National ToT for

LaQshya Quality Improvement Cycles

15-16 October, 2018

LaQshya Quality Improvement cycle -1

Dr Ashutosh Sarwa (M.D.)

Senior Technical officer, PMU-LaQshya
Maternal Health Division, MoHFW
 CONTENT
• Objective
• Target
• Responsibilities of DCTs and Facility Quality
Circles
• Key activities for QI visits
• Outline of key activities during QI visits
• Way forward
 OBJECTIVE
Facilitating
availability of all
essential resources
required for
Strengthen Essential
Documentation
documentation
Practices
Capacity building of
providers for the use of the
relevant documents.

1. Real time Partograph

2. Safe Childbirth Checklist
3. Safe Surgical Checklist
 TARGETS
 At least 90% deliveries are
conducted using Safe Childbirth
Checklist and Surgical Safety
Checklists in Labour Room and
Maternity OT (If applicable)

 Partograph is generated using

real-time information in at least
90% deliveries in labour rooms
Responsibilities of District coaching team
 Facilitate Quality Circle formation/ functioning
 Assessment of:
 LR &OT on documentation process (LaQshya-NQAS, MPR*)
 Skill assessment (partograph) by OSCEs
 Facilitate Action Planning based on the identified gaps
 Facilitate mechanisms for ensuring availability of resources for
performing the practices related to documentations
 Onsite training and handholding of quality circle & LR and
Maternity OT staff

*Documentation of other key activities i.e. referral audit, MDSR,

C-section audit, Microbiological sampling is also important
 Responsibilities of Facility Quality Circle
Establish mechanism for :
 Uninterrupted supply of partograph, SCC, SSC and all the
registers/reporting formats
 Use of SCC in all the vaginal deliveries
 Use of SSC in all the C-sections
 Use of Partograph to monitor progress of all the deliveries
 Every staff is trained and skilled
 Entry of data in IT system and regular reporting of the
indicators in monthly progress report (MPR)*
 Review the current status of documentation processes

*Documentation of other key activities i.e. referral audit, MDSR,

C-section audit, Microbiological sampling is also important
 KEY ACTIVITIES FOR QI VISITS
QI Visits
S.
N.
Areas addressed during QI visit
1st 2nd 3rd 4th

1 Meeting with medical superintendent    

or facility in-charge
2 Assessment of labor room and  
maternity OT & skills of the staff

3 Facilitate quality circle to prepare an 

action plan for QI cycle-1
4 Mentoring on entire documentation    
(Need based) (Need based) (Need based)
practices

5 Follow up on action plan prepared   

during previous visit
 OUTLINE OF KEY ACTIVITIES DURING 1st QI VISITS
Quality circle DCT
Tasks  Facilitate Quality Circle  Mentoring on
formation/ functioning documentation
 Assessment of labour room & practices in labour
OT on documentation room and OT
process.
 Based on assessment ,
prepare action plan
Logistics • QI checklist (refer QI cycle 1) • Standardized case
sheets and records
Improveme • Establish a sustainable • Onsite training and
nt and mechanism as per action plan handholding
sustenance and gap identified
mechanism
 OUTLINE OF KEY ACTIVITIES DURING QI VISITS
Visit Outline Facility stakeholders to be involved in the task
Quality circle DCT

2nd, Follow up • Based on action plan • Based on

3rd and gap identified action plan
Visit and gap
identified
4th Follow up • Reassess the status • Reinforce the
Visit & re- of labour room & OT significance of
assessmen documentation documentatio
t process and start of n and start of
next cycle next cycle
 MENTORING SESSION PLAN
S.
Skills/practices Logisticsrequired Methodology
No.
1 Filling GoI’s GoI’s standard • Review of existing
standard maternity maternity Case maternity case sheets
case sheet sheet containing • Facilitated discussion
including SCC/SSC SCC/SSC
2 Filling GoI’s GoI’s standard LR • Review of existing
standard labour register register
room register • Facilitated discussion
3 Filling partograph,  Partograph  Review of filled
Identification and  Partograph partographs available
management of case study in the records
complications  Case study
 Facilitated discussion
 Onsite Mentoring
 WAY FORWARD
At the end of Cycle 1
• Identified gaps should be addressed by now
• Persisting ones should be resolved at the earliest
• Cycle 2 starts on the 60th visit day of cycle 1