Background
Basic services | Comprehensive services |
---|---|
(1) Administer parenteral antibiotics | Perform signal functions 1–7, plus: |
(2) Administer uterotonic drugs (i.e. parenteral oxytocin) | (8) Perform surgery (e.g. caesarean section) |
(3) Administer parenteral anticonvulsants for preeclampsia and eclampsia (i.e. magnesium sulfate). | (9) Perform blood transfusion |
(4) Manually remove the placenta | |
(5) Remove retained products (e.g. manual vacuum extraction, dilation and curettage) | |
(6) Perform assisted vaginal delivery (e.g. vacuum extraction, forceps delivery) | |
(7) Perform basic neonatal resuscitation (e.g. with bag and mask) | |
A basic emergency obstetric care facility is one in which all functions 1–7 are performed. A comprehensive emergency obstetric care facility is one in which all functions 1–9 are performed. |
Well performing and motivated workforce: includes various strategies to manage and cope with job stress, managing dual practice among healthcare workers, exit interview and any structural or cultural modification in the healthcare environment. |
Interpersonal care and social support: These are interventions provided by professionals or non-professionals aimed at improving psychological well-being of patients as well as healthcare workers. Pregnancy, perinatal deaths, childbirth and parenting are some of the specific phenomena that require continuous social support. |
Safety culture: Facility based safety culture includes any intervention to enhance the safety of healthcare workers and patients in healthcare environment including hand hygiene promotion, interventions to reduce medication errors and preventive vaccinations for the health care professionals. |
Staffing models: These are organizational interventions for staff management including skill, qualification or grade mix, maintaining staff-patient ratios and measures for improving collaboration between two or more health and/or social care professionals. |
Facility level characteristics
Well performing and motivated workforce
Interpersonal care and social support
Safety culture
Staffing models
Methods
Findings
Well performing and motivated workforce
Reviews (n=12) | Description of included interventions | Type of Studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes
|
MNCH specific outcomes
| ||||||
Baker 2010[36] | Strategies to improve professional practice that are planned taking account of prospectively identified barriers to change. | 26 trials (12 meta-analyzed) | Healthcare professionals responsible for patient care in HIC | Desired professional practice | Yes | 1.52 (1.27- 1.82) | |
Blanca-Gutierrez 2012[35] | Implementation of any intervention to reduce absenteeism among hospital nursing staff. | RCT: 11 observational trials: 4 | Nursing staff | Nurses working full-time versus other working time | No | 3.2 days on average absenteeism in nurses full-time versus 2.5 working in time partial | |
Cognitive behavioral therapy | The intervention group had an average of 2.29 absences hours against 14 hours in the group control | ||||||
Flexibility of shifts (From 4 hour shifts duration up to 12 hours | 41% reduction absenteeism | ||||||
Rewards | Decreased 24.97% of total days of absenteeism | ||||||
Flint 2011[39] | Any form of exit interview undertaken at the voluntary cessation of employment or at a prescribed time following departure from the organization was eligible. These could be a face to face exit interview, a telephone exit interview, a self-completed exit interview survey, electronic exit interview survey and mailed exit interview survey. | No trials included | Healthcare professionals | Turnover rate | No | No studies identified for inclusion | |
Flodgren 2012[58] | An organizational infrastructure was defined as the underlying foundation or basic framework through which clinical care is delivered and supported. | ITS: 01 | Healthcare organizations comprising nurses, midwives and health visitors in hospital and community settings in HIC | Risk of developing healthcare-acquired pressure ulcers (HAPUs). | No | 0.7% (1.7-3.3) | |
Kiwanuka 2011[40] | Dual practice was defined as the holding of more than one job by a health professional. Approaches identified and considered to manage dual practice were complete prohibition. Restrictions on private sector earnings, Providing incentives for exclusive public service, Raising health worker salaries, allowing private practice in public facilities, self-regulation, regulation of private sector. | None included | All health professionals in LMIC | Increased working hours, reduced waiting hours, absenteeism, reduced sick leaves | No | No studies identified for inclusion | |
