Bridging Gaps in Maternal Care: Evaluating LaQshya (Labor Room Quality Improvement Initiative) Implementation at a Tertiary Hospital

Abstract

Objective The LaQshya (Labor Room Quality Improvement Initiative) Program, initiated by the Ministry of Health and Family Welfare, aims to improve the quality of maternal and neonatal care in labor rooms and maternity operation theaters to reduce morbidity and mortality. This study evaluates LaQshya implementation at a tertiary referral hospital in Nagpur, India, examining infrastructural, clinical, and operational compliance with program guidelines. It identifies both strengths and gaps, explores patient and staff perceptions, and implements targeted corrective interventions, assessing their impact on key performance indicators. Design A quasi-experimental before-and-after mixed-methods study was conducted at Indira Gandhi Government Medical College and Hospital (IGGMCH), a high-volume tertiary care referral center. The evaluation covered infrastructure, staff training, clinical practices, infection control, and quality management under LaQshya guidelines. Method Purposive sampling included 50 healthcare professionals (30 doctors and 20 staff nurses) trained in LaQshya protocols and actively involved in labor room and maternity operation theater (OT) services. Data collection involved on-site observations, record reviews, and structured interviews. The official LaQshya compliance checklist was used to assess eight core domains. Quantitative findings were complemented by qualitative interviews, analyzed using Braun and Clarke's six-step thematic framework, with integration of results for a holistic interpretation. Results Baseline scores for the labor room (48%) and maternity OT (56%) fell below the LaQshya certification threshold (70%). Strong performance was seen in service provision (95.5%), clinical care in key areas, and respect for patient rights, with improvements in privacy measures, patient-provider communication, and documentation practices after intervention. Critical gaps were identified in quality management, infection control, and emergency preparedness. Infrastructure upgrades, standardization of clinical protocols, improved signage, staff retraining, and better biomedical waste segregation yielded measurable gains, including increased partograph use (0% to 78%), hand hygiene compliance (36% to 74%), and patient satisfaction scores (3.1 to 4.2 out of 5). Conclusion The LaQshya program at IGGMCH demonstrated tangible improvements in several quality domains, notably patient rights, service provision, and adherence to clinical protocols, following targeted interventions. Nonetheless, persistent challenges in staffing, quality management systems, and infrastructure maintenance require continued focus. Sustained capacity building, regular audits, and robust infection control practices are essential for achieving and maintaining full LaQshya compliance.