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Improvement Basics and an Introduction to Collaborative
Improvement
CORE Group Fall Meeting: Collaborative Improvement Approaches at the Community Level
Lani Marquez, MHSDirector of Knowledge Management
USAID Health Care Improvement ProjectUniversity Research Co., LLC (URC)
USAID HEALTH CARE IMPROVEMENT PROJECT2
Outline of the session
• Basics of quality improvement in health care and the improvement collaborative approach (Lani)
• Case study: Community malaria collaborative in Benin (Judy)
• Case study: OVC collaborative in Ethiopia (Nicole)
• Plans for a community collaborative in Senegal (David)
• Discussion
USAID HEALTH CARE IMPROVEMENT PROJECT3
How have we traditionally tried to improve health programs?
• Standards and guidelines• More or new staff• Training• Supervision• More supplies and equipment• Regulations—licensing, accreditation
Evidence indicates that all are necessary…but not sufficient to achieve desired results
USAID HEALTH CARE IMPROVEMENT PROJECT4
Traditional approaches have often failed to address processes of care
Inputs OutcomesