title: Developing clinical indicators for the secondary health system in India.
abstract: OBJECTIVE
  One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality.
  
  
  METHODS
  During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified.
  
  
  METHODS
  Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems.
  
  
  METHODS
  It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, 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.
  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.
authors.affiliation: School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai, India. harshad@tiss.edu
authors.forename: Harshad
authors.initials: H
authors.lastname: Thakur
authors.forename: S
authors.initials: S
authors.lastname: Chavhan
authors.forename: Raju
authors.initials: R
authors.lastname: Jotkar
authors.forename: Kanchan
authors.initials: K
authors.lastname: Mukherjee
mesh_terms: D006302:Health Services Research / Q000379:methods; D006801:Humans; D007194:India; D009936:Organizational Innovation; D016730:Program Development / Q000379:methods; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care