Centro per la Salute del Bambino, Trieste, Italy.
International perinatal care consultant, Trieste, Italy.
J Glob Health. 2020 Dec;10(2):020433. doi: 10.7189/jogh.10.020433.
Information about the use of the findings of quality assessments in maternal and neonatal (MN) care is lacking and the development of tools capable to effectively address quality gaps is a key priority. Furthermore, little is known about factors that act as barriers or facilitators to change at facility level. Based on the extensive experience made with the WHO Quality Assessment and Improvement MN (QA/QI MN) tool, an overview is provided of the improvements in quality of care (QoC) which were obtained over time and of the factors influencing change.
All documented reports on the implementation of the WHO QA/QI MN tool were searched and screened for inclusion. Reports were considered if bringing evidence from both the baseline assessment and the reassessment. Changes were considered in four domains: maternal care, neonatal care, infrastructure and policies, with reference made to WHO maternal and neonatal care standards. The observed improvements were categorized according to intensity and extent across the sample of health facilities. Factors influencing change were categorized into internal and external and further classified as barriers or facilitators.
Changes were documented after an average period of 1.2 years from first assessment in 27 facilities belonging to 9 different countries in Central and Eastern Europe (3), Central Asia (3), sub-Saharan Africa (2) and Latin America (1). Improvements were observed in all areas of care but were greater and more frequently observed in areas related to appropriate case management and respectful care for both mothers and newborns. Although widespread across most facilities and countries, the observed improvements were not covering all the quality gaps observed at the baseline assessment nor were always sufficient to achieve standard care. Factors facilitating change as well as barriers were mainly related to the capacity of the managers and head of units to involve and motivate their staff members.
The use of WHO QA/QI MN tool proved effective in promoting significant changes in quality of care. The review of observed improvements and of factors influencing change at facility level shows that participatory assessment tools that promote a constructive dialogue with hospital managers and staff and support them in acquiring capacity in this role are crucial to implement effective quality cycles.
关于在孕产妇和新生儿（MN）护理中使用质量评估结果的信息缺乏，开发能够有效解决质量差距的工具是当务之急。此外，对于影响医疗机构层面变革的因素知之甚少。基于在世界卫生组织（WHO）质量评估和改进 MN（QA/QI MN）工具方面的丰富经验，本文概述了随着时间的推移在护理质量（QoC）方面取得的改进以及影响变革的因素。
搜索并筛选了所有关于实施 WHO QA/QI MN 工具的记录报告，以纳入研究。如果报告同时提供了基线评估和重新评估的证据，则认为其符合纳入标准。变化在四个领域进行了评估：孕产妇护理、新生儿护理、基础设施和政策，并参考了世卫组织孕产妇和新生儿护理标准。观察到的改进根据卫生设施样本中的强度和范围进行了分类。影响变革的因素分为内部和外部因素，并进一步分为障碍或促进因素。
在 9 个不同国家的 27 家医疗机构中，从第一次评估开始，平均 1.2 年后记录到了变化，这些国家分布在中欧和东欧（3 个）、中亚（3 个）、撒哈拉以南非洲（2 个）和拉丁美洲（1 个）。所有护理领域都观察到了改进，但在与适当病例管理和对母亲和新生儿的尊重护理相关的领域，改进更为显著和频繁。尽管在大多数医疗机构和国家都广泛存在，但观察到的改进并未涵盖基线评估中观察到的所有质量差距，也并非总是足以实现标准护理。促进变革的因素以及障碍主要与管理人员和单位负责人的能力有关，他们能够使员工参与并激励他们。
WHO QA/QI MN 工具的使用证明了其在促进护理质量的重大变革方面是有效的。对医疗机构层面观察到的改进和影响变革的因素的审查表明，促进与医院管理人员和员工进行建设性对话并支持他们在这一角色中获得能力的参与式评估工具对于实施有效的质量周期至关重要。
