Leading Staff through Change: Links to the Larger System

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Leading Staff through Change Links to the Larger
System

• MODULE 7
• Facilitative Supervision for Quality Improvement
  Curriculum
• 2008

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What Is Health-Sector Reform (HSR) after All?
Decentralization
Privatization
Cost reduction
Participation
State reforms
Donors interests
People must pay
Enhanced health system
Financing health
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Characteristics of HSR
Essential services packages (ESPs)
Laws and regulations
Organizational change
Financing
Social participation
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Types of Health-Sector Reforms

• Type
• Structural
• Political
• Administrative
• Financial

• Example
• Creation of new health authorities
• Negotiation of essential services package
• Decentralized management
• Introduction of fees for services, health
  insurance, funding sources for health care

(Mills 1997)
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Phases in the Change Process

• Recognize a challenge
• Identify promising practices
• Adapt and test one promising practice or set of
  practices
• Implement the new practice(s)
• Scale up the successful new practice(s)

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Supervisors Recognize a Challenge

• Ask staff about work problems (gaps between
  actual and desired practices).
• Ask clients and stakeholders the same question.
• Study service data.
• Bring together a cross-section of staff, share
  findings, create a shared vision.
• Come to a common understanding of the problem,
  and analyze both obstacles and the organizational
  factors that will support change.
• Turn the problem into a challenge.
• Begin to bring senior managers on board.

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Supervisors Identify Promising Practices (1)

• Explore what other people/organizations are doing
  to meet similar challenges.
• Ask experts what practices have worked elsewhere
  with similar challenges.
• If local solutions are unavailable, seek advice
  from other regions, specialists, universities,
  etc.

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Supervisors Identify Promising Practices (2)

• Read professional journals or use Internet.
• Share relevant ideas with your staff and other
  stakeholders, and explore potential benefits and
  disadvantages of different practices.
• Choose one intervention or practice (or a set of
  them) that you and your staff agree best matches
  your challenge, needs, mission, and resources.

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Adapt and Test One Promising Practice

• Select a change team to champion the change
  effort with the rest of staff.
• With a team, assess readiness for change and plan
  ways to address factors and steps that were
  missing from previous change efforts.
• Study how your proposed practice has worked
  elsewhere (lessons learned).
• Discuss with a team how the practice can be
  adapted.

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Adapt and Test One Promising Practice (2)

• Decide what the new practice will accomplish, how
  to assess progress, and what indicators to use.
• Introduce the practice on a small scale, and
  carefully monitor it.
• Encourage staff to experiment with adaptation and
  documentation to find the best variation of the
  practice.
• Show your commitment to this change on an ongoing
  basis.

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Implement the New Practice(s) (1)

• Introduce new practice(s) on a wider scale, and
  meet with any people who block the change.
• Be sure that staff implementing the change
  understand their roles and have been given
  resources and time.
• Train staff to apply and use new practice(s).
• Provide short-term targets and acknowledge
  staffs early achievements, to build confidence.
• Supervise staff closely and support them
  throughout implementation.

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Implement the New Practice(s) (2)

• Provide staff, senior management, and other
  stakeholders with regular feedback on the
  implementation process.
• Communicate enthusiasm for their contributions
  and pride in their results.
• Monitor, document progress against indicators,
  and make further adaptations.
• Document successes resulting from the new
  practice(s), lessons learned, future benefits,
  and opportunities for expanding the practice(s).
• Pay attention to denial and resistance, and help
  people to move forward.

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Scale Up the Successful New Practice(s) (1)

• Working with a team
• Develop an initial approach for scaling up the
  new practice, including communication strategies
  for engaging and motivating key decision makers.
• Present your successes and rationale for
  expansion to a wider stakeholder group, and
  create a shared vision.
• Publicize the success in article, papers,
  journals, and presentations.
• Reach an agreement with key decision makers on
  how to scale up and support the process.

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Scale Up the Successful New Practice(s) (2)

• Working with a team
• Adapt and incorporate the management systems
  needed for your new practice(s) (clinical
  protocols, data collection procedures,
  supervisory tools, planning and budgeting
  templates).
• Agree on who will take responsibility as the
  primary change agents for the scale-up.
• Act as a resource as managers adjust
  organizational structure, allocation of staff,
  reporting relationships, and performance
  expectations to reflect the new practice(s).

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never
doubt that a small group of thoughtful, committed
people can change the world. Indeed, it is the
only thing that ever has. Margaret Mead,
anthropologist
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Links to the Larger System
With other services within the facility
With stakeholders policymakers, funding
sources, partners
With networks of health services
Supervisors
With communities
With the larger health system
With other sectors
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Liaison with Decision Makersand Potential
Partners

• Analysis of stakeholders
• Analysis of partners and coalitions
• Analysis of sources of funding for service
  delivery
• Development of an advocacy plan

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Role of Supervisors as a Liaison with Communities

• Help staff to assess community members
  perspective.
• Incorporate community involvement into facilitys
  ongoing QI process.
• Support two-way communication between the
  facility and the community.
• Help the facility to provide more relevant,
  accessible services.
• Promote sustainability of services.
• Enhance the facilitys reputation within the
  community.
• Promote empowerment, increased awareness, and
  behavior change in the community.

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Liaison between Services within a Facility
Inreach A strategy for informing clients and
staff within a facility about other services
available, and for referring clients to services
in other facilities according to the clients
needs
The purpose is to reduce missed opportunities for
providing services to clients.
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What Might Be Done to Improve Qualityin
Countries Undergoing Health-Sector Reform?

• Develop/update standards and guidelines.
• Use COPE and Performance Needs Assessment to
  make services more efficient and client-oriented.
• Use Community COPE or Participatory Learning and
  Action (PLA) to help providers understand clients
  needs, to involve community in the QI process,
  and to identify additional resources within the
  community.
• Train supervisors in the facilitative approach to
  supervision.