ISQUA17-2958SCALING UP QUALITY IMPROVEMENT IN NURSING EDUCATION THROUGH A SYSTEM APPROACH: THE INDIA EXPERIENCE

Abstract

Objectives: To demonstrate a sustainable quality improvement model for nursing education and support it's scale-up to address the issue of shortage of skill nursing Human Resource for Health in India. Methods: In 2010, Jhpiego adopted a standards based quality improvement approach for strengthening nursing education. Project interventions aimed at standardizing nursing education across 162 public sector nursing institutions in ten states of India and creating an enabling policy environment and establishing institutional mechanisms for sustainability. Baseline institutional assessments revealed a dismal scenario with average score of 24% standards achieved. Institutional action plans were made to address the identified gaps. Monthly supportive supervision visits (SSVs) were conducted for provision of onsite support, capacity building, facilitating translation of knowledge and skills into practice by nursing faculty and service providers. 6-monthly repeat assessments helped measure progress. Interventions at institutional level included establishing standardized training infrastructure, faculty development program, use of structured resource materials and leveraging virtual learning for wider dissemination. Clinical skills standardization training for service providers, strengthening supply chain management and promoting compliance to quality of care protocols were undertaken to ensure adequate clinical experience for student nurses. The project informed policy and regulatory mechanisms by sharing evidence with decision makers and creating networks for sharing of experiences, learning resources, and innovative approaches like virtual training. Lessons learnt were used to conduct advocacy with INC for incorporation of components like competency based training, effective teaching skills, quality assurance, and promoting inter-professional education in the existing curriculum. Sustained buy-in by GoI has resulted in an increased allocation (220 fold) of funds from $0.15 million in 2011 to $35.08 million in 2015 for strengthening nursing cadre and a decision to scale up this quality improvement model to all public sector nursing institutions across the country. Results: The average standards achieved increased from 24% to 67%. >50% of the targeted institutions have achieved the agreed benchmark of 70% standards with about 48% having a wellestablished skills lab and 80% a fully equipped computer lab and library. More than 95% of clinical practice sites have a functional newborn care corner and adhere to GoI's quality of care protocols. The success of this pilot in almost 25% of India's public sector institutions has helped GoI take a decision for nation-wide scale up to all 689 government nursing institutions and make necessary budgetary allocations. INC is now working towards introduction of standards and competency based trainings and evaluation at scale in over 6000+ private nursing institutions. Conclusion: Systems approach, evidence based interventions, creating stakeholder networks and an enabling policy environment are key to successful scale up of quality improvement in nursing education. GoI's efforts in this direction will ensure availability of a highly skilled and competent nursing workforce and steer the country towards its commitment to Universal Health Coverage.