Coaching Intensity, Adherence to Essential Birth Practices, and Health Outcomes in the BetterBirth Trial in Uttar Pradesh, India

Barnhart, Dale A.; Spiegelman, Donna; Zigler, Corwin; Kara, Nabihah; Delaney, Megan Marx; Kalita, Tapan; Maji, Pinki; Hirschhorn, Lisa R.; Semrau, Katherine

doi:10.9745/ghsp-d-19-00317

Cited by 8 publications

(14 citation statements)

References 57 publications

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“…These findings are significant given other large-scale clinical quality improvement initiatives in Uttar Pradesh that find that high costs and sustained investments are critical to ensuring changes in clinical and non-clinical staff practices. 27 This study provides evidence that a light-touch, spread approach may improve outcomes beyond PCMC outcomes if appropriate strategies are identified in similar facilities.…”

Section: Discussionmentioning

confidence: 87%

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

Sudhinaraset

Giessler

Nakphong

et al. 2021

Sexual and Reproductive Health Matters

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Section: Discussionmentioning

confidence: 87%

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

Sudhinaraset

Giessler

Nakphong

et al. 2021

Sexual and Reproductive Health Matters

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“…Fifty-four supervision approaches demonstrated improvements in HRH outputs (95%), of which 36 cited improved skills, knowledge, or attitudes. Some studies demonstrated results at several levels of Bloom’s taxonomy of learning outcomes [ 50 ], from testing individual HCW knowledge and comprehension of health areas or tasks [ 11 , 51 – 53 ] to measuring the application of specific clinical tasks and adherence to standards of care [ 11 – 13 , 26 , 28 , 54 ]. Improved attitudes documented by the studies included improved job satisfaction, commitment, and conscientiousness [ 33 ]; increased awareness of the importance of posting facility job aids [ 55 ]; increased recognition and support [ 31 ], and attitudes toward patients [ 45 ].…”

Section: Resultsmentioning

confidence: 99%

Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

Deussom¹,

Mwarey²,

Bayu³

et al. 2022

Hum Resour Health

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Background The strength of a health system—and ultimately the health of a population—depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services. Methods The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions’ effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs. Results Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact. Conclusion Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.

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“…Recent large-scale studies in Uttar Pradesh have shown both the potential to change some common practices among both clinical and non-clinical staff, and highlighted the high cost and long-term investments needed to effect those changes [18,19]. The Quality Improvement (QI) literature has documented both the sustained effect, and the gradual change and simplification of interventions over time in hospital settings [20].…”

Section: Challengementioning

confidence: 99%

“…The Quality Improvement (QI) literature has documented both the sustained effect, and the gradual change and simplification of interventions over time in hospital settings [20]. Team-based QI interventions demand significant time and resources commitments and so there has been experimentation in many settings with "Light Touch" variations [21][22][23][24]. We conducted a study to see if a lessdemanding Light Touch intervention could produce improvments in person-centered care similar to a fullintensity QI initiative.…”

Section: Challengementioning

confidence: 99%

A comparison of intensive vs. light-touch quality improvement interventions for maternal health in Uttar Pradesh, India

Montagu

Giessler

Nakphong

et al. 2020

BMC Health Serv Res

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Background Poor patient experiences during delivery leads to delayed presentation at facilities and contributes to poor maternal health outcomes. Person-centered maternity care (PCMC) is a key component of quality. Improving PCMC requires changing the process of care which can be complex and necessitate significant external input, making replication and scale difficult. This study compares the effectiveness two Quality Improvement (QI) intervention phases, one Intensive, one Light-Touch. Methods We use a matched case-control design to compare two phases of a QI Intervention targeting PCMC, with three facilities in each. The Intensive phase was introduced into three government facilities where teams were supported to identify, design, and test potential improvements over 12 months. The Light-Touch phase was subsequently introduced in three other government facilities and changes were tracked over six months. We compared the two groups using multivariate linear regression and difference-in-difference models to assess changes in PCMC outcome Results Both Intensive and Light-Touch arms demonstrated large improvements in PCMC. On a scale from 0 to 100, Intensive facilities increased in PCMC scores from 85.02 to 97.13, while Light-Touch facilities increased from 63.42 to 87.47. For both there was a ‘halo’ effect, with a similar improvement recorded for the specific improvement activities focused on, as w ell as aspects of PCMC not directly addressed. Conclusions This study demonstrates that a short, inexpensive, light-touch and directive intervention can change staff practices and significantly improve the experiences of women during childbirth. It also shows that improvements in a few areas of provider-patient interaction have a ‘halo’ effect, changing many other aspects of patient-provider interaction at the same time. Trial registration QI Phase 1 - NCT04208867. Retrospectively registered. December 19th, 2019. QI Phase 2 –NCT04208841. Retrospectively registered. December 23, 2019.

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Coaching Intensity, Adherence to Essential Birth Practices, and Health Outcomes in the BetterBirth Trial in Uttar Pradesh, India

Cited by 8 publications

References 57 publications

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

Can changes to improve person-centred maternity care be spread across public health facilities in Uttar Pradesh, India?

Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

A comparison of intensive vs. light-touch quality improvement interventions for maternal health in Uttar Pradesh, India

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