The training program for the nurses included attendance at a two-day workshop where the following topics were presented by expert clinicians: patho-physiology of COPD, assessment of COPD, spirometry, smoking cessation, management of COPD according to COPDX guidelines, role of pulmonary rehabilitation in the management of COPD, and the management of exacerbations.
These included the existence and widespread use of evidence-based clinical practice guidelines, the roles and activity of a local Practice Improvement Committee (a clinical governance oversight committee), and the routine use of regular and formal practice review.
Supervisors were instructed separately on data collection guidelines, their roles and their responsibility to ensure data quality.
Establish a client referral scheme between different health agencies with uniform guidelines, clear roles and consistent evaluation.
The complex service processes with no agreed uniform guidelines, clear roles and consistent outcome evaluation may bring more difficulties to establish the referral and communication networks; in turn, a lack of the referral and communication networks or a lack of uniform guidelines, clear roles and consistent outcome evaluation systems also may lead to more complicated service processes.
The major obstacles to the coordination of delivering these integrated services are lack of service resource integration; and lack of a mechanism for coordination of the health systems, with no uniform guidelines, clear roles or consistent evaluation.
(KI 2: CHMT member) The responses from district level were almost similar to those provided by HFGC members, that the guidelines on roles and responsibilities of HFGCs have not been disseminated though they have been distributed to some of the health facilities.
They stressed that making district health departments more resourceful in policy and planning, human resource management, resource allocation, monitoring and evaluation and financial matters, and developing clear guidelines for roles and responsibilities of officials at every level from the centre to the districts may help to improve services.
According to the guidelines, the role of lenders like Mr. Saatchi should be limited to consultations over the "objects to be selected from the lender's collection and the significance to be given to those objects in the exhibition".
Nurses were also provided with a structured opportunity to practice using the guidelines in role-plays.
The effects of the guidelines and role of involvement on improvement were reported to be moderate or limited.
