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Table 5 Leadership for perinatal care: domains and indicators

From: A health system framework for perinatal care in South African district hospitals: a Delphi technique

Domains Indicators
Accountability 1. Operational managers have documented disciplinary procedures for control and prevention of the following:
 a) Late coming
 b) Absenteeism
 c) Non-adherence to clinical guidelines
 d) Lack of respect or abusive behavior by health care professionals toward mothers
2. Operational managers meet, within 24 h, with the team of health care professionals who were on duty during an adverse perinatal event (death or morbidity) resulting from intrapartum care
3. Operational managers have clear standard operating procedures for implementing a perinatal audit process (i.e. 24-h meeting post perinatal death or morbidity; preparatory meeting for monthly review meeting; and monthly perinatal review meeting)
Protocols of management Operational managers have documented protocols with regards to the
following:
1. Clear referral protocol from district hospital to regional hospital
2. Clear referral protocol from clinic or Community Health Center (CHC) to district hospital
3. Clear protocol with admission and discharge criteria for mothers
4. Clear protocol with admission and discharge criteria for neonates
5. Clear protocol, guided by staff norms, on staff allocation per shift, for latent phase and labour wards, with respect to number of staff
6. Clear protocol, guided by staff norms, on staff allocation per shift, for latent phase and labour wards, with respect to health care professional skill mix
7. Clear protocol on maintenance of medical equipment
8. Clear protocol on procurement of medical equipment
9. Clear protocol on monitoring of medicines stock
10. Clear protocol on infection prevention and control
11. Availability of protocols for intrapartum care (as per Maternity Care Guidelines)
12. Availability of protocols for neonatal care (as per Initiative for Newborn Care (INC) guidelines)
Supervision 1. Operational managers ensure ongoing supervision for all staff in latent phase and labour wards
2. Operational managers ensure clinical mentorship is provided to all health care professionals in latent phase and labour wards whose perinatal care skills need improvement
Induction Program 1. Operational managers allocate an advanced or experienced midwife to work alongside a health care professional who has just completed nursing training and has never worked in latent and labour wards
2. Operational managers ensure that experienced health care professional who have not been working in latent and labour wards go through an induction program to review and assess all important processes and skills for perinatal care
3. Operational managers ensure that skills of new staff (newly qualified and those who have been working in other hospital units) in latent and labour wards are assessed before and after the induction program
Teamwork Hospital clinical manager ensures that doctors and nurses who work in latent phase and labour wards, work in harmony
Interest in perinatal outcomes Senior hospital managers consistently participate in monthly perinatal review meetings that are held in their district hospitals
Stability 1. District hospital has a formally appointed hospital CEO (not an Acting CEO)
2. Minimal management turnover (i.e senior hospital managers remain in leadership posts for at least 3 years)
Community Engagement Senior hospital managers organize campaigns to engage with community to raise awareness on risk factors for perinatal deaths that are attributable to patient factors