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Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

机译:在为改善肯尼亚地区医院的儿科和新生儿护理而进行的为期18个月的干预中的实施经验

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摘要

Background. We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it. Methods. We used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators. Results. Four hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving, and orientation of new staff to guidelines. In four control hospitals receiving a minimal intervention, local supervision and leadership to implement new guidelines, despite their official introduction, were largely absent. Conclusion. The actual content of an intervention and how it is implemented and received may be critical determinants of whether it achieves its aims. We have carefully described our intervention approach to facilitate appraisal of the quantitative results of the intervention's effect on quality of care. Our findings suggest ongoing training, external supportive supervision, open feedback, and local facilitation may be valuable additions to more typical in-service training approaches, and may be feasible. © 2009 Nzinga et al; licensee BioMed Central Ltd.
机译:背景。我们进行了一项干预研究,旨在改善肯尼亚儿童和新生儿的住院治疗。在判断一项干预措施是否达到其目的时,必须了解如何进行干预。在这里,我们描述了实施团队如何在18个月内实施干预措施,并提供了一些有关卫生保健人员(干预措施的主要目标)如何接受干预措施的见解。方法。我们使用了两种方法。首先,对干预措施的描述是基于对培训记录,对医院的监督和反馈访问以及与当地医院服务人员进行电话通话期间讨论的关键主题的简要日志的分析。为此,在研究开始时建立了记录保存,并在干预期结束时进行了分析。其次,我们计划在干预项目中嵌套进行定性研究,并使用深入的访谈和小组讨论来探索卫生工作者和促进者对实施的看法。在对所有访谈数据进行主题分析之后,在医院服务人员的帮助下,对结果进行了介绍,讨论和修订。结果。四家医院接受了全面的干预,包括指南,培训和两到三个月的支持监督以及六个月的绩效反馈访问。监督人员的访问,以及与管理员,卫生工作者和协助者互动的机会,经常被用于即席,有限的进修培训或新员工的入职培训。与高级职员的私人联系似乎鼓励了当地对干预目标的承诺。通过与管理员和员工进行公开会议和讨论,可以最好地提供反馈。监督虽然有时被认为是发现问题,但它却帮助当地协调员成为许多活动的重点,包括联络,当地监测和反馈,解决问题以及新员工适应指导方针等方面的关键作用。在接受最低限度干预的四家控制医院中,尽管正式引入了新指南,但当地监督和领导层却很少。结论。干预措施的实际内容以及如何实施和接收干预措施可能是决定其是否实现目标的关键因素。我们仔细描述了我们的干预方法,以方便评估干预对护理质量的定量结果。我们的研究结果表明,正在进行的培训,外部支持性监督,开放反馈和本地协助可能是对更典型的在职培训方法的宝贵补充,并且可能是可行的。 ©2009 Nzinga等;被许可人BioMed Central Ltd.

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