Transcript PowerPoint B - The ACQUIRE Project

Introducing QI Tools and
Approaches
COPE®
APPENDIX F
Session B
Facilitative Supervision for
Quality Improvement Curriculum
2008
Goals of Quality Improvement
Actual
practice



Best
practice
Quality services that meet clients’ needs
Improved performance of staff and institutions
Better health
The QI Process
Information gathering
and analysis
Follow-up/
evaluation
Action plan development
and prioritization
Implementation
EngenderHealth’s QI Package
QI Approaches
QI Tools

Facilitative supervision

COPE®

Whole-site training
(including Inreach)

Community COPE

Quality Measuring Tool

Cost Analysis Tool

Medical Monitoring
Information Gathering
CFA
Client
interview
Observation
of services
Data
review
Record/
case review
Staff
interview
Facility
audit
INFO
COPE®
Quality
Measuring
Tool
Community
assessment
PNA
INFO
Cost analysis
Identify gap between
actual practice and best
practice
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
Clients’ Rights

Information

Access to services

Informed choice

Safe services

Privacy and confidentiality

Dignity, comfort, and expression of opinion

Continuity of care
Staff Needs

Facilitative supervision and management

Information, training, and development

Supplies, equipment, and infrastructure
COPE®: ClientOriented,
ProviderEfficient 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.
Who Are Our Customers?

External customers?

Internal customers?
COPE Tools

Self-assessment guides, including
record-review checklist

Client interviews

Client-flow analysis (CFA)

Action plan
COPE for Reproductive Health Services:
Topics

Antenatal care

Gynecologic disorders

Labor and delivery


Postpartum and
newborn care
Disorders of the male
reproductive system

Sexuality

Family planning

Infertility

Postabortion care

Harmful practices

RTIs/STIs/HIV
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.
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.
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
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.
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.
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.
Client Register Form (for CFA)
Client № _______
Type of visit:
Male
Female
Contraceptive method____
Revisit
First visit
Time of client’s arrival in clinic:
Staff member
Initials
Time service
started
Time service
completed
Total
contact (in
minutes)
First contact
_____________
_________
_________
________
Second contact
_____________
_________
_________
________
Third contact
_____________
_________
_________
________
Fourth contact
_____________
_________
_________
________
Comments
Visit types
C-Counseling
FP – Family Planning
G – Gynecological disorder
FP methods
A – condom
B – pills
C - Injectables
Client-Flow Analysis
9:00
1
2
3
4
5
6
7
:15
:30
:45
10:00
:15
:30
:45
11:00
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
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!
Developing a Clear Problem Statement (2)

Focus on processes and systems.

Do not blame individuals for mistakes.

Define problems and processes that are
manageable.
Analyze the Root Cause of the Problem:
Multiple Why’s
Why?
Why?
Why?
Are there any other causes?
Action Plan Format
Problem
Cause(s) RecomBy Whom
mendation
By When
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
staff’s convenience)

Conduct client interviews

Use self-assessment guides, including client-record review
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 staff’s convenience.)

Conduct client interviews and prepare an action plan

Use self-assessment guides and prepare an action plan
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
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
Tasks for QI Committee

Make the action plan accessible for all staff to
see it.

Follow up the site’s action plan.

Support staff responsible for implementing
solutions.

Schedule subsequent COPE exercises.

Help monitor results.
Second and later exercises
Review status of action plan
Conduct self-assessment,
client interviews
Apply other tools as needed
Follow up:
By staff, by off-site
supervisors, by
COPE® Committee
First COPE®
Identify needs:
Self-assessment,
client interviews
Ongoing
COPE®
process
Implement
solutions
Develop
an action plan
Analyze root causes
The COPE Toolbox

COPE Handbook

COPE Toolbooks:
– Family planning
– Reproductive health
– Adolescent reproductive
health
– Child health
– Emergency obstetric care
– Maternal health
– PMTCT services
– Community
involvement
– Cervical cancer
– HIV treatment and care
– HIV testing and counseling
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
Implement Interventions

Clarify roles and expectations

Supervision and follow-up

Whole-site training

Reorganization of work

Resource development (job aids, etc.)

Supplies and equipment
Evaluation

Reassess

What worked?

Why did it work?

What did not work?

Why not?

Revise action plan
Using the Action Plan for Evaluation
Number of
problems
identified
Number of
problems
solved
Number of
problems partially
solved
10
6
2
The QI Process
Information gathering
and analysis
Follow-up/
evaluation
Action plan development
and prioritization
Implementation