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