Monitoring: approaches, achievements and perspectives

Monitoring as a tool for improving the

perinatal care quality

• Inspection!

• Just a visit, but no relationship is established.

• Command approach instead of supervisory functions.

• Emphasis on personality instead of the process.

• Dealing with issues in a sporadic way.

• Lack of follow-up, consistency and continuity.

Main objective

Determine existing problems

in order to find ways to resolve

them

ManualI n s t r u c t i o n

on monitoring visits conducting in the frame of the Swiss-Ukrainian

“Mother and Child Health” Programme

implementation

Form 1. General information about the health care facility.

Form 2. Organisation of health care in the units.

Form 3. The health care facility performance indicators (for 12 months).

Form 4. Monitoring of the neonatal intensive careunit/room and the postnatal unit, an interview with a neonatologist.

Form 5. Interview with a children’s nurse.

Form 6. Interview with an obstetrician.

Form7. Antenatal observation

In case of multiple pregnancy and

pregnancy after the Caesarian

Section (interview with a

antenatal clinic head or a doctor)

Form 8. Interview with a mother

Creation of monitoring teams

1. Obstetricians:

– Chief obstetrician of the Health Care and Resorts Department,

– District obstetricians.

2. Neonatologists:

– Chief obstetrician of the

Health Care and Resorts

Department,

– neonatologists.

Team training• Teaching the basic course

materials

• Teaching to conduct monitoring visits.

Conditions for conducting a visit (1)• Available team of trained specialists.• Advise the health care facility at least two

weeks prior to the visit. • Prepare required forms and documents. • The facility should fill in forms №1 and № 2 for

the reporting period. –The team of specialists should analyze the

completed forms and prepare questions before the visit.

–The team should also analyze reports of the previous visits.

Conditions for conducting a visit (2)

• Make changes in the standard visit program according to the facility’s particular issues.

• Prepare clinical cases. • Ask to prepare medical records of pregnant

women, mothers and newborns. –Unclear cases.–Cases of long APV in the clinic.–Cases of newborns with body weight under

1500,0 in the central district clinic.

The visit objectives (1)• To consolidate the health care

workers’ theoretical knowledge and practical skills.

• Help the health care workers to correctly introduce and use obtained skills in their daily practice.

• Assess factors influencing performance in the facility.

The visit objectives (2)• Collect and analyze main performance

indicators.

• Identify problems of the health care workers.

• Help the management and

health care workers to resolve

the problems identified .

• Draw up a report with clear

recommendations.

The visitstructure:

1. Familiarisation of the

facility personnel with the

visit objectives and

procedures 2. Monitoring of the

health care

organisation

and provision3. Analysis of the

conditions (premises,

equipment)

5. Documentation and

performance analysis 6. Summary of

the problems and

helping to

resolve themReport

Clinical cases

(situational tasks)

Practical

skills

Practical

cases4. Interviews with

the health care

workers and

women

Wrap-up meeting

with the personnel

and the

management

Familiarisation of the facility personnel with the visit objectives and procedures

–What has

changed?

–Difficulties?

–Proposals

–Help

Analysis of the available conditions (rational distribution of premises and equipment)

Interview with a neonatologist and a

children’s nurse

Interview with an obstetrician

Interviews with mothers

Documentation and performance analysis

Summarisation of the problems and helping

to resolve them

Wrap-up meeting with the health care workers and managers

Thank Remind Ask Listen

attentively Summarize Add

Final report

Ways to resolve

the existing problems

As a result of the monitoring visits

• The number of beds in the maternity clinics was optimized by closing small clinics (less then 400 births per year):

Ivano-Frankivsk region - 2, Vinnytsia region - 6.• Reconstruction of the maternal units (optimal

zoning): Ivano-Frankivsk region - 4, Volyn region - 3, Vinnytsia - 4.

Local protocols approval

Region

Local

visits

Including

experts

Total

Vinnytsia region 29 18 47

Volyn region 26 17 43

Ivano-Frankivsk

region

14 21 35

AR Crimea (as of

February 2014)

5 14 19

Number of the monitoring visitsTotal: 144

Peer-to-Peer monitoring visits• To observe how health care practitioners

work in other regions.

• To exchange experience in monitoring.

• An opportunity to bring to your region new effective approaches to perinatal care from another region.

ProspectsMonitoring teams will continue to visit

regional health care facilities. The monitoring results are used:• In preparing issues to be considered at

the collegium meetings.• In the work of the clinical experts

commission for assessing the health care quality for certain patients or patients groups.

• In taking operational and strategic decisions by the health care managers.

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