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ECHO Hamrahi 5th session 12th April 2022

The topic of the 5th ECHO Hamrahi session, taking place on the 12th of April, 2002, was QI in palliative care. After an introduction from Dr Odette Spruijt, various topics were presented by Dr Vidya Viswanath, Dr Anjum Joad and Dr Sunil Kumar.

Dr Odette Spruijt – Didactic

Introduction to the PC-PAICE/ EQUIP program, (Palliative Care –  Promoting Assessment and Improvement of the Cancer Experience / Enable Quality, Improve Patient care – India ) established in 2017 by Stanford Uni.

This program had Stanford organisational and QI leaders and collaborators in India, as well as coaches from peer institutions in the US and Australia. It was the first cohort of seven leading palliative care programs in India. It subsequently developed with Tata Trusts and National Cancer Grid India, initiating a QI and educational hub led by Dr Nandini Vallath and Dr Sarbani Ghosh. The second cohort had seven sites during 2018 and 2019.

In 2019 it transitioned to Enable Quality, Improve Patient Care, India (EQUIP-India), led from Mumbai and expanded to palliative and oncology services. It continues the same methodology and incorporates culture-nuanced structure, processes, contents, evaluation and national mentoring capacity alongside international mentors.

Odette also reviewed of some of the QI tools taught to cohorts – A3 approach, Root cause analyses utilising Fishbone, GEMBA walks, Pareto charts, 2×2 charts, 5 ‘Whys’, and Run Charts to ‘tell the QI story’.

Discussion of issues of sustainability and reliability of interventions  

Dr Vidya Viswanath – Homi Babha Palliative Care , Vizag, AP – Organising Home Care Services

  • This was a QI project which aimed at improving home care system, recognising erratic home care visits with no system in place. They developed a SMART goal – to increase from 2-3 visits per week to 6 per week.
  • Baseline Run Chart showed varied bt 0-4 visits.
  • GEMBA walk most valuable – went to each person involved in the process of organising and conducting home visits, asked and observed their processes.

Achieved their SMART goal through two key interventions: development of software to categorise patients in need of home care vs OPD; received a grant to develop home care for city-based patients.

Dr Anjum Joad – BMCHRC,  Jaipur, Rajasthan. COPE – Comprehensive Out Patient Evaluation

Their project was to improve documentation of comprehensive assessment of new outpatients on first visit to OPD, defined as completing seven assessment forms with a SMART goal to increase completion from 20 % to 75 % of patients by June 2019.

Project included root cause analyses using Fishbone, Pareto and 2 x 2 table to identify interventions which may have the greatest effect on driving change in the desired direction. The outcome was to develop one form which incorporated all the essential elements of assessment – called the 4S.

Baseline analyses informing interventions

Dr Sunil Kumar – TIPS, Trivandrum, Kerala – City Homecare team, Relax! Protocols are ready for you

The third project, presented by Dr Kumar, aimed to improve staff satisfaction with the quality of home care services, from a satisfaction score of 5.82 to 7.6. The goal was maintaining appropriateness of registration process at 80% and improving triage process accuracy from 33% to 66%

The team developed seven interventions including algorithms and tools for triaging, dedicated phone follow-up processes, a Field Support Team, training and role-plays for service providers, brochures about the homecare service, clarifying purpose and scope, and systems to disseminate information. Each intervention was allocated to a dedicated staff member to implement and maintain. While this system has not continued according to the project, it has influenced ongoing service development and been adapted according to resources and learnings.

These were real world projects so all team results fluctuated with staff shortages and other resource issues. All agreed that participation in these QI programs resulted in great learning and examination of practice. Even when projects were not sustained, the learnings and impact on overall service quality improvement, reflective practice, new thinking and team engagement continued to influence and motivate participants.

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