Department of Pediatrics, University College of Medical Sciences, Delhi, India.
Department of Neonatology, Lady Hardinge Medical College, New Delhi, India
BMJ Open Qual. 2020 Aug;9(3). doi: 10.1136/bmjoq-2019-000908.
Hub and spoke model has been used across industries to augment peripheral services by centralising key resources. This exercise evaluated the feasibility of whether such a model can be developed and implemented for quality improvement across rural and urban settings in India with support from a network for quality improvement.
This model was implemented using support from the state and district administration. Medical colleges were designated as hubs and the secondary and primary care facilities as spokes. Training in quality improvement (QI) was done using WHO's point of care quality improvement methodology. Identified personnel from hubs were also trained as mentors. Both network mentors (from QI network) and hub-mentors (from medical colleges) undertook mentoring visits to their allotted facilities. Each of the participating facility completed their QI projects with support from mentors.
Two QI training workshops and two experience sharing sessions were conducted for implementing the model. A total of 34 mentoring visits were undertaken by network mentors instead of planned 14 visits and rural hub-mentors could undertake only four visits against planned 18 visits. Ten QI projects were successfully completed by teams, 80% of these projects started during the initial intensive phase of mentoring. The projects ranged from 3 to 10 months with median duration being 5 months.
Various components of a health system must work in synergy to sustain improvements in quality of care. Quality networks and collaboratives can play a significant role in creating this synergy. Active participation of district and state administration is a critical factor to produce a culture of quality in the health system.
轮辐式模型已在多个行业中得到应用，通过集中核心资源来增强外围服务。本研究旨在评估在印度农村和城市地区，利用质量改进网络的支持，是否可以开发和实施这种模式来实现质量改进。
本研究在州和地区行政部门的支持下实施。将医学院指定为中心，将二级和一级保健设施指定为轮辐。使用世界卫生组织（WHO）的即时质量改进方法进行质量改进（QI）培训。还培训了来自中心的指定人员作为导师。网络导师（来自 QI 网络）和中心导师（来自医学院）都对他们分配的设施进行了指导访问。每个参与的设施都在导师的支持下完成了他们的 QI 项目。
为实施该模型，共举办了 2 次 QI 培训研讨会和 2 次经验分享会议。网络导师共进行了 34 次指导访问，而不是计划的 14 次访问，农村中心导师只能进行 4 次访问，而不是计划的 18 次访问。10 个 QI 项目由团队成功完成，其中 80%的项目在指导的初始强化阶段开始。项目持续时间从 3 个月到 10 个月不等，中位数为 5 个月。
医疗体系的各个组成部分必须协同工作，以维持医疗质量的提高。质量网络和合作组织可以在创造这种协同作用方面发挥重要作用。地区和州行政部门的积极参与是在卫生系统中培养质量文化的关键因素。
