Impact of Point of Care Quality Improvement Training and Coaching on Quality Perceptions of Health Care Workers: Implication for Quality Policy

Figures & data

Table 1 Validity and Reliability of the Instrument

Psychometric Attribute	Instrument
	PHC	Hospital
Number of items	42	39
Outfit Mean Square	0.98	0.93
Mean	0.00	0.00
Standard Deviation	0.78	0.85
Separation	7.33	6.17
Reliability	0.98	0.97
Cronbach’s alpha	0.93	0.95
Chi-square (χ^2)	12,720	7196
P-value	0.001	0.001
Unidimensionality
Raw variance explained by measure	45.9%	58.5%
Unexplained variance 1st contrast	20.4%	13.2%

Table 2 Changes of Perceptions of Staff in the PHC Group (n=60)

Variables	Mean (logit)		Mean Difference	CI (95%)		p-value*
	Baseline	Endline		Lower	Upper
QI Understanding	0.5942	1.8178	−1.22363	−1.64699	−0.80027	0.001
QI Engagement	1.3140	2.9922	−1.67820	−2.41865	−0.93775	0.001
POCQI Skill	0.8727	6.0083	−5.13564	−6.18472	−4.08656	0.001
Process	2.2897	2.6319	−0.34220	−0.88887	−0.20448	0.218
Intermediate Outcome	2.8438	2.8854	−0.04159	−0.79663	−0.71345	0.913
Quality performance	0.5942	1.8178	−0.88689	−1.03447	−0.73930	0.001

Note: *2 tailed.

Table 3 Changes of Perceptions of Staff in the Hospital Group (n=40)

Variables	Mean (logit)		Mean Difference	CI (95%)		p-value*
	Baseline	Endline		Lower	Upper
QI Understanding	0.8175	1.8235	1.00600	0.43895	1.57305	0.001
QI Engagement	1.1890	2.7053	1.51625	0.52357	2.50893	0.003
POCQI skill	0.5520	3.3498	2.79775	2.07363	3.52187	0.001
Process	1.4418	2.9183	1.47650	0.36974	2.58326	0.010
Outcome	6.9433	9.2648	2.32150	0.38462	4.25838	0.019
Quality performance	0.1860	1.2525	1.06650	0.79553	1.33747	0.001

Note: *2 tailed.

Table 4 Comparison of Perceived Quality of Infant Health Services Before and After POCQI Interventions in Indramayu and Cianjur Districts

No	Regency	Quality	Before Intervention	After Intervention
1	Indramayu District	PHC Patient Perception	Infant health service is still not good, registration queues for about 1 hour. The equipment in the Emergency Room (ER) is damaged, and when referring patients, they are not accompanied by health workers. It does not have a suggestion box as a means for patients to express complaints about service quality.	The patient is satisfied, the officer explains clearly, and the queue is perceived as not too long. Health workers accompany patients when referring to hospitals, but not routinely. All PHCs already have a suggestion box.
		Public Hospital Patient Perception	ER service is quite good.	Patient services in the ER, until the delivery process, are handled well.
		Private Hospital Patient Perception	The service is good, the staff is friendly, and the place is clean. However, the staff do not inform patients well.	Officers become more informative and care for patients. The hospital has made changes to the service flow. Make handwashing stations in various places so that patients have no trouble finding places to wash their hands.
		Perceptions of PPHC Health Workers	There is no feedback from the leadership about the quality of services provided to patients. Compliance with Standard Operating Procedure (SOP) management has not been maximally carried out. The existing service SOPs are general.	After training and coaching POCQI health workers became more detailed in providing services and observing patients, all services provided were patient-centered. There is supervision to carry out SOP management for health workers. Making SOPs per patient service case.
		Perceptions of Public Hospital Health Workers	The hospital quality team has a high burden. The room service team only reports response time, doctor visit hours, medication errors, etc.	There is a division of tasks between the hospital quality assurance team and the hospital POCQI team. Service is more patient-centered. Completing SOPs per patient service case
		Perceptions of Private Hospital Health Workers	Health workers feel unable to improve the quality of their inputs are not met,	Health workers can improve quality through service processes, care more for patients, and complete SOPs per patient case. Service is more patient-centered.
2	Cianjur District	PHC Patient Perception	Affordable cost of care but waiting times are long.	Patients are satisfied with the current PHC services because they have made various repair efforts such as the room for mother and child health service, which is different from the treatment center, there is a playroom for children Patients rarely complain to the primary health center.
		Public Hospital Patient Perception	The service at the hospital is good, and the nurses are friendly, but some doctors are not friendly.	Patients are satisfied with the services provided by the hospital, both in terms of facilities, infrastructure, friendliness, clarity in action.
		Private Hospital Patient Perception	Infant health services are not good and lack human resources, facilities, and infrastructure. There is no NICU and PICU room. The health workers took a long time to decide to refer patients to a higher facility.	The staff is more friendly and cares about patients, the infrastructure is better.
		Perceptions of PPHC Health Workers	So far, quality improvement has focused more on inputs, so that the PHC does not make any changes if there are no tools, facilities, and budget,	The PHC staffs understand that improving the quality of POCQI services is more of a process so that each employee can move to change the service process for the better. Service is more patient-centered The PHC staffs are also enthusiastic about improving the quality of infant health services because so far, the focus has only been on maternal health services. The PHC conducts an audit if there are staffs who do not comply with the mutually agreed SOP.
		Perceptions of Public Hospital Health Workers	Some staff do not comply with SOPs in providing health services.	The compliance of staff with SOPs has increased. Creating new SOPs as an effort to improve infant health services, including SOPs for incubators. Service is more patient-centered.
		Perceptions of Private Hospital Health Workers	Staff do not care and understand the importance of infant health services.	Staff are becoming more concerned with the care of infants, making new SOPs. Patient-centered service

Table 5 Comparison of POCQI Activities for Infant Health Services Before and After POCQI Interventions in Indramayu and Cianjur Districts

No	POCQI Activities	Before POCQI Intervention	After POCQI Intervention
1	POCQI Team Formation	PHCs and hospitals do not yet have a POCQI team, but they do have a quality team.	-All PHCs and hospitals have formed POCQI teams. -POCQI Team members vary between 5–12 people.
2	Performing 4 POCQI Steps	-Comprehension of service quality is still focused on quality assurance related to accreditation and improvement of inputs. -All health centers and hospitals have not carried out the four steps of POCQI because they do not know and do not understand the four steps of POCQI.	-PHCs and hospital staff have understood what Quality Improvement and POCQI mean and have made improvements to process aspects. -PHCs and hospitals have been able to take the first step of POCQI, which is to determine problems and prioritize problems and goals using the specific, measurable, achievable, reliable and time-bound (SMART) principle. -PHCs and hospitals have been able to carry out POCQI’s second step, namely using the fishbone instrument to identify the cause of the problem and alternative solutions to the problem. -PHCs and hospitals have been able to carry out POCQI’s third step, namely developing change ideas and implementing Plan-Do-Study-Action (PDSA). -PHCs and hospitals have been able to carry out POCQI’s fourth step, namely through continuous improvement.