ISQUA16-1154ANALYSIS OF AN EXTERNAL EVALUATION PROJECT IN ARGENTINE PUBLIC MATERNITY HOSPITALS

Abstract

Objectives: The Undersecretary for Community Health of the National Ministry of Health (MOH) was concerned because forecast data indicated that Argentina would not achieve its Millennium Development Goals (MDGs) 4 and 5, despite the many programs that had been implemented to improve perinatal care. The safety and quality of hospital care impacted the effectiveness of many of these programs. The Undersecretary held a summit meeting in which provincial health ministers recommended a hospital accreditation program to accelerate improvement. As a first step, a project was initiated to determine if external evaluation (EE) would be a feasible methodology for identifying: 1) gaps in safety and quality and 2) improvement priorities based on potential risks to patients. This project was limited to EE and did not study the impact of the EEs on the MDGs. Method(s): Standards for EEs were selected based on the MOH's analysis of safety and quality problems, MOH programs, government regulations, recommendations from organizations such as WHO and UNICEF, and national and international accreditation programs. Once approved and field tested, experts assigned a risk-value of 1-10 to standards based on how much non-compliance might negatively impact care. Sampling methodology was used in each hospital, where teams of 4 trained perinatal professionals traced the structures and processes related to the care being experienced by selected mother-child pairs. Tracing consisted of interviews with personnel and patients, walk-arounds, observation, and review of outcome data and medical records. Evaluators focused on processes, not staff performance. They documented findings and scored 300 standards. A spreadsheet then multiplied each score by its predetermined risk value, automatically prioritizing high risk findings. Result(s): 16 public hospitals, each with more than 3,000 births annually, representing 15% of the annual births in public institutions, participated in the intervention. A pre-evaluation meeting was held at each hospital to present the project, the standards and methodology. The evaluation lasted 2-3 days. Afterwards, each institution received an executive summary and a presentation with photos of strengths and non-compliant processes, graphs, and suggestions for next steps. A detailed spreadsheet prioritizing findings based on risk, and formatted so that action plans and progress could be registered, was also provided. The MOH received reports on tendencies in the findings. The 3 most problematic functions, determined by those high-risk weighted standards that had the most number of organizations scoring non-compliant, related to:1) adult CPR and preparedness for emergency obstetric care 2) patient identification 3) and medication management. Conclusion(s): Provincial ministers of health had recommended a hospital accreditation program with EE methodology to accelerate improvement efforts towards the MDGs 4 and 5. The EEs conducted in this study identified and prioritized safety risks and quality gaps in 16 Argentine public hospitals. Tendencies showed less than 80% compliance in multiple key functions in many of the participating hospitals. Review of the specific findings indicate that there are opportunities for improvement through strengthening support and oversight mechanisms. Logically, interventions targeted towards correcting the most frequently cited high-risk priorities have the potential to improve safety and quality. However, the effectiveness of EE, as part of an accreditation program, and as a tool for improving outcomes in Argentina, requires further study.