Standards-Based Management and Recognition for Improving Quality in Maternal and Newborn Care

This approach consists of two key components: the systematic utilization of performance standards as the basis for the organization and functioning of health services, and the rewarding of compliance with standards through recognition mechanisms. The SBM-R process begins with the development of evidence-based operational standards in a specific area of health delivery, in this case, maternal and newborn care. The performance standards developed are included in the assessment tool and can be used for self, peer, internal, and external assessment at the facility level. The implementation of the assessment tool leads to the identification of performance gaps that need to be reduced or eliminated. Local health managers and providers analyze the causes of the gaps and identify and implement appropriate interventions to correct them. Local health authorities are encouraged to focus on action and begin with simple interventions to achieve early results, create momentum for change, and gradually acquire change management skills to address more complex gaps. Partial improvements are rewarded during the process using a combination of measures, including feedback and social recognition. The performance assessment tool lists key performance standards organized by area of program support and includes verification criteria for each performance standard that is easily observable with "Yes" (Y), "No" (N), and "Not Applicable" (N/A) answer options. The tool objectively establishes the desired level of performance, measures actual level of performance when applied to a facility or institution, and helps identify performance gaps. The assessment tool consists of four areas and a total of 40 standards. The tool should be used to conduct assessments in the facility, and the standards have specific instructions about how and where to collect/verify the information needed. The three methods of data collection are direct structured observation, document review, and interviews or clinical simulations. When using the assessment tool, the results should be summarized using the summary table at the end of each area and filled in the summary sheet. The number of standards achieved per area and in the row of total should be written in the summary sheet, and the percentage of standards achieved per area and in total should be calculated by dividing the number of standards achieved by the total number of standards in each area and multiplying the results by 100. For a facility to obtain recognition, it should reach at least 80% compliance with the standards overall. Continuous measurement of progress is used as a mechanism to guide the process, inform managerial decisions, and reinforce the momentum for change. Through continuous measurement, managers, providers, and communities can monitor progress, assess the success of interventions, identify gaps, and introduce necessary adjustments to their plans.