Introducing QI Tools and Approaches

Taking QI & PI Approaches

and Tools to ScaleAPPENDIX F

Session G

Facilitative Supervision for Quality Improvement Curriculum

2008

The QI Process

Information gathering and analysis

Action plan developmentand prioritization

Implementation

Follow-up/evaluation

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

Action Plans (examples)

INFO

INFO

District Supervisor’s

Plan

Community Action Plan

COPE® Action Plan

Site Training Plan

Taking QI/PI Approaches to Scale

Replication?Diffusion?

Expansion?Institutionalization?

Taking QI & PI Approaches to Scale

Process:

– of planning, implementation and evaluation of strategies and activities

– designed to increase and expand the use of the QI approaches

Taking QI & PI Approaches to Scale

Endpoint is institutionalization -- sustained use leading to sustained improvement

Other systems are created or adapted to support its use

From Pilot to Institutionalization

Site selection Orientation for managers and staff Training Range of facilitators, supervisors, staff involved Funding/other support for activities and

solutions Systems and management Partnerships Communities Supporters and Leadership

Site Selection

Starting with “best potential for change”

Moving beyond to “real”

Need to go everywhere - eventually

Choosing sites - by interest, by supportive supervisors

Orientation and Training

Orientation for managers

Orientation for staff

Training for facilitators, participants

Involve a range of supervisors, facilitators, staff to address staff turnover problem

Resources

For conducting activities

For implementing interventions

Needs will be raised during assessment (COPE exercise)

Focus on local solutions, local resources

Identify external sources of support

Link action plans with cost-sharing

Systems and Management

Inclusion of QI approaches and tools (COPE & other) in quality assurance policies and guidelines

Monitoring and supervision systems in place

Emphasize role of supervisor as liaison to sources for support

Incorporate review of QI action plans in regular meetings

Partnerships

MOH, other NGOs, private sector to support the process

Other sectors - Education, Development, Social Services

Local businesses

Other funding organizations

Communities

Use COPE for Community Involvement

Educating communities about their rights

Empowering community members to articulate their needs

Local decision-making for health funds through Health Sector Reform

Combine resources and efforts for problem-solving

Supporters and Leadership

Site level

Institutional level

Charismatic leaders

How to build support and enthusiasm at a national level?

Share “success stories” and lessons learned

Environmental Context

Health Sector Reform

National policies

Other organizations

Other sectors

Other actors (donors, insurers, etc.)

New or well-known ideas (BTC)

Example: Taking COPE to Scale

Strategies for taking COPE to scale Planning and conducting activities to

introduce COPE Planning and conducting activities to

expand use of COPE within an institution Evaluation of strategies and activities to

expand use of COPE Evaluation of impact of COPE Update strategies, share lessons learned

What Systems Support the Use of COPE?

Supervision --- Facilitative Supervision

Training --- Whole Site Training, Inreach

Monitoring --- Medical Monitoring, MIS

Evaluation --- QMT, Annual Reporting, etc.

Community level --- Community COPE, PLA, advocacy for Informed Choice, MAP, PAC, etc.

The Goal of Taking Approaches to Scale

COPE and other QI/PI approaches used throughout a program/institution

Quality Improvement process sustained over time -- ultimately sustained when our (others) assistance is withdrawn