Quality indicator development and implementation in maternity units.

Measuring the quality of inpatient obstetrical care has generated considerable interest in recent years. Numerous quality measures have been proposed by national and international programmes and by obstetrics societies; however, no agreement has been reached on which measures should be used. Differences in opinions across healthcare professionals complicate the development of a standardised set of quality indicators. The use of structured methods, particularly consensus methods such as Delphi techniques, can help to choose indicators according to quality goals. Once relevant indicators are identified, maternity units should consider using a dashboard to plan and improve their services. Statistical process control is a statistical method designed to monitor and control processes. This method seems particularly promising for monitoring quality indicators in maternity units. Among statistical process control techniques, cumulative sum charts that monitor pre-selected quality indicators can be easily designed for obstetrics and gynaecology units. Cumulative sum charts provide clinicians with a picture of current practices, and rapidly detect unwanted changes in quality indicator rates.