Parmelli 2011[15] | Strategy intended to change organizational culture in order to improve healthcare performance | None included | Any type of healthcare organization | Professional performance, patient outcomes | No | No studies identified for inclusion | |
Pearson 2007[59] | Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. | Descriptive:02 Qualitative:04 Discursive: 13 | Staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment | Nursing staff outcomes, patient outcomes, organizational outcomes and systems level outcomes. | No | Appropriate and competent linguistic services, and intercultural staff training and education would contribute to the development of a culturally competent workforce. | |
Peñaloza 2011[60] | The complex combination of factors that drives the migration flow of health professionals contributes to the complexity of the strategies to manage this flow. | ITS: 01 | Any group of health professionals who are nationals of a LMIC and whose graduate training was in a LMIC. | Yearly number of Philippine nurses migrating to the USA | No | +807.6 nurses, (95% CI 480.9 to 1134.3) | |
Rowe 2005 (Overview)[61] | An essential first step towards improving performance understands the factors that influence it. Such factors fall into two categories: interventions (e.g., training) and non-intervention determinants (e.g., patient’s age). | Overview | All health workers in LMIC | No | Simple dissemination of written guidelines is often ineffective. Supervision and audit with feedback is effective. Multifaceted interventions might be more effective than single interventions | ||
Socha 2011[62] | Review of the literature on the consequences of dual practice for the physician labor supply; the quality of the public health care; the costs of the public health care provision. Section 5 discusses regulatory responses | Overview | No | Narrative | |||
Tanj -Dijkstra 2011[38] | Physical environmental stimuli are part of the (shared) healthcare environment and can be classified as ambient, architectural or interior design features that influence healthcare personnel through mediation by psychological processes. | CBA: 01 | Both medical and paramedical personnel whoare directly involved in treatment and care of patients in healthcare settings. | Change in mood | Intervention group: 4.3 lower | ||
Satisfaction with physical environment | Not estimable | ||||||
Change in unscheduled absenteeism | Intervention group: 3.2 lower | ||||||
Van Wyk 2010[34] | We included any intervention intended to improve health workers’ ability to cope or manage job stress. These include: (a) formal and informal staff-support groups; (b) training or education in coping skills (or stress management) and communication; (c) management interventions, e.g. multidisciplinary meetings, feedback sessions, etc. | RCT’s: 10 | Professional health workers and health teams working in primary, secondary, tertiary, community, residential and referral care settings. |
Job stress:
| Yes |
Job stress:
| |
Assertiveness training vs. in-service training | -6.10 (-8.39- - 3.81) | ||||||
Stress management vs. no intervention | -0.06 (-0.44 – 0.32) | ||||||
Mindfulness training vs. no intervention | 3.44 (-4.10- 10.98) | ||||||
Management intervention vs. no intervention | 0.66 (-1.24 – 2.44) | ||||||
Burnout (emotional exhaustion)
|
Burnout (emotional exhaustion)
| ||||||
Stress management vs. no intervention | -6.00 (-8.16- -3.84) | ||||||
Job satisfaction:
|
Job satisfaction:
| ||||||
Mindfulness training vs. no intervention | 1.48 (-4.81 – 7.77) | ||||||
Stress management vs. no intervention | -0.13 (-0.53 – 0.27) | ||||||
Management intervention vs. no intervention | -0.63 (-1.23- -0.03) | ||||||
Absence:
|
Absence:
| ||||||
Management intervention vs. no intervention | 20.35 (-10.65- 51.35) |
Interpersonal care / social support
Reviews (n=5) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Outcomes
|
MNCH specific outcomes
| ||||||
Flenady 2008[43] | Any intervention provided by professional or non-professional individuals or groups aimed at improving psychological wellbeing after perinatal death. | No trials included | Professional or non-professional | N/A | No studies identified for inclusion | ||
Hodnett 2010[41] | Standardized or individualized programs of additional social support, provided in either home visits, during regular antenatal clinic visits, and/or by telephone on several occasions during pregnancy. | RCT’s: 17 | Pregnant women at risk of having preterm or growth restricted babies, or both in developed countries | Antenatal hospital admission | Yes | 0.79 (0.68-0.92) | |
Caesarean birth | 0.87 (0.78-0.97) | ||||||
Preterm birth | 0.92 (0.83-1.01) | ||||||
Perinatal mortality | 0.96 (0.74-1.26) | ||||||
Hodnett 2011[23] | Labour support by either a familiar or unfamiliar person (with or without healthcare professional qualifications). | Trials: 21 | Healthcare professional (nurse, midwife) or training as a doula or childbirth educator, or be a family member, spouse/partner, friend or stranger with little or no special training in labour support in developed countries | Spontaneous vaginal birth | Yes | 1.08 (1.04-1.12) | |
Intrapartum analgesia | 0.90 (0.84-0.97) | ||||||
Dissatisfaction | 0.69 (0.59-0.79) | ||||||
Labour duration | -0.58 (-0.86 to -0.30) | ||||||
Caesarean | 0.79 (0.67-0.92) | ||||||
Instrumental vaginal birth | 0.90 (0.84-0.96) | ||||||
Regional analgesia | 0.93 (0.88-0.99) | ||||||
Baby with a low 5-minute Apgar score | 0.70 (0.50-0.96) | ||||||
Logsdon 2004[63] | Paraprofessional (individuals who have received specialized training in order to meet the needs of a patient population or to implement a research or project intervention) support to pregnant and parenting women. | Total : 8 studies RCT: 3 Pre-post:1 Reterospective:3 Descriptive: 1 | Paraprofessionals in developed countries | Incidence of premature birth and low birth weight and small for gestational age infants, use of healthcare services, school retention in mothers and repeat pregnancies, child abuse, discipline, and maternal-infant interaction | No | Narrative | |
Renfrew 2012[42] | ‘Support’ interventions include elements such as reassurance, praise, information, and the opportunity to discuss and to respond to the mother’s questions, and it could also include staff training to improve the supportive care given to women during breast feeding. | RCT’s / Quasi: 52 | Health professionals or lay people, trained or untrained, in hospital and community settings. Mostly in HIC | Stopping ‘any breastfeeding’ before 6 months | Yes | 0.91 (0.88-0.96) |
Safety culture
Reviews (n=9) | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes
|
MNCH specific outcomes
| ||||||
Burls 2006[44] | Influenza vaccination | cRCT: 3 RCT: 03 Before/after studies: 05Surveys: 07 | Health care workers in hospitals, nursing homes or the community in contact with high-risk individuals in HIC | Vaccination uptake | No | Range 5% - 45% | |
Effectiveness | Narrative | ||||||
Gould 2011[48] | Hand hygiene | ITS: 02 RCT: 01 CBA: 01 | Nurses, doctors and other allied health professionals (except operating theatre staff) in any hospital or community setting, (HIC) | Effectiveness | No | Multifaceted campaigns with social marketing or staff involvement appear to have an effect | |
Hollmeyer 2009[45] | Identify self-reported reasons among HCW for vaccine acceptance or non-acceptance and to identify predictive factors that are statistically associated with influenza vaccine acceptance. | 13 studies | Physicians, nurses or both and not support staff or para/non-medical personnel | Self-reported reasons | No | If HCW get immunized against influenza, they do so primarily for their own benefit and not for the benefit to their patients | |
Predictive factors | |||||||
Morello 2013[50] | There were a number of different safety culture strategies tested, including leadership walk rounds, structured educational programs, team-based strategies, simulation-based training programs, multi-faceted unit-based programs and multi-component organizational interventions. | cRCT: 1 Pre-Post: 7 Historically controlled studies: 13 | Any study on with health care workers within a hospital, hospital department or clinical unit | Leadership walk rounds | No | 2/2 studies some to moderate effect | |
Multi-faceted unit-based programs | 6/7 studies some to moderate effect | ||||||
Multi-component organizational strategies | 1 study showed no effect | ||||||
Structured educational programs | 1/2 studies some to moderate effect | ||||||
Simulation-based training programs | 1/4 studies some to moderate effect | ||||||
Team based strategies | 1/3 studies some to moderate effect | ||||||
Other patient safety culture strategies | 1/2 studies some to moderate effect | ||||||
Nascimanto 2009[64] | Safety culture and patient safety | 48 references | General health care environment | No | Narrative | ||
Ng 2011[46] | Influenza vaccination | RCT: 03 | Mean number of working days lost | Yes | 0.08 (0.19 to 0.02) | ||
Days with ILI symptoms | 0.12 ( 0.3 to 0.06) | ||||||
RR of ILI episodes | 1.14 ( 0.15 to 8.52) | ||||||
Royal 2006[49] | Interventions applied in primary care which aimed to reduce drug-related morbidity, hospitalization or death resulting from medication overuse or misuse. | 38 studies | Pharmacist, Nurses, healthcare professionals in HIC | Hospital admission in pharmacist led intervention | Yes | 0.64 (0.43- 0.96) | |
Complex interventions to reduce fall in elderly | 0.91 (0.68-1.21) | ||||||
Seale 2011[47] | Any study examining seasonal influenza vaccination (uptake, attitudes and/or programs) among Australian hospital Health care workers was included. | 10 studies | Health care workers in Australia | Policies and implementation of vaccine protocols | No | 16 to 77% coverage of vaccination after intervention compared to 8 to 50% coverage before intervention | |
Weaver 2013[51] | 20 studies explicitly included team training or tools to improve team communication processes, 8 explicitly included some form of executive walk rounds or interdisciplinary rounding, and 8 explicitly used comprehensive unit based safety program (CUSP). | Pre–post studies: 27 RCT: 4 Observational: 3 | Any health care professionals or paraprofessionals practicing in adult or pediatric inpatient settings |
CUSP
Staff perceptions of safety culture | No | 6/8 studies reported statistically significant improvements in | |
Safety culture score | 23/32 studies reported improvement | ||||||
Patient outcomes | 6/11 studies reported improvement |
Staffing models
Reviews | Description of included interventions | Type of studies included (no) | Targeted health care providers | Outcome reported | Pooled data (Y/N) | Results | |
---|---|---|---|---|---|---|---|
Other outcomes
|
MNCH specific outcomes
| ||||||
Butler 2011[53] | Interventions of staffing models, staffing levels, skill mix, grade mix, or qualification mix. | RCT: 08 CBA:5 CCT: 02 | Hospital nursing staff and hospital patients in HIC | In-hospital mortality | Yes | 0.96 (0.59-1.56) | |
Length of stay | 1.35 lower (1.92-0.78) | ||||||
Readmission | 1.15 (0.88-1.52) | ||||||
ED within 30 days | 1.14 (0.79-1.62) | ||||||
Post-discharge admission | 1.33 (0.93-1.91) | ||||||
ED visit or death | 1.03 (0.7 - 1.53) | ||||||
Post discharge adverse events Glycosylated hemoglobin | 0.5 lower (1.9 lower – 0.9 higher) | ||||||
Medical procedures in labor | Reduced (1/1) | ||||||
Length of stay | Reduced (1/1) | ||||||
Hodgekinsons 2011[65] | Interventions of interest included organizational interventions (e.g. team/modular nursing, primary nursing, hierarchical nursing, care pairs or partner-in-care models) or regulatory interventions (e.g. staff patient/resident ratios). | ITS: 01 CBA: 01 | Nurses and personal care attendants in HIC | • Incidence of pressure ulcers; | No | Two studies generally favour the use of primary care | |
• Incidence of falls; | |||||||
• Incidence of medication errors and adverse events; | |||||||
• Validated quality of life measurements. | |||||||
• Days/hours lost to sick leave; | |||||||
• Days/hours lost to stress leave; | |||||||
• Staff turnover rates (as a percentage of staff total); | |||||||
• Staff burnout (as defined by the authors). | |||||||
Kane 2007[55] | Nursing staffing models | 7 case-control 3 case series 42 cross sectional 43 assessed temporality | Nurses in HIC | In hospital related mortality by increasing 1 RN FTE/patient day | Yes | 0.92 (0.90-0.94) | |
Failure to rescue by increasing 1 RN FTE/patient day | 0.91 (0.89; 0.94) | ||||||
Length of stay by increasing 1 RN FTE/patient day | -0.25 (0.02) | ||||||
Kane 2007[54] | Various authors had used different operational definitions for the RN-to-patient ratio, including number of patients cared for by 1 RN per shift and the number of RN FTEs per patient day, 1000 patient days, or occupied bed. | 17 cohort, 7 cross sectional, 4 case control, | Nurses |
Per additional full time equivalent per patient day
| Yes |
Per additional full time equivalent per patient day
| |
Hospital related mortality in ICUs | 0.91 (0.86-0.96 | ||||||
Surgical | 0.84 (0.80-0.89) | ||||||
Medical patients | 0.94 (0.94-0.95) | ||||||
An increase by 1 RN per patient day
|
An increase by 1 RN per patient day
| ||||||
Hospital acquired Pneumonia | 0.70 (0.56-0.88) | ||||||
Unplanned extubation | 0.49 (0.36-0.67) | ||||||
Respiratory failure | 0.40 (0.27-0.59) | ||||||
Cardiac arrest | 0.72 (0.62-0.84) | ||||||
Risk of failure to rescue | 0.84 (0.79-0.90) | ||||||
Length of stay was shorter by 24% | 0.76 (0.62-0.94) | ||||||
Thungjaroenkul 2007[56] | Nursing staff | 17 studies: 2 prospective, 10 retrospective, 4 retrospective and prospective study, 1 Pre-post quasi-experimental design | Nurses in HIC | Patient length of stay | No | Sufficient numbers of RNs may prevent patient adverse events that cause patients to stay longer | |
Hospital costs | |||||||
Zwarenstein 2009[52] | A practice-based intervention introduced to a practice setting with an explicit objective of improving collaboration between two or more health and/or social care professionals. | 5 RCT | Health care professionals | Health measures | No | IPC interventions can improve healthcare processes and outcomes, | |
Quality of life measures | |||||||
Complication rates |