Evaluation of a tailored implementation strategy for audit-generated improvements in perinatal care

Perinatal audit identifies substandard factors in perinatal care for quality improvement of care. However, not all identified improvement objectives achieve effective implementation. The ACTion method, using a 7-step Plan-Do-Check-Act cycle, was developed for local perinatal care professionals to enhance tailored implementation by interactive learning, training and coaching of implementation and behaviour change principles.This study aimed to evaluate the efficacy of the ACTion method within all perinatal cooperation groups (PCGs) in the northern region of the Netherlands.

A mixed-methods design was used for effect and process evaluation. Descriptive and inferential statistical methods were applied to analyse participants' knowledge; skills; motivation; and the number, nature and implementation stage of improvement objectives. Additionally, influencing factors were examined through inductive thematic analysis.

A multidisciplinary ACTion team was formed in all 11 PCGs. From the initially 93 participating ACTion team members, 86% completed the full training.Knowledge and skills after implementation of the ACTion method improved significantly, with mean scores increasing from 2.53 to 3.70 on a 1-5 Likert scale (p<0.001, r=0.9). ACTion teams addressed 3-19 improvement objectives, with implementation ranging from 14% to 67%, depending on time of start of the project and influencing factors. In total, 98 improvement objectives were addressed, of which 46 (47%) were fully implemented and secured. As emerged from interviews, a proactive key person and ongoing coaching during the follow-up phase were instrumental in driving these efforts. The multidisciplinary approach and collaborative efforts in regional obstetric care enhanced mutual understanding and cooperation across disciplines. Impeding factors included limited time, manpower and lack of commitment within the PCG.

A locally tailored approach, involving interactive learning, training and coaching in the ACTion method, provides a valuable framework for implementing audit-driven improvement objectives in maternal and perinatal care, while simultaneously fostering interprofessional cooperation.