Presentation at the National Capitalization conference of the Swiss-Ukrainian Mother and Child Health Programme (Kyiv, Ukraine, April 23, 2015) http://motherandchild.org.ua/eng/event/768

1. Monitoring: approaches,
achievements and perspectives

2. Monitoring as a tool
for improving the
perinatal care quality

3. • Inspection!
• Just a visit, but no relationship is established.
• Command approach instead of supervisory
functions.
• Emphasis on personality instead of the process.
• Dealing with issues in a sporadic way.
• Lack of follow-up, consistency and continuity.

4. Main objective
Determine
existing problems
in order to find
ways to resolve
them

5. Manual
I n s t r u c t i o n
on monitoring visits
conducting in the frame
of the Swiss-Ukrainian
“Mother and Child
Health” Programme
implementation

6. Form 1. General
information about the
health care facility.
Form 2. Organisation of
health care in the units.
Form 3. The health care
facility performance
indicators (for 12
months).

7. Form 4. Monitoring of the neonatal intensive care
unit/room and the postnatal unit, an interview with
a neonatologist.
Form 5. Interview with a children’s nurse.
Form 6. Interview with an obstetrician.

8. Form7. Antenatal observation
In case of multiple pregnancy and
pregnancy after the Caesarian
Section (interview with a
antenatal clinic head or a doctor)
Form 8. Interview with a mother

9. Creation of monitoring teams
1. Obstetricians:
– Chief obstetrician of the Health Care and Resorts
Department,
– District obstetricians.
2. Neonatologists:
– Chief obstetrician of the
Health Care and Resorts
Department,
– neonatologists.

10. Team training
• Teaching the basic course
materials
• Teaching to conduct
monitoring visits.

11. Conditions for conducting a visit (1)
• Available team of trained specialists.
• Advise the health care facility at least two
weeks prior to the visit.
• Prepare required forms and documents.
• The facility should fill in forms №1 and № 2 for
the reporting period.
–The team of specialists should analyze the
completed forms and prepare questions
before the visit.
–The team should also analyze reports of the
previous visits.

12. Conditions for conducting a visit (2)
• Make changes in the standard visit program
according to the facility’s particular issues.
• Prepare clinical cases.
• Ask to prepare medical records of pregnant
women, mothers and newborns.
–Unclear cases.
–Cases of long APV in the clinic.
–Cases of newborns with body weight under
1500,0 in the central district clinic.

13. The visit objectives (1)
• To consolidate the health care
workers’ theoretical
knowledge and practical skills.
• Help the health care workers
to correctly introduce and use
obtained skills in their daily
practice.
• Assess factors influencing
performance in the facility.

14. The visit objectives (2)
• Collect and analyze main performance
indicators.
• Identify problems of the health care workers.
• Help the management and
health care workers to resolve
the problems identified .
• Draw up a report with clear
recommendations.

15. The visit
structure:

16. 1. Familiarisation of the
facility personnel with the
visit objectives and
procedures 2. Monitoring of the
health care
organisation
and provision3. Analysis of the
conditions (premises,
equipment)
5. Documentation and
performance analysis 6. Summary of
the problems and
helping to
resolve them
Report
Clinical cases
(situational tasks)
Practical
skills
Practical
cases4. Interviews with
the health care
workers and
women
Wrap-up meeting
with the personnel
and the
management

17. Familiarisation of the facility personnel
with the visit objectives and procedures
–What has
changed?
–Difficulties?
–Proposals
–Help

24. Analysis of the available conditions (rational
distribution of premises and equipment)

25. Interview with a
neonatologist and a
children’s nurse

26. Interview with an obstetrician

27. Interviews with mothers

28. Documentation and
performance analysis

29. Summarisation of the
problems and helping
to resolve them

30. Wrap-up meeting with the health care
workers and managers
 Thank
 Remind
 Ask
 Listen
attentively
 Summarize
 Add

31. Final report

32. Ways
to resolve
the existing
problems

33. As a result of the monitoring visits
• The number of beds in the maternity clinics
was optimized by closing small clinics (less
then 400 births per year):
Ivano-Frankivsk region - 2,
Vinnytsia region - 6.
• Reconstruction of the maternal units (optimal
zoning):
 Ivano-Frankivsk region - 4,
 Volyn region - 3,
 Vinnytsia - 4.

34. Local protocols approval

35. Region
Local
visits
Including
experts
Total
Vinnytsia region 29 18 47
Volyn region 26 17 43
Ivano-Frankivsk
region
14 21 35
AR Crimea (as of
February 2014)
5 14 19
Number of the monitoring visits
Total: 144

36. Peer-to-Peer monitoring visits
• To observe how health care practitioners
work in other regions.
• To exchange experience in monitoring.
• An opportunity to bring to your region new
effective approaches to perinatal care from
another region.

37. Prospects
 Monitoring teams will continue to visit
regional health care facilities.
 The monitoring results are used:
• In preparing issues to be considered at
the collegium meetings.
• In the work of the clinical experts
commission for assessing the health
care quality for certain patients or
patients groups.
• In taking operational and strategic
decisions by the health care managers.

40. 15,47%