Use of a Context Assessment Toolkit to Improve Sustainability of Quality Improvement Initiatives: Experience from Tamil Nadu, India

Abstract Background Consideration of context is essential for the successful modification and execution of initiatives aimed at enhancing healthcare. To address contextual variation, Ariadne Labs developed the Context Assessment Toolkit (CAT), comprising a collection of surveys and supporting materials to help practitioners tailor their interventions to specific local environments. In Chengalpattu, Tamil Nadu, India, Sree Renga Hospital employed components of the CAT in a 9-hospital quality improvement (QI) collaborative aiming to elevate the quality of care during childbirth by consistently implementing the WHO Safe Childbirth Checklist (SCC). Methods The CAT conversation guide, introduced during the second of two PDSA cycles of SCC implementation, was used with QI collaborative facility leaders and staff to identify implementation challenges. The completed conversations were analysed with mixed methods data to identify strengths and challenges of individual organisations. Descriptive analysis helped identify contextual factors requiring improvement, and individualized action plans, focusing on strategies to sustain QI, were developed for each hospital. Hospital leaders provided feedback on the use and accuracy of the CAT conversation guide. The sustainability of SCC implementation was assessed six months after the action plans. Results The CAT conversation guide facilitated 79 conversations (26 hospital leaders, 53 hospital staff) across nine Collaborative hospitals. Most hospital leaders (88%) indicated that the CAT accurately identified the organisation's strengths. All (100%) leaders agreed that the CAT accurately identified the organisation’s challenges. Hospitals were able to implement the action plans; adherence to and timeliness of SCC items remained high (99% completion; 84% timeliness) six months after implementation. Conclusions The CAT conversation guide accurately identified individual hospital strengths and challenges. It facilitated the development of feasible, individualized action plans to foster the sustainability of a hospital’s improvements. The CAT conversation guide may be an efficient tool to support the implementation of intervention adaptation of QI projects.