Public Experiments for Better Healthcare Systems.
maxiMUMcare is a campaign for ‘massive action, within a well defined time-frame of three years. There is need for setting aside space and time as well as focusing on common aims. We keep in mind that high work-loads allow little activity for ‘meta-systemic’ activities like quality improvement and therefore do not expect all the ‘solutions’ to be relevant to everyone. The campaign will support a large number of mini-forums or Labs to foster sharing of intention, know-how, momentum and the joy of collective improvement . maxiMUMcare will highlight the ’causes’ and provide methodological support. The credit is totally that of the participants
The QualLab Model
The QualLab Model assumes no prior knowledge of Improvement Methods. It combines training , organization, collaboration,community engagement and policy advocacy as a target- based campaign to create ‘rich’ capabilities for improvement . The systemic schema of an hypothetical BirthRight QualLab is given below.
Healthcare Organisations in Developing countries do not have a legacy of strong Quality Assurance Systems. Most of them do not have quality plans , quality departments with dedicated budgets or professionally certified quality professionals . Keeping this in mind, the QualLab Model provides ‘Issue–based’,’Just–in–Time‘ components to frog-leap into Quality Improvement : Issue- based , Real-Time Leadership [LeadLabs], Knowledge and Evidence Base [ LearnLabs]; for situations that require zero-based initiatives [DesignLabs]; Measure Definition,Data Collection and Data-quality [StatLabs] and where possible Cost Estimations [CostLabs]. The AuditLabs are optional and are used when there is no local baseline data. The SocialLabs are a prerequisite for collaboration between organisations and would require all participating organisations to be on the same ‘Social- Media’ page. Patients and public could be invited to share their ideas through this common social forum. The campaign is designed as a ‘public experiment’ and therefore MediaLabs are included to announce the particular QualLab and to keep open the possibility of policy advocacy from the beginning. All of these are contingent components but are necessary to provide the conditions to turn the PDSA wheel that is the core of the ImpactLabs. While ImpactLab is largely constituted by the issue related process owners, the other components are modular and may be reused in other QualLabs. The ‘Labs’ are not packaged solutions but Studio-Based Learning opportunities. While there will be no upper limit to the number of QualLabs there will be a lower limit for participation and later accreditation.
The cross-walks are periodic second person assessments between the participating organisations using standardized surveys instruments. This allows both evaluation and learning.
The ‘Commune’ not only bring the participants face- to- face to share experience but will also bring the ‘system into the room’ by addressing the big- picture implications of the QualLab. These will also be interface with the maxiMUMcare campaign stakeholders, sponsors , government agency, insurance and TPA organisations, NGOs interested in the issue , as well as students interested in Improvement Science.
The theoretical underpinnings are elaborated in the ‘Theory of Change’ page .The entire QualLab Model is premised on the three knowledge- based components of the Learning forum.
Community of Solutions:
Surgical Safety QualLab
Increase adoption of WHO surgical Checklist
Safe Practice QualLab
Reduce harm to patients and providers .
PreventDVT QualLab
Reduced Deep Vein Thrombosis in Post Operative Patients.
Antibiotic Resistance QualLab
Antibiotic utilisation practice patterns
Mental Health QualLab
Comphrehensive mental health services
BirthRight QualLab
Reduce Maternal Mortality and Infant Mortality
Celebrate Age QualLab
Improve the quality of Geriatric care
Accelerated Access DesignLab
Improving Ease-of- Use for Minimal, Essential and Advanced Healthcare.
Hand Wash AuditLab
Improve Compliance with Hand wash
Gendered Care LearnLab
Improve the gender sensitivity of professionals, including towards Transgender
ICD Coding LearnLabs
Collaborative Learning to acquire skills in Coding
Quality Plan LeadLab
Introduce processes for balanced measurement , budget allocation and execution of Strategic Plans
UrbanHeart QualLab
eGovHealth ShoutLab
Advocacy for migration to digital governance of healthcare services
Cancer Screen DesignLab
Improving Early Detection of Cancer
Patient Transfer SimuLab
Reduce Lapses, Delays and Harm in the transfer of patients.
ResistTB DesignLab
Control drug resistant TB
Dignity of Death LearnLab
Improve Quality at the End-of-Life care.
Physician Safety DesignLab
Eliminate violence against provider.
MedicalRecords QualLab
Improve Clinical documentation
Capability Domains: 2. Supply of Value 5. Delivery of Healthcare.
