Linking process data to outcome data; unexpected things I learned at Quality Improvement forum
By Paul Mubiri | During the most recent quality improvement (QI) learning session under the Preterm Birth Initiative study, several events took place. First, we saw four health facilities in this collaborative making presentations of their own process data and later link it to their outcome data.
A number of health workers that presented articulately walked the audience through their journey of where they started from (baseline) to the present day. For example, many started with very lower percentages for use of partograms in monitoring labour and the different change ideas that brought about the change to achieve the high percentage (about 90%).
What was more interesting to learn was their recognition of unacceptable levels they started from and owned up the process with the support of a QI coach. They acknowledged there were system related challenges that hindered their progress. however, through QI many of the challenges were found to be within their control to address and those beyond their control the health facility managers handled. I saw team spirit, concern to provide better care, enthusiasm, a culture that has developed among many more others.
The QI expert from Ghana took it over to engage the health workers of their most recent neonatal deaths and analyze the events surrounding the death and thereafter present and engage with the audience to identify gaps in their systems that might have contributed to the death and how we can avert the next death. This session was very educative and informative sessions that allow a different set of eyes to highlight gaps and remedies to these gaps. Unlike the previous learning sessions, the health workers were more receptive to feedback and engaged the doctors, fellow midwives of possible solutions.
However, despite the tremendous progress in the processes, health workers struggled to link the process data to outcome data. With many still struggling to clearly demonstrate how these processes relate to outcomes. None the less, we are currently developing various mechanisms of linking process data to outcome data including beginning to plot both process and outcome data side by side. Techniques such as run chart rules have been highlighted during the QI learning sessions and validated widely by the QI practitioners to determine whether there is evidence of improvement or change without necessarily using more complex statistics. There is great need to link quality improvements projects processes to outcomes if we are really to sustain the change ideas and inculcate these as part of the system.
Mr Paul Mubiri is the Data manager for PTBi-EA in Uganda