Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
BMC Pregnancy Childbirth. 2024 Apr 4;24(1):239. doi: 10.1186/s12884-024-06450-x.
Poor intrapartum care in India contributes to high maternal and newborn mortality. India's Labor Room Quality Improvement Initiative (LaQshya) launched in 2017, aims to improve intrapartum care by minimizing complications, enforcing protocols, and promoting respectful maternity care (RMC). However, limited studies pose a challenge to fully examine its potential to assess quality of maternal and newborn care. This study aims to bridge this knowledge gap and reviews LaQshya's ability to assess maternal and newborn care quality. Findings will guide modifications for enhancing LaQshya's effectiveness.
We reviewed LaQshya's ability to assess the quality of care through a two-step approach: a comprehensive descriptive analysis using document reviews to highlight program attributes, enablers, and challenges affecting LaQshya's quality assessment capability, and a comparison of its measurement parameters with the 352 quality measures outlined in the WHO Standards for Maternal and Newborn Care. Comparing LaQshya with WHO standards offers insights into how its measurement criteria align with global standards for assessing maternity and newborn care quality.
LaQshya utilizes several proven catalysts to enhance and measure quality- institutional structures, empirical measures, external validation, certification, and performance incentives for high-quality care. The program also embodies contemporary methods like quality circles, rapid improvement cycles, ongoing facility training, and plan-do-check, and act (PDCA) strategies for sustained quality enhancement. Key drivers of LaQshya's assessment are- leadership, staff mentoring, digital infrastructure and stakeholder engagement from certified facilities. However, governance issues, understaffing, unclear directives, competency gaps, staff reluctance towards new quality improvement approaches inhibit the program, and its capacity to enhance quality of care. LaQshya addresses 76% of WHO's 352 quality measures for maternal and newborn care but lacks comprehensive assessment of crucial elements: harmful labor practices, mistreatment of mothers or newborns, childbirth support, and effective clinical leadership and supervision.
LaQshya is a powerful model for evaluating quality of care, surpassing other global assessment tools. To achieve its maximum potential, we suggest strengthening district governance structures and offering tailored training programs for RMC and other new quality processes. Furthermore, expanding its quality measurement metrics to effectively assess provider accountability, patient outcomes, rights, staff supervision, and health facility leadership will increase its ability to assess quality improvements.
印度的分娩期护理不足导致产妇和新生儿死亡率居高不下。印度于 2017 年启动了产房质量改进倡议（LaQshya），旨在通过最小化并发症、执行协议和促进尊重产妇护理（RMC）来改善分娩期护理。然而，有限的研究对充分评估其评估产妇和新生儿护理质量的潜力构成了挑战。本研究旨在弥补这一知识差距，并回顾 LaQshya 评估产妇和新生儿护理质量的能力。研究结果将为增强 LaQshya 的有效性提供指导。
我们通过两步法回顾了 LaQshya 通过评估护理质量的能力：使用文件审查进行全面描述性分析，以突出计划属性、推动者和影响 LaQshya 质量评估能力的挑战；并将其测量参数与世界卫生组织（WHO）产妇和新生儿护理标准中概述的 352 项质量措施进行比较。将 LaQshya 与世界卫生组织标准进行比较可以深入了解其测量标准如何与评估产妇和新生儿护理质量的全球标准保持一致。
LaQshya 利用了一些经过验证的催化剂来增强和衡量质量——机构结构、经验措施、外部验证、认证和高质量护理的绩效激励。该计划还体现了当代方法，如质量圈、快速改进周期、持续的设施培训以及计划-执行-检查-行动（PDCA）策略，以持续提高质量。LaQshya 评估的关键驱动因素是——领导力、员工指导、数字基础设施和来自认证设施的利益相关者参与。然而，治理问题、人手不足、指令不明确、能力差距、员工对新质量改进方法的抵触情绪都抑制了该计划及其提高护理质量的能力。LaQshya 解决了世界卫生组织 352 项产妇和新生儿护理质量措施中的 76%，但缺乏对关键要素的全面评估：有害的分娩实践、对母亲或新生儿的虐待、分娩支持以及有效的临床领导和监督。
LaQshya 是评估护理质量的有力模式，超过了其他全球评估工具。为了充分发挥其潜力，我们建议加强地区治理结构，并为 RMC 和其他新的质量流程提供量身定制的培训计划。此外，扩大其质量测量指标以有效评估提供者的问责制、患者的结果、权利、员工监督和卫生机构的领导力，将提高其评估质量改进的能力。
