At Soapbox, many of our projects in healthcare facilities and maternity units adopt a process of continuous quality improvement (CQI). CQI is a facility-based process which is staff-led and participatory. Once learnt, the process can be transferred to any area of concern, potentially outliving the specific project, and allowing previously achieved goals to be returned to if standards slip.
The process begins with a facility staff team identifying a behavioural area they wish to target for improvement, such as hand hygiene compliance, and they then conduct a baseline assessment to identify the barriers that limit compliance. Barriers to the successful behaviour may be evident from the research or experience e.g. lack of soap for handwashing. This enables the team to narrow down to specific behaviours such as the ordering and distribution of soap.
The team then decide on an achievable goal for improving behaviour. In the case of hand hygiene, handwashing with soap can be a huge deterrent against infections, especially within maternity unit environments so it may be that a goal of 50% compliance is set after a baseline measurement of 25%. After the improvements have been attempted, a facility audit committee use data collection tools, such as short checklists or apps, to see if the goal was achieved. A representative from the audit committee then presents the audit results to the facility staff, who then decide on the next goal. If successful, the next cycle may aim for 75% compliance and the process will continue. There are usually several cycles for each overall goal, and some can be very quick, depending on the barriers targeted.
The ethos of CQI is that no change is too small. The process motivates problem solving and avoids a culture of blame. Facilities are often encouraged to ‘buddy’ with other facilities for support and/or a sense of friendly competition. Changes aimed for in each cycle can be very small, making them achievable targets and encouraging further changes leading improvements in the quality of care.
CQI is a process which delivers sustainable changes that have the potential to save lives. Changes may happen slowly and in small doses, but in doing so we are heading in the right direction towards our goal for clean, safe birth for every mother and newborn.