Developing clinical indicators for the secondary health system in India

Quality problem or issue. One of the prime goals of any health system is to deliver good and competent quality of health-care. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. Initial assessment. During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. Choice of solution. Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. Implementation. It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and train-ing manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indi-cators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. Evaluation and lessons learned. Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme