Mobilizing Teams for Change: The Power of

Improvement Collaboratives in MNCH Programs

Youssef Tawfik, MBBCH, MPHSr. Quality Improvement Advisor, MNCH University Research Co.,

Reconvening Bangkok: 2007 to 2010 March 6-11, 2010.

What are the quality obstacles?

Resources Processes Results (Outcomes)

Non-compliance with standards

Poor organization of care (inefficiency)

Not sensitive to client needs

Inadequate health services delivered

Negative health outcomes

Poor client satisfaction

Lack updated standards

HR shortage

Poor Providers’ skills

Weak Infrastructure

Weak Health systems

Poor access to care

The Basic Principles of Quality Improvement

• Understand client needs

• Understand the system and processes of care

• Teamwork

• Measure results

• MAKE CHANGES

Definition of an Improvement Collaborative

An Improvement Collaborative is an organized network of a large number of sites (e.g. districts, facilities or communities) that work together for a limited period of time, usually 9 to 24 months, to rapidly achieve significant improvements in a focused topic through shared learning and intentional spread methods.

The system, processes, quality and efficiency of care are to be improved.

Components of Improvement Collaboratives

• Network of participating organizations/sites involved in shared learning

• Quality Improvement (QI) team at each site• Focused on one clinical/public health topic• Work to find better ways to implement best practices and

achieve better results• Regular communication between sites• Common key indicators reported and shared monthly

Two Types of Collaboratives• Demonstration collaborative: 15-60 sites who

work intensively for 9 to 24 months to adapt to their local situation a best model of care.

• Spread collaborative: 40 to 150 sites who work for 12 to 24 months to spread to their sites the best practices and solutions developed in the demonstration collaborative

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

From: Associates in Process Improvement

Accelerating Improvement for Rapid Results

PharmacistNurse(s) Physican

Lab technician

Manager

Who would be a member of the quality improvement team?

All the people who are involved in the particular

process of care at each site

Midwife

Spread of MNCH interventions through collaboratives

Demonstration

slice

Collaborative = multiple sites working simultaneously and learning together to improve specific MNCH services’ and systems’ indicators.

Regional QI team

District QI team

District 2

District 3

District 1

National QI team

Case example: Russia - Organization of Tula Oblast Intentional Spread Collaborative after

Demonstration Collaborative

Arrows show expansion from initial sites to neighboring spread sites

Results of collaborative improvement related to MNCH care: 14 applications in 8 countries for 92 indicators

0

20

40

60

80

100

baseline 0-25% baseline 26-50% baseline 51-75% baseline >75%

perc

enta

ge

Minimum Baseline in Category Absolute improvement

0

5

10

15

20

25

MNCH reaching 80% MNCH reaching 90%

Mont

hs to

reac

h 80%

or 90

% co

mplia

nce w

ith st

anda

rds

Starting <=50% Demo Starting <=50% Subse. Wave Starting <=50% Spread

Starting > 50% Demo Starting > 50% Subse. Wave Starting > 50% Spread

Average absolute improvement over baseline values – 92 indicators

Speed of improvement – time to Reach 80% or 90% of patients Receiving care according to standards

Were gains maintained over time?

Niger MNCH Russia MNCH Ecuador MNCH

Thank You