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QUALITY IMPROVEMENTREFERRAL SYSTEM STRENGTHENINGSTRENGTHENING ACCOUNTABILITY

Quality Improvement

EMAS tackles high maternal and newborn mortality rates in Indonesia through facility and health provider strengthening. In the EMAS model, master hospitals and health centers—known as Vanguards—regularly mentor other hospitals and health centers. When these recipient facilities reach a minimum standard of excellence, they too become mentors helping to propagate a quality assurance cycle.
In EMAS' first two years, local partner Budi Kemuliaan was the primary trainer for EMAS Vanguards. In EMAS’s third year beginning October 2013, Budi Kemuliaan takes on an advisory role and it is the Vanguards which are now tasked to expand to another 47 hospitals and 89 health centers (Puskesmas).
EMAS interventions are targeted towards preventing and treating the main causes of maternal and neonatal death. For pregnant mothers this is post-partum hemorrhage, eclampsia, sepsis and obstruction. For newborn babies this is asphyxia, complications of prematurity, infection and respiratory distress.
At the facility level, this means that EMAS facilities are staffed and stocked according to national standards and that EMAS hospital and Puskesmas regularly monitor their performance using clinical dashboards. The dashboards provide quick, clear data on medical staff to patient ratios, rate of adherence to evidence based protocols, percentage of deliveries resulting in referral or C-section, number of emergency drills conducted and deaths by month with the proportion audited, among other medical quality indicators.
At the provider level, this means doctors, nurses and midwives in EMAS facilities both possess the skill to care for sick patients and adhere to the highest standards of care.  EMAS has begun rolling out decision support tools (DST) to provide more focused context for mentoring. DST are essentially formal checklists. The checklists ensure, for example, that a 2 kilogram baby born at 1 a.m. in a small EMAS Puskesmas goes through the same process of care as a 3 kg baby born at 12pm at a large RSUD Hospital in Tegal. Health care providers will not need to remember the indications for and dose of antibiotics due to treat premature rupture of membranes because they will already be identified for them. They only need to check the box.
Whatever the level of intervention, EMAS will achieve its goals through mentorship and side-by-side work with staff, providers and leaders in Indonesia's health community.  We will measure and report on our results.