introducing qi tools and approaches cope ® appendix f session b facilitative supervision for...
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Introducing QI Tools and Approaches
COPE®
APPENDIX FSession 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
Action plan developmentand prioritization
Implementation
Follow-up/evaluation
EngenderHealth’s QI Package
QI Approaches Facilitative
supervision
Whole-site training (including Inreach)
QI Tools COPE®
Community COPE
Quality Measuring Tool
Cost Analysis Tool
Medical Monitoring
INFO
Communityassessment
Client interview
CFA Observationof services
Datareview
Facility audit
Record/case review
INFO
Staff interview
COPE®
Information Gathering
Identify gap between actual practice and best practice
Quality Measuring
ToolCost analysis
PNA
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®: Client-
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.
Oriented, Provider-
Efficient services
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
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
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:
Client-Flow Analysis
9:00 :15 :30 :45 10:00 :15 :30 :45 11:00
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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
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) Recom-mendation
By Whom By When
Schedule for the First COPE Exercise
Day 1Morning: 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 (AllActivities are carried out during routine work hours atstaff’s convenience) Conduct client interviews Use self-assessment guides, including client-record review
Schedule for the First COPE Exercise (2)
Day 2Morning 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 3Morning: 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.
Implement solutions
Analyze root causes
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, byCOPE® Committee
Develop an action plan
First COPE®
Identify needs:Self-assessment,client interviews
Ongoing
COPE®
process
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
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
Action plan developmentand prioritization
Implementation
Follow-up/evaluation