Travels With the Quality Improvement Team

This guest blog post was written by Dr. Sneha Kurian, a summer intern with the Quality and Process Improvement team in Hyderabad. Sneha is a second year MBA student at Symbiosis Institute of Health Sciences Pune, where she studies Hospital and Healthcare Management. Sneha learned about ACCESS Health International through fellow students in her program who had attended a workshop I conducted at the Indian Institute of Health Management Research (IIHMR) Jaipur.

My journey with ACCESS Health started on the May 12, 2015. Like any other intern, I came to this organization with many hopes and expectations. During my initial days at ACCESS Health, I was introduced to the Safe Care, Saving Lives project. The project works with staff at public and private sector healthcare facilities to improve newborn care.

When I joined ACCESS Health, the entire project team was busy gearing up for the second learning session of the project. The learning sessions are intensive workshops that bring together the teams from each of the participating hospitals. The hospital staff had previously developed improvement projects and strategies for their individual facilities. During the learning session, they shared their individual project progress, and their challenges. It was a wonderful and worthwhile experience to hear doctors and nurses share stories of their successes achieved through the project.

This learning session was the result of months of hard work by the ACCESS Health Quality Improvement team. The learning session made me curious about the role the ACCESS Health project team plays in bringing about change in the participating hospitals. I soon discovered that the project team members visit each of the twenty project hospitals every fifteen days to provide support.

A typical hospital visit starts with the ACCESS Health project team fixing a date for the visit with the hospital quality improvement team. Each hospital quality team consist of an administrator, head of department, resident doctors, a nursing superintendent, nursing staff, and a data operator. During each visit, the hospital team updates the ACCESS Health team on the progress of their individual improvement project. The ACCESS Health project team members spend most of their time understanding and reviewing the change strategies tested at the hospital. The ACCESS Health team analyses the data from the hospital to provide further guidance to hospital team.

I was really curious about what kept the ACCESS Health team motivated. “Nothing beats the joy of being a part of project that saves many little lives and also brings a smile to a mother’s face,” one of the team members explained to me. This sentiment inspired me. And thanks to my mentors, I got an opportunity to travel with the ACCESS Health quality team to visit a hospital and see this work in action.

Our trip began early in the morning. We were making a 3.5 hour journey to a remote town (mandal) called Banswada. The town is about 176 kilometers (about 110 miles) away from Hyderabad. Along the way, members of the ACCESS Health project team shared their own experiences and challenges with the project. They spoke of the differences in experiences among the different hospitals they were overseeing. I learned about the quality improvement tools that were used to drive the improvement processes at the hospitals. Area Hospital Banswada, the hospital we planned to visit, was working on prevention of birth asphyxia and sepsis. Prior to our visit, the ACCESS Health team had prepared posters explaining hand hygiene, hand washing techniques, and neonatal resuscitation program protocol. Audit forms to measure improvement and questionnaires for the hospital had also been prepared in advanced.

After we had been on the road for a while, I noticed a gradual change in the terrain. The road became bumpy, with only paddy fields on both sides. I realized that the place we were going was in quite a remote and interior part of the region. We passed very few shops on our way. All I could see around me were fields and hardworking farmers, cattle, and tractors. The area, with its muddy terrain, seemed underdeveloped. I learned from the ACCESS Health team that the Area Hospital we were visiting was the only hospital for Banswada and for eight other smaller towns around Banswada. I began forming a picture in my mind of what this rural and remote hospital would be like. After a long journey, we reached the hospital at noon.

I was surprised to see the hospital. It was nowhere close to what I had thought it would look like. The hospital was well managed and clean. There was none of the chaos I had seen in other area hospitals. There were many patients, but the crowd was well managed. I had a hard time believing that this was the only hospital in the area. I saw happy parents offering coconuts to the gods as thanksgiving for their healthy baby.

We met the medical superintendent, Dr. Srinivas Prasad, who is a pediatrician by training, as well as the gynecologist for the hospital, Dr. Sudha Chakravarthula. These two were the champions and pillars of the hospital. They were in charge of both the hospital and the quality improvement initiative. Our team received the routine project update from the hospital leaders. I learned that the difficulties facing the hospital were due to communication barriers. Dr. Prasad and Dr. Chakravarthula did not know whom to approach in the health department or government to address their basic and immediate hospital needs. The hospital leaders also expressed concern about the shortage of staff. Yet, in spite of these restraints and concerns, members of the hospital improvement team were working to the best of their abilities to achieve the best outcomes.

I joined the team on rounds of the labor room and sick newborn care unit. I saw the little changes the quality team had brought about, such as the arrival of trained staff in newborn resuscitation for every high risk delivery. The doctors also showed us the structural layout of the new labor room being built.

The ACCESS team had prepared a questionnaire for the Humans of Safe Care, Saving Lives series. The Humans of Safe Care, Saving Lives series profiles the dedicated individuals behind the project. (See the first and second posts.) The ACCESS Health team interviewed Dr. Prasad and Dr. Chakravarthula to learn about their personal lives and their journey into healthcare. I was amazed to discover how diligent and devoted they were to their work. The doctors were determined to bring about positive change, in collaboration with ACCESS Health.

These three months of my internship have added much value to my life, both professionally and personally. I am glad I chose ACCESS Health for my summer internship. I was trained and exposed to the topics related to my project and was able to participate in training sessions. I also had the opportunity to interact with other teams within ACCESS Health. It has been a wonderful learning experience. I couldn’t ask for anything more. Even though I have to leave, I have formed a bond for life with all the people I had the opportunity to work with. Our time together was an enriching and memorable journey.