Optimizing health workforce performance in reduced resources settings to sustain continuous improvement of patient outcomes: a retrospective, serial, cross-sectional analysis of a comprehensive multidisciplinary approach, with special focus on maternal and neonatal health

Staff attrition and frequent turnover in the clinical areas represent a threat to adequate standards of quality of services and its improvement. We describe an example of comprehensive multidisciplinary approach to strengthen health services delivery based on initiatives to: i) reinforce leadership and management of the clinical team; ii) support evidence-based knowledge and performance of the health workforce (HW) for improved efficiency, standardization and resilience to staff migration and/or turnover; iii) develop tools to measure dimensions of leadership and teamwork spirit, competence and quality of health services delivery. Results from a retrospective serial cross-sectional analysis of 17 months of implementation of the approach are presented, with special focus on maternal and neonatal outcomes, to inspire future approach and expansion. Considering deliveries and outcomes occurred at the same institution during the periods January2019- May2020 (period A – control I), January2021-May2022 (period B – control II) compared to January2023-May2024 (period C - test), we observed significant improvements in clinical outcomes (reduction of institutional perinatal mortality from 18.9:1000 and 27.9:1000 to 7.3:1000). This despite the increase of staff turnover and increased workload in the maternity department (particularly between period C vs. period B). These data support that the integrated multidisciplinary approach described may help to promote optimization of HW performance, to assist in increasing competency, and resilience to the threat to quality of services, posed by high turnover of team members, often happening in low-resources and rural settings.