Person Centred Care Through Shared Leadership (Bihar)

Problem Statement

Banka district hospital is the CEmONC centre for a population of more than 2 million across a geographic area of 3020 sq. km. Among many challenges, there was low rate of 1.02% C-sections, which was not assuredly available (most cases were referred to higher facilities at night despite 3 pairs of surgeons and anaesthetists). The office orders clearly was not helping the local team take up the responsibility.

Programme Description

The hospital leadership and frontline workers participated in Continuous Quality Improvement (CQI) Collaborative of Bihar State Health Society since February 2018 which primarily focussed on human psyche and humane aspects of change. The leadership and coaching workshops conducted ensured buy-in of commitment and accountability from civil surgeons, medical superintendents, district Programme managers and hospital managers while orienting them about role of a coach. The frontline staff and leadership was sensitized on system thinking and collaboration. The focus was on building a culture of trust and transparency . Labour room nurses were encouraged by hospital leadership to bihar report complications, LAMA, referrals, near misses without fear so that further corrections and amendments could be made. As a demonstration of doing the deputy superintendent himself started doing C-sections after his EmOC training. Consistent engagement and regular interaction between the entire team has kept things improving. Intrinsic motivation was built in the staff by storytelling of real experiences, felicitation of champions and engaging with all team members over tea on a weekly basis which nurtured informal relationship and strengthened team work. Strengthening existing data systems and transparency regarding results and progress was also emphasized.

Programme Outcomes

C-section rate improved from the baseline median of 1% and achieved the monthly target of 5% from January 2019 to May 2019. Patients satisfaction surveys scored an average 84 out of 100 marks in the month of July 19.

It was concluded that high impact leadership behaviours by hospital leadership and staff with support from District Health Society and Civil Surgeon, were important key enablers for improvement in services. 

Scalability

Positive results from this Programme indicate a potential of combining appropriate leadership capacity building in science of continuous improvement

Implementation Partners

Care, India and Institute for Healthcare Improvement

Financial Implications

Within the resources made available to the district by State and NHM

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019