Table 1

PDSA cycles for implementation of birth companion in labour ward

PlanDoStudyAct
PDSA 1
(16–21 January 2019)		Development of a policy and sensitisation of doctors and nurses:

  • Formulation of SOP

  • Meetings with labour ward team

  • PowerPoint presentations on respectful maternity care and birth companion

  • Clear-cut prerequisites of birth companion

  • Ensuring partition by curtains for privacy

Implementation of change idea by QI team as plannedMedian value of birth companion practice in 25% of deliveriesThe idea was adapted.
Lessons learnt:
It was felt that one-time sensitisation is not enough.
PDSA 2
(22–31 January 2019)		More involvement of labouring women and their family members and continued reinforcement:

  • Counselling by staff nurse at admission

  • Designated dress code for easy identification of birth companion

  • Posters

  • WhatsApp group for daily reminder

Cycle was carried out as per plan.
An additional column was added in birth register for data recording		Data plotted on run chart (figure 2)
There was a shift in the median noted after PDSA 2
Median reached 66.6%		The idea was adopted.
Lessons learnt:
Daily reminders and active participation of patients and their families brought the result.
Sustainability needs to be assessed.
PDSA 3
(May 2019)		Modification of SOP in consultation with senior faculty:

  • Sharing of SOP with entire department

  • Resensitisation of new labour ward team

Reinforcement by QI teamThe percentage of birth companion subsequently declined, but it picked up after PDSA 3 (figure 1)The idea was adopted.
Lessons learnt:
Sustainability is difficult with frequent change of labour room teams.
Inputs from senior faculty are vital.
PDSA 4
(June 2019 to February 2020)		Sustainability:

  • Policy of giving overs to new labour room team

  • Regular team meetings

  • Monthly data review

Cycle was carried out as per planMedian value reached 65, and hence the goal of 50% was achievedAdopted.
Lessons learnt
Despite challenges, sequential steps helped in attaining the goal within existing resources

  • PDSA, plan-do-study-act; QI, quality improvement; SOP, standard operating procedure.