Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

Table 6 Case study characteristics and programme implementation details

	Case study 1	Case study 2	Case study 3	Case study 4
Key characteristics
Type and level	Public—medical college**	Private—secondary	Public—medical college**	Public—secondary
Area	Urban	Urban	Urban	Rural/tribal
Monthly admissions to NCU	103	59	152	145
No. beds in NCU	11	18	18	Missing
Paediatricians per 10 beds in NCU [state average 2]	2.7	1.7	1.1	n/a
Nurse per 10 bed in NCU [state average 7]	11.8	6.7	6.1	n/a
Monthly deliveries	1153	n/a	375	325
Baseline performance in NCU (selected indicators)
% of occasions when hand hygiene was followed in NCU [state average 16%]	15	42	0	0
% observed babies on exclusive breastfeeding [state average 72%]	91	100	96	75
Implementation
Duration of implementation (months)	April 2017 January 2018 (10)	June–December 2017 (6)	July 2017 July 2018 (13)	July 2017 July 2018 (13)
Total no. EBPs at programme end (based on interview)	2	0	6	9
Total no. EBP^ (based on programme reports)	5	2	5	8
NCU
QI team	Active	No QI team	Active	Active
Focus EBP (based on participants’ interviews)	Hand hygiene ANTT	0	Hand-hygiene TMA KMC	Hand hygiene ANTT Exclusive BF KMC TMA
Labour room
QI team	Not formed	No labour room	Formed but unstructured QI work	Active
Focus EBP (based on participants’ interviews)	None	n/a	ANCS HRC [Vitamin K administration]	NRP at delivery HRC Early BF ANCS

ANTT anti-septic non-touch technique for IV line insertion, ANCS ante-natal corticosteroid administration, BF breastfeeding, HRC high risk categorisation at admission, KMC Kangaroo Mother Care, NCU newborn care unit, NRP neonatal resuscitation trained personnel, TMA temperature monitoring at admission
^#At baseline
^*These were public secondary facilities at baselines, then accredited as medical colleges while the programme was ongoing
^Discrepancies are as follows:
- Case study 1: qualitative interviews did not confirm QI activities on 3 practices in the labour room. Participants referred to additional practices, but suggested they had been working on these before this programme and were supported by concurrent programmes
- Case study 2: programme reports include practices for which the facility provided monthly data; however, use of the QI approach was not confirmed by qualitative interviews
- Case study 3: vitamin K was not in the SCSL change package. It was introduced in LR to rationalise over-admission in NCU where the only reason for referral to NCU was vitamin K administration
- Case study 4: interview participants also referred to exclusive breastfeeding, for which the facility did not collect data

ISSN: 1748-5908