Details of the PDSA cycles
| PDSA | PDSA 1 | PDSA 2 | PDSA 3 | Sustenance |
| When | 1 February 2019 to 10 March 2019 | 20 March 2019 to 20 July 2019 | 10 August 2019 to 15 October 2019 | 20 October 2019 to 30 April 2021 |
| Plan | Training nurses, provision of bed. | Remove visiting restrictions for fathers/grandmothers for doing KMC. | Reduce variation in counselling. | Sustain KMC-QI champion and recognition, simpler data collection. |
| Do | Half-day KMC training session for all nurses, HDU 2/4 beds marked for KMC. Track KMC rates. | Foster KMC posters, change visiting restrictions policy, foster KMC was emphasised in daily counselling sessions. | Structured counselling of mothers for KMC using a standard video. | QI champions—cake cutting and celebrations, data collection on daily dashboard, KMC part of discharge policy, display run charts monthly. |
| Study | KMC increased from 2.7 to 5 hours/baby/day. Availability of mothers is a concern. | KMC increased from 5 to 5.7 hours/baby/day. Mother had concerns if there was no weight gain despite KMC and less motivation. | KMC increased beyond 6 hours/baby/day. | Prolonged KMC could be sustained for nearly 18 months despite COVID-19 pandemic. |
| Act | Try foster KMC with father/grandmothers. | Continue foster KMC and attempt structured counselling of mothers. | Sustain KMC. | Continued sustenance. SOP for prolonged KMC. |
HDU, high dependency unit; KMC, kangaroo mother care; PDSA, Plan-Do-Study-Act; QI, quality improvement; SOP, standard operating procedure.