Transcript Assuring Safety for Clinical Techniques and Procedures MODULE 5 Facilitative Supervision for Quality Improvement Curriculum.

Assuring Safety for
Clinical Techniques and
Procedures
MODULE 5
Facilitative Supervision for
Quality Improvement Curriculum
2008
Assuring Safety

Skilled providers

Updated, evidence-based standards
and guidelines

Infection prevention control

Appropriate supplies, equipment,
and infrastructure

Supportive supervision
Medical Monitoring Is:

A medical QI intervention that entails the
objective and ongoing assessment of the
READINESS and the PROCESSES of service
delivery.

Conducted to identify gaps between actual
practice and clinical standards, and leads to
recommendations for improvement.
Exercise: Work in Four Groups
Groups 1 & 3:
What do you usually do to assess readiness? What
tools do you use?
Groups 2 & 4:
What do you usually do to assess processes and
procedures? What tools do you use?
Assessing Readiness of Care

Staffing

Facility, infrastructure

Equipment, instruments and supplies

Essential drugs and contraceptives

Range of available services

Functioning support systems

Functioning referral system
Assessing Processes of Care (1)

Observation of services and procedures
–
–
–
–
Medical techniques
Clinical examinations and procedures
Ensuring informed and voluntary decision making
Client-provider interaction
• Counseling
– Infection prevention

Client interviews

Staff interviews

Self, peer, and supervisor assessment
Assessing Processes of Care (2)

Data collection systems
– Analysis of relevant medical data and reports
– Management information systems
– Use of data for decision making

Linkages to other services
–
–
–
–
Within the site
To other health sites/institutions
To clinical and nonclinical trainers
To headquarters
When and by Whom?

Ongoing
– Performed regularly by on-site staff and
supervisors

Periodically
– Performed by onsite and off-site
supervisors
Supervisory System
On-site
supervisors and staff
Off-site
supervisors

Facility level

National/central level

Department or ward level

Regional/area level

Peers

State/district level

Peers (supervisors)
Medical Monitoring Tools
Used by on-site and off-site supervisors and staff

Checklists for
– Observation of services/procedures
– Record review
– Facility audit
– Assessment of provider knowledge and skills

Client and staff interview guides
Supervisory Visits: Exercise
Small Group Work (10 minutes): Discuss the assigned
question with your group, record the results on a sheet of
flipchart paper, and present the results to the entire group
Group 1: What should an off-site supervisor do before the
supervisory visit?
Group 2: What should an off-site supervisor do during the
supervisory visit?
Group 3: What should an off-site supervisor do after the
supervisory visit?
Supervisory Visits: Before the Visit
1.
Review the site’s and the last supervisory visit’s
report and action plans.
2.
Review previous agreements and a list of
recommendations from the last supervisory
visit.
3.
Communicate with the facility the date of the
visit, the purpose of the visit, and the planned
activities.
4.
Develop and agree on an agenda.
Supervisory Visits: During the Visit
1.
Meet with staff and on-site supervisors
2.
Follow-up on previous visits and action plans
3.
Observe services and audit the facility
4.
Review records
5.
Provide constructive feedback
6.
Provide on-the-spot technical assistance and coaching
7.
Teach the staff to conduct self-assessment activities and
to use the results
Supervisory Visits: During the Visit (2)
8.
Update staff on changes in national standards
9.
Recognize achievements and motivate staff
9.
Discuss findings with the staff and record them in the
site’s supervision notebook
10.
Help to develop solutions
11.
Help staff to identify external resources
12.
Agree on follow-up
Site Action Plan Format
Problem
Cause(s)
Recommendations
By
Whom?
By
When?
After the Supervisory Visit:
Off-Site Supervisors
1.
Write a report and send a copy to the site.
2.
Integrate the findings into the off-site supervisor’s
ongoing action plan.
3.
Follow up with the site on implementation of a site’s
plan.
4.
Provide assistance with problems that the site’s staff
cannot solve on their own, by following up with district/
regional/national levels, as needed.
5.
Evaluate the quality of services provided by a site.
6.
Plan and conduct follow-up visits.
Off-Site Supervisor’s Action Plan Format
Problem
Action/
Resources Needed
Timeframe
Follow-up
Notes
Exercise:
Using Checklists for Medical Monitoring
Group A: Counseling
Group B: Infection prevention
Group C: Facility audit
Guiding Principles for Supervisors
Be Facilitative

Work as a team member to model FS

Talk and listen to all levels of staff

Recognize jobs well done

Solve problems on the spot, when possible

Provide feedback in a constructive way

Involve staff in decision-making process
– Never criticize staff in front of a client or other staff
Supervisors Should Promote:
Creating a mechanism for ongoing quality assurance
 Encouraging self- and peer-assessment by site staff
 Strengthening on-site medical monitoring mechanisms
to improve quality of services and to ensure the
fundamentals of care
 Following up on the site’s action plan and providing
support
 Analyzing relevant medical data and reports for service
improvement
 Strengthening support systems involved in health care
provision: supervision, training, finance, human
resources, logistics, and monitoring and evaluation

The QI Process
Information gathering
and analysis
Follow-up/
evaluation
Action plan development
and prioritization
Implementation
Planning for Action (1)
COPE® Action Plan
Site Training Plan
Information
Gathering
Medical
Monitoring Plan
Community
Action Plan
Cost Analysis Plan
The QMT Plan
Off-Site Supervisor’s
Pre-Visit Plan
Off-Site
Supervisor’s Input
Consolidated
Site
Quality/
Performance
Improvement
Plan
Planning for Action (2)
Consolidated
Site
Quality/
Performance
Improvement
Plan
System
(Headquarters/
Region/
District)
Consolidated
Quality/
Performance
Improvement
Plans