Continuous Quality Improvement –

Knowledge Management by Any Other Name

Peter HobbyDirector of Communications and KM

Center for Pharmaceutical ManagementManagement Sciences for Health

Improved Access. Improved Services. Better Health Outcomes

• Goal• To assure the availability of quality pharmaceutical

products and effective pharmaceutical services to achieve desired health outcomes

• Objective• To promote and use a systems-strengthening

approach consistent with the Global Health Initiative that will result in positive and sustainable health impact

Health Outcomes

Services

ProductsSystems for Improved Access to

Pharmaceuticals and Services

Improved Access. Improved Services. Better Health Outcomes

Improved Access. Improved Services…

What is CQI?The continuous quality improvement (CQI) concept…

• Program management method known also as continual improvement process and plan-do-study-act.

• Includes reflection on processes to trim inefficiencies• Adaptation through small-scale, incremental changes. • Creates and codifies learning in applied settings• Indicators or targets helps determine success.

Improved Access. Improved Services. Better Health Outcomes

Why Implement CQI ?

• To improve quality through continual reviews and small-scale changes that do not overwhelm the staff or the system

• To implement self-determined changes, NOT the ones thrust in from outside

• To help reduce variations in practice (which are common and often have no clear reason or basis)

• To identify opportunities for cost containment in the current environment of escalating health care costs

Improved Access. Improved Services. Better Health Outcomes

PLAN (Prepare the change)

DO (implement the change)

STUDY (monitor and analyze

impact of the change)

ACT (revise and standardize the

change)

PDSA Cycle

Adapted from: CIE & Datatel – CQI 101

Improved Access. Improved Services. Better Health Outcomes

PDSA for JordanA multidisciplinary team conducts CQI through PDSA cycles

• PLAN• Study the existing practice (collect data and

current process)• Identify issues/problems• Develop action plan for change, including plan for

measuring success• DO

• Undertake the planned activities on a small scale

Improved Access. Improved Services. Better Health Outcomes

PDSA for Jordan

• STUDY• Examine or check the result of the action before waiting too long• Look for signs of progress, constraints, or unexpected outcomes• Look for any lessons brought by this small scale action

• ACT• Use the findings (and lessons learned) from the study to identify

and make any necessary mid-course modifications or adjustment

• Then continue the PDSA process with the next cycle, going from P to D to S to A (in an iterative manner)

Improved Access. Improved Services. Better Health Outcomes

CQI for Antibiotic Prophylaxis in C-section: Conclusion • The CQI framework has a

strong potential to—• Standardize processes• Strengthen systems• Progressively improve

antibiotic prophylaxis in c-section

• The framework can easily be expanded later to improve prophylaxis for other surgeries Source: vzimbel.com

MSH has helped groups in:

Afghanistan, China, Ethiopia, Jordan, Kenya,

Liberia, Malawi, Mozambique, Rwanda, South

Africa, South Sudan, Tanzania, and Uganda, to:

Where Else has CQI Worked?

South Africa Example

• Increase in the percentage of 64 primary health care facilities that complied with national cold chain management standards from 26 to 48%

• 70% improvement in medicine labeling practices and a 27% increase in the number of patients who knew how to take their medication properly

• 17% increase in the number of prescriptions that complied with standard treatment guidelines

• 17% reduction in the number of medication errors recorded at four hospitals.

How Else has CQI Been Applied?

• Establish revolving drug funds in 340 NGO clinics.• Help hospitals to establish Drug and Therapeutics

Committees to address service delivery bottlenecks• Use in HIV/AIDS training to improve inventory

management and increase use of SOPs by 50% • Create action plans to improve antibiotic prophylaxis

practices for C-sections, including practice profiles , baseline data, and self-monitoring indicators

• Applied at 44 hospitals now scoring above 70% on indicators of inventory management, storage management, and supply chain management.

Thank You