Development of a hub and spoke model for quality improvement in rural and urban healthcare settings in India: a pilot study

Abstract

ObjectiveHub and spoke model has been used across industries to augment peripheral services by centralising key resources. This exercise evaluated the feasibility of whether such a model can be developed and implemented for quality improvement across rural and urban settings in India with support from a network for quality improvement.MethodsThis model was implemented using support from the state and district administration. Medical colleges were designated as hubs and the secondary and primary care facilities as spokes. Training in quality improvement (QI) was done using WHO’s point of care quality improvement methodology. Identified personnel from hubs were also trained as mentors. Both network mentors (from QI network) and hub-mentors (from medical colleges) undertook mentoring visits to their allotted facilities. Each of the participating facility completed their QI projects with support from mentors.ResultsTwo QI training workshops and two experience sharing sessions were conducted for implementing the model. A total of 34 mentoring visits were undertaken by network mentors instead of planned 14 visits and rural hub-mentors could undertake only four visits against planned 18 visits. Ten QI projects were successfully completed by teams, 80% of these projects started during the initial intensive phase of mentoring. The projects ranged from 3 to 10 months with median duration being 5 months.DiscussionVarious components of a health system must work in synergy to sustain improvements in quality of care. Quality networks and collaboratives can play a significant role in creating this synergy. Active participation of district and state administration is a critical factor to produce a culture of quality in the health system.

Facilitators, barriers and considerations for the implementation of healthcare innovation: A qualitative rapid systematic review

“… % represented the percentage of papers that identified the subtheme as important; a. Addis et al., 2019; b. Ahmed et al., 2020; c. Barnett et al., 2011; d. Conway et al., 2019; e. Ho et al., 2019; f. Katzman et al., 2016; g. Keddem et al., 2020; h. Ross et al., 2018; i. Shrubsole, 2019; j. Srivastava et al., 2020; k. Svensson et al., 2017; l. Vogel et al., 2016; m. Wiecha et al., 2004 ( n = 13). …”

“…Buy-in may involve (1) belief that the innovation will improve pa- (3) ensuring there is adequate staffing to accommodate changes and clinical load (Keddem et al, 2020;Svensson et al, 2017;Vogel et al, 2016), and (4) adding formal meetings to brainstorm ongoing issues with implementation, encourage communication and promote a positive workplace culture (Ho et al, 2019;Melo & Bishop, 2020;Ross et al, 2018;Srivastava et al, 2020).…”

Increasing postpartum IUCD coverage through a QI initiative: a step towards reducing the unmet need of postpartum contraception

“…The point of care quality improvement methodology was followed. 11 The team members (including representatives from faculty members, residents, nurses and interns along with FP counsellors) met weekly to investigate the progress made and identified the issues that needed to be addressed in order to achieve the desired results. The data were tabulated using the Standards for Quality Improvement Reporting Excellence guidelines.…”

Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting

“…The study has good generalisability for similar settings as the POCQI methodology has proven to be a useful tool to achieve improvements in processes and outcomes of care in resource-constrained settings. 22 23 POCQI can seed regional QI collaboratives across LMIC settings using QI to improve compliance to evidence-based bundles, thus catalysing better infection control in busy NICUs. 15 16 33 34 38 Studying more extended sustenance periods, cost-benefit analysis of implementing checklists and the impact of individual interventions of bundles could be included in future study designs.…”

“…[17][18][19][20][21] The Point Of Care Quality Improvement (POCQI) methodology developed by WHO has been used in several maternal and neonatal health settings in LMIC settings. [22][23][24] The current study was planned with an aim to reduce LONS incidence, CLABSI and allcause mortality among VLBW neonates with central lines in situ by improving compliance to central line insertion and maintenance bundles using the POCQI methodology. Open access units is 1:5, and the nurse:patient ratio is 1:6.…”