Introducing QI Tools and Approaches Taking QI

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Introducing QI Tools and Approaches Taking QI
PI Approaches and Tools to Scale
APPENDIX FSession G Facilitative Supervision
for Quality Improvement Curriculum 2008
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The QI Process
Information gathering and analysis
Action plan development and prioritization
Follow-up/ evaluation
Implementation
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Information Gathering
Record/ case review
Data review
CFA
Observation of services
Client interview
Staff interview
COPE
Facility audit
INFO
Quality Measuring Tool
Community assessment
Cost analysis
Identify gap between actual practice and best
practice
INFO
PNA
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Action Plans (examples)
District Supervisors Plan
INFO
COPE Action Plan
Site Training Plan
INFO
Community Action Plan
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Replication? Diffusion?
Taking QI/PI Approaches to Scale
Expansion?Institutionalization?
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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

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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

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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

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Site Selection

• Starting with best potential for change
• Moving beyond to real
• Need to go everywhere - eventually
• Choosing sites - by interest, by supportive
  supervisors

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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

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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

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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

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Partnerships

• MOH, other NGOs, private sector to support the
  process
• Other sectors - Education, Development, Social
  Services
• Local businesses
• Other funding organizations

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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

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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

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Environmental Context

• Health Sector Reform
• National policies
• Other organizations
• Other sectors
• Other actors (donors, insurers, etc.)
• New or well-known ideas (BTC)

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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

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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.

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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