J Perinatol 2016;36:S3–8. 10.1038/jp.2016.183 - DOI - PMC - PubMed
    1. Rao KD, Shahrawat R, Bhatnagar A. Composition and distribution of the health workforce in India: estimates based on data from the national sample survey. WHO South East Asia J Public Health 2016;5:133–40. 10.4103/2224-3151.206250 - DOI - PubMed