Transcript Supervision, Training, and Quality Assurance Lonny Born TA Hserv/Epi 544 W’ 07

Supervision, Training, and
Quality Assurance
Lonny Born
TA Hserv/Epi 544 W’ 07
University of Washington
February 1, 2007
Part I – Supervision
Supervision (1)
Supervising MCH Workers
Role Play
Nurse:
Nursing student:
Supervisor:
Provincial Direction:
Patients:
Organization Flowchart
Supervision (2)
Failure of Supervision Systems?
1. Personnel shortages
2. Transport
3. Qualified and/or inappropriate supervisors
4. Power, status, and control
Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE
TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981
Supervision (3)
What is the role of the supervisor?
a.
b.
c.
d.
e.
f.
g.
In community health?
Setting the conditions of employment?
Amount of personal training?
Qualified?
Maintaining and improving structure and
capacity
Fund raising and budgeting?
Training and support
Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE
TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981
Supervision (4)
Four Principal Tasks
I.
Ranking the most important elements for
a given program
1. Legitimation
2. Protecting role integrity
3. Motivation
4. Education and guidance
5. Technical assistance
6. Linkage
7. Monitoring and control
8. Evaluation
Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE
TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981
Supervision (5)
Four Principal Tasks
II.
Identify available mechanisms which
might be used for supervision and
specify to what extent each might
contribute to the objectives
1. Intermediate level personnel
2. Community supervision
3. Communication media
Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE
TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981
Supervision (6)
Four Principal Tasks
III. Mobilize training and related resources
for the mechanisms used in supervision.
1. Who to plan with?
IV. Provide frontline workers with a
continuous support system
- Formalized?
- Accountability
- Include policy-making evident at all levels
Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE
TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981
Supervision (7)
What can be done to overcome obstacles?
1. Change from the idea of “supervision” with emphasis
on one-directional monitoring to the idea of a twoway exchange involving support and evaluation of
the system.
2. Reevaluate the mechanisms for supervision and
support.
3. Plan and train using different mechanisms for
different supervision tasks according to the context.
4. Establish health system commitment to supporting
those in the field
Colle, RD. Tasks required for technical management and supervision in the rural health and development programs in the THE
TRAINING AND SUPPORT OF PRIMARY HEALTH WORKERS. Proceedings of the 1981 Conference, June 15-17, 1981
Part II – Training
Evaluating
Training
Programs
Training for
effective
performance
Tools and
Techniques
(1)
Decision Tree
Tools and Techniques (2) Training
Needs Assessment
1.
Analysis of job descriptions and work plans
•
Skills needed?
•
Fit with organizational objectives?
2.
Task Analysis
•
List skills needed
•
Group those with similar training needs
•
Transform into training objectives
3.
On-the-job supervision, observations and interviews
•
Watch for gaps in understanding, attitude, performance
4.
Client surveys
•
Exit interviews from point of service
•
Focus group surveys
Preparing a training program
• Develop a general plan for training with overall
course objectives
• Write objectives for each training session
• Determine the training approach, methods, and
techniques
• Develop training session plans
• Prepare evaluation plan and forms
• Determine resource requirements and budget
• Prepare a summary of the training program
plan/proposal
General
Plan for
Training
(1)
Overview
General
Plan for
Training (2):
Overall
objectives
General
Plan for
Training (3):
Individual
Session
objectives
Training
Methodology
and Techniques
Training Plan:
Individual
Session
Final
Evaluation
Plan and
Forms
The MCH Training
Budget
• Facilitator(s) – training program design and training
implementation (salaries/honoraria; per diems; travel)
• Materials, equipment, facilities (purchase and shipping of
materials; duplication; supplies; refreshments; equipment
rental; facility rental)
• Participants (travel to and from training; per diems)
• Secretarial, clerical, logistics (typing; reproduction of
materials during training; communication; transport of
supplies and workshop participants
• Post-training activities (reproducing reports; follow-up
visits and evaluation)
Training Summary
• Write a report summarizing the training.
Be sure to include all stakeholders,
participants and clients.
• Follow-up the summary report.
ANOTHER APPROACH:
Integrated Management of
Childhood Illnesses (IMCI)
• integrated approach
• aims to reduce death, illness and disability,
and to promote improved growth and
development
• includes both preventive and curative
elements
• implemented by families, communities and
health facilities
Adapted from previous guest speakers Donna Denno and Sally Stansfield
IMCI Addresses Most Causes of
Death
•
•
•
•
•
Pneumonia
Diarrhea
Measles
Malaria
Malnutrition
Adapted from previous guest speakers Donna Denno and Sally Stansfield
•
•
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•
•
•
•
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Sepsis
Meningitis
Dehydration
Anemia
Ear infection
HIV/AIDS
Wheezing
Sore throat
Three Components of IMCI
• Improves health worker skills
• Improves health systems
• Improves family and community
practices
Adapted from previous guest speakers Donna Denno and Sally Stansfield
Improves Family and
Community Practices
• Community participation
• Preventive care
– Immunization
– Breast-feeding and other nutritional
counseling
• Home care of sick children
• Recognition of severe illness
• Care-seeking behavior
Adapted from previous guest speakers Donna Denno and Sally Stansfield
Improves Health Worker Skills
• Targets first level health facilities
• Addresses causes of at least 70% of
deaths
• Case management guidelines
• Training
• Supervision
• Monitoring
Adapted from previous guest speakers Donna Denno and Sally Stansfield
Improves Health Systems
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•
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Planning and Management
Availability of drugs and supplies
Organization of work
Monitoring and supervision
Referral pathways and systems
Health information systems
Adapted from previous guest speakers Donna Denno and Sally Stansfield
IMCI Multicountry Evaluation
• Training health workersimproved
performance
• Difficult to maintain & expand existing
IMCI sites
• District and national health systems lack
sufficient management structure, funding,
coordination, supervision, and manpower
• Low utilization rates of health
servicesIMCI cannot impact child
mortality.
Adapted from previous guest speakers Donna Denno and Sally Stansfield
Improving Health Worker Skills,
Community Care, and Health Systems
Clinical
Assessment
and treatment by health workers
Knowledge,
Beliefs
and skills
caretakers
Capacity, structure
and functions of
health system
Adapted from previous guest speakers Donna Denno and Sally Stansfield
Part III – Quality Assurance (QA)
Four Principles of QA
• Focus on client perspective and needs
• View work in terms of systems and
processes
• Make data-based decisions
• Teamwork
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
What is Quality?
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Technical performance
Access to services
Effectiveness of care
Efficiency of service delivery
Interpersonal relations
Continuity of services
Safety
Physical infrastructure and comfort
Choice
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
3 components of QA (1)
Defining Quality (QD)
• Minimum
• Ideal
• Optimal and achievable
STANDARDS?
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
3 components of QA (2)
Measuring Quality (QM)
• Baseline
• Monitoring
• Evaluation
• Programmatic evaluationvariation
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
3 components of QA (3)
Improving Quality (QI)
1) Identify 
2) Analyze 
3) Develop 
4) Test and implement
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
Institutionalization of Quality Assurance
Policy
QD
Quality
Care
Core Values
QI
Resources
QM
S up p o rt
F u n c t io n s
Leadership
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
View work in terms of systems
and processes
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
Implementing QA
Maturity
QA is formally, philosophically integrated into the
structure and function of the organization or health
system
Consolidation
Expansion
Experimental
Awareness
Pre-existing -
Organization has no formal
or deliberate QA
USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—Quality Assurance—2005
Happy Supervising and Training