Introducing%20QI%20Tools%20and%20Approaches%20COPE

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Introducing QI Tools and ApproachesCOPE
APPENDIX FSession B Facilitative Supervision
for Quality Improvement Curriculum 2008
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Goals of Quality Improvement
Actual practice

• Quality services that meet clients needs
• Improved performance of staff and institutions
• Better health

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The QI Process
Information gathering and analysis
Action plan development and prioritization
Follow-up/ evaluation
Implementation
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EngenderHealths QI Package

• QI Approaches
• Facilitative supervision
• Whole-site training (including Inreach)

• QI Tools
• COPE
• Community COPE
• Quality Measuring Tool
• Cost Analysis Tool
• Medical Monitoring

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Information Gathering
Record/ case review
Data review
CFA
Observation of services
Client interview
Staff interview
COPE
Facility audit
INFO
Quality Measuring Tool
Community assessment
Cost analysis
Identify gap between actual practice and best
practice
INFO
PNA
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Underlying Principles

• A customer mindset
• Staff involvement and ownership
• Focus on systems and processes
• Cost-consciousness and efficiency
• Continuous quality improvement
• Staff development and capacity building

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Clients Rights

• Information
• Access to services
• Informed choice
• Safe services
• Privacy and confidentiality
• Dignity, comfort, and expression of opinion
• Continuity of care

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Staff Needs

• Facilitative supervision and management
• Information, training, and development
• Supplies, equipment, and infrastructure

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COPE Client-
Oriented,
Provider-
Efficient services

• COPE is a continuous, participatory process with
  tools to improve the quality of care through
  self-assessment.
• There tools are used by all levels of staff and
  supervisors to collectively identify and solve
  problems.
• COPE is based on a framework of clients rights
  and staff needs.

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Who Are Our Customers?

• External customers?
• Internal customers?

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COPE Tools

• Self-assessment guides, including record-review
  checklist
• Client interviews
• Client-flow analysis (CFA)
• Action plan

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COPE for Reproductive Health Services Topics

• Antenatal care
• Labor and delivery
• Postpartum and newborn care
• Family planning
• Postabortion care
• RTIs/STIs/HIV

• Gynecologic disorders
• Disorders of the male reproductive system
• Sexuality
• Infertility
• Harmful practices

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The Self-Assessment Guides

• Self-assessment the heart of COPE
• By staff, for staff To encourage staff and
  supervisors to recognize what they are doing well
  and to identify and solve the problems they face.
• The guides are not a test.
• Trigger questions relate to common issues at most
  service sites.

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How to Use the Self-Assessment Guides (1)

• Staff might split into teams, each working on
  one or more guides.
• If something does not apply to the site, skip
  it.
• If something important is not listed, add it!
• No means a possible problem try to find out
  more.

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How to Use the Self-Assessment Guides (2)

• Be honest about problems
• Get input from coworkers who are not on your team
• Be specific and concrete

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Client Record-Review Checklist

• The checklist is a part of the self-assessment
  guide on safety.
• Ten client records are selected at random.
• Records are assessed to learn whether key
  information is being recorded accurately and
  completely.

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Client Interviews

• Why conduct client interviews?
• To learn what clients think about services.
• To get suggestions from clients about how to
  improve services.
• Because we do not know what clients say unless we
  ask them.
• To show that we care about their needs.

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Client-Flow Analysis (CFA)

• CFA is a process for measuring the time each
  client spends waiting for services and the time
  that staff spend in direct contact with each
  client.

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Client Register Form (for CFA)
Client ? _______
Type of visit
Male Female Contraceptive method____
Revisit First visit Time of clients
arrival in clinic
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Client-Flow Analysis
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30
45
1000
15
30
45
1100
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Developing the Action Plan

• Involve all levels of staff in the discussion
• Review problems identified
• Analyze root causes of problems

• Recommend solutions
• Be specific
• Prioritize

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Developing a Clear Problem Statement (1)

• Problem The difference between the actual and
  desired situation
• Must agree that this is a problem
• Count the problem (state measurable
  indicators). But do not try to measure everything!

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Developing a Clear Problem Statement (2)

• Focus on processes and systems.
• Do not blame individuals for mistakes.
• Define problems and processes that are manageable.

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Analyze the Root Cause of the Problem Multiple
Whys
Why?
Why?
Why?
Are there any other causes?
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Action Plan Format
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Schedule for the First COPE Exercise

• Day 1
• Morning Introducing COPE
• Conduct tour of facility/meet management and
  participants
• Hold COPE introductory meeting with staff
  (approximately three hours)
• Afternoon Client interviews and self-assessment
  (All
• Activities are carried out during routine work
  hours at
• staffs convenience)
• Conduct client interviews
• Use self-assessment guides, including
  client-record review

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Schedule for the First COPE Exercise (2)

• Day 2
• Morning and afternoon Client interviews and
• self-assessment
• (All activities are carried out during routine
• work hours, at staffs convenience.)
• Conduct client interviews and prepare an action
  plan
• Use self-assessment guides and prepare an action
  plan

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Schedule for the 1st COPE Exercise (3)

• Day 3
• Morning Action plan
• Action plan meeting
• Select QI Committee members
• Schedule the follow-up meetings and next COPE
  exercise

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Action Plan Meeting

• Presentation of action plans
• Prioritization of problems and consolidation into
  one action plan for the site
• Discussion of site strengths
• Establishment of QI Committee
• Setting of date for follow-up with QI Committee

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Tasks for QI Committee

• Make the action plan accessible for all staff to
  see it.
• Follow up the sites action plan.
• Support staff responsible for implementing
  solutions.
• Schedule subsequent COPE exercises.
• Help monitor results.

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Second and later exercises Review status of
action plan Conduct self-assessment, client
interviews Apply other tools as needed
First COPE Identify needs Self-assessment, clien
t interviews
Follow up By staff, by off-site supervisors,
by COPE Committee
Ongoing COPE process
Analyze root causes
Implement solutions
Develop an action plan
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The COPE Toolbox

• COPE Handbook
• COPE Toolbooks
• Family planning
• Reproductive health
• Child health
• Maternal health
• Community involvement

• Adolescent reproductive health
• Emergency obstetric care
• PMTCT services
• Cervical cancer
• HIV treatment and care
• HIV testing and counseling

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Benefits of COPE

• Develops a customer focus among staff
• Empowers staff at all levels and builds teamwork
• Provides tools for local problem identification
  and problem solving
• Helps to communicate standards and improve
  performance
• Presents concrete and immediate opportunities for
  action
• Responds to local needs in decentralized health
  systems

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Implement Interventions

• Clarify roles and expectations
• Supervision and follow-up
• Whole-site training
• Reorganization of work
• Resource development (job aids, etc.)
• Supplies and equipment

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Evaluation

• Reassess
• What worked?
• Why did it work?
• What did not work?
• Why not?
• Revise action plan

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Using the Action Plan for Evaluation
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The QI Process
Information gathering and analysis
Action plan development and prioritization
Follow-up/ evaluation
Implementation