I was always in the quest of knowing and searching for what is quality, how to measure it and how to deliver quality healthcare in NICU although from beginning I was of the opinion that its about system and not individuals.The first exposure to quality took place when we applied for accreditation of our NICU for fellowship in neonatal care. While undergoing the accreditation process, I realized the importance of documenting quality parameters. Then, we applied for state health scheme. Although it did not work out but I developed some insights into the quality assurance process. So, during the inspection of fellowship centre accreditation by NNF, I met Dr. Vikram Datta and Dr Sushil Srivastava and learnt some of my early lessons about delivering quality care, in the process.
But it was when my friend Dr. Vikram Datta invited me to attend the Quality Improvement Workshop in October 2016 that I had a “eureka moment”. I thought I got all the keys to unlock the understanding of quality in healthcare. It was Dr. Mahtab Singh who mentored me, offsite as well as onsite, after the POCQI Workshop – and then my journey into quality improvement began. My first QI project was the use of Fenton’s Growth Chart for Preterm and as a novice, I faltered at many steps while using POCQI methodology for this project. I made an Aim Statement on my own, without involving the team and also did the Root-Cause Analysis myself, alone. But because of the highly motivated staff, the project was a success despite all such limitations.
Then a few like-minded people under the leadership of Vikram Datta formed an informal network called Nationwide Quality of Care Network (NQOCN) in 2017, the website of which was inaugurated in the workshop at Aurangabad in August 2017. I presented my second project Using Sucrose Analgesia Prior To Painful Procedures in NICU and this time. I used all the steps and tools in a better manner and the result was there for everybody to see. I learnt the basics of PDSA from Dr Mahtab. I learnt that for getting the right change idea, we need to break things into smallest possible & simplify and also how to design PDSA.
Later on, we conducted three more QI projects and I used that experience to sharpen my skills of using the POCQI tools. Of course, I encountered resistance to change but, believe me, I always welcome resistance and utilise it for learning purposes. While working on our fellow’s QI project on CLABSI, I realised quickly that for a better buy in from all stakeholders, we must first agree that we have the problem which needs attention as one of my colleague was of the opinion that we don’t have this problem until we shared the data. I also understood that we need to give the staff the purpose & value for motivation & to get a better buy in. During this project, I realised that everyone in our system is a leader & distributing leadership is a vital part of sustaining a change.
Incidentally, we had applied for entry level NABH accreditation. During the process of accreditation, I realised the importance of documenting data. In God we trust, all others must bring data!
Very soon, I realised, there is more than tools as far as quality improvement is concerned. I understood that you need to tackle the behavioural part of change management in order to have success and sustainability in delivering quality improvement. But I was stuck at how to tackle these behavioural issues. Co-incidentally, I had subscribed to iTunes and streamed podcasts about Quality in Healthcare- here , I found the answer that went on to open many ideological doors!
And there began my journey into the psychology of change- the adaptive side of quality improvement.
Meanwhile, we conducted many QI workshops across India including the TOT workshops. We also undertook many responsibilities as part of NQOCN in many states. Also, the LAQSHYA programme by government of India. This way, we got exposure to different institutes having different capabilities and manpower and working with them, I realised more and more that we need to incorporate the psychology of change into POCQI methodology. And this led to the formation of our writing group on psychology of change which is now dealing with incorporating psychology into POCQI methodology. And recently, on 22nd August 2020, we inaugurated our chapter on community of practice successfully, a platform for everyone to share their experiences in quality improvement, a place for all to showcase their efforts. First of its kind in India.
I know this is just a beginning, but what a beginning!
We have a lot of challenges ahead of us at NQOCN and the following lines sum up our sentiments about this journey:
The woods are lovely, dark and deep, But I have promises to keep, And miles to go before I sleep, Miles to go before I sleep.
Dr Kedar Sawleshwarkar
MBBS,MD Ex-Associate Professor GMC Aurangabad National Faculty NRP-India National Instructor FBNC Program Faculty, Developmentally supportive care foundation of newborn and Children, India National coach & Treasurer, Nationwide Quality Improvement Network, NQOCN National Mentor, LAQSHYA, Govt of India Director & Fellowship co-ordinator,NICU, Deogiri Children’s Hospital, Aurangabad E- mail- firstname.lastname@example.org Twitter- @kedarpriya1, @nqocn, Mob- 9372007090