Using data to save lives
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They didn’t see it as one of those “usual projects” with people coming from somewhere else to the health centre or hospital to pick data, massage it, and send reports to donors for more funds. This was different: Frontline staff owned the whole improvement work.
From the innovative phase through to the third phase of this project, Project Fives Alive! (PFA), has been serving as a platform for continuous improvement even for health staff.
Our strategy in the hospitals has been to use quarterly learning sessions and monthly site visits to the facilities to increase their capacity in quality improvement (QI) to reduce mortality and morbidity in children under five years of age (Under-5).
Key staff directly involved in under-5 care are invited to the learning sessions: The doctor and nurse in the children’s ward, nurse in the maternity ward in charge of neonatal care, outpatient department (OPD) nurse, and health information officer. We look for invitees who are passionate about and willing to make changes from the usual practice that will make a baby live to see at least his or her fifth birthday.
Because the project promotes local ownership, one management sponsor is also invited to represent management interest; with this, management feels part of the improvement work and shares in the responsibilities.
The learning session is usually a two-day programme of sharing and learning among the sister hospitals in the Catholic network in a common province. The beauty of this innovation is that facilities are mandated to come with data on the process and outcome measures directly linked to under-5 care – for example, under-5 mortality, malaria case fatality, protocol adherence rate, cervical dilatation for mothers during labour, and stock out rate for consumables such as blood, antibiotics, and anti-malarials. These measures give an indication of how well the system is functioning, the lapses, and the critical points for improvement.
Again, bringing together facilities in the same province encourages peer-to-peer learning about best practices and evidence-based medicine. Participants have the opportunity to learn the core concepts of quality improvement (QI), such as systems thinking and the model for improvement; and QI tools such as process mapping, root cause analysis, and run charts.
The teaching and learning are so basic that all attendees can grasp and understand it well; and yet so powerful that attendees can use this learning to improve the hospital/system functioning. Each core team also makes a presentation to update the gathering on their data, highlight their strong points and weaknesses, and allow room for suggestions of improvement.
Through these learning sessions, PFA continues to build the technical capacity of health workers in the area of QI, which is quite new a public health approach in our country. The lives of the children under five are being saved, thanks to this different focus. We don’t just collect data; we now use data to help us understand how our systems are functioning. And we learn from our peers and improvement advisors how we can fix the system using quality improvement.
By Mrs Josephine Agyeman-Duah/Project Officer/Ghana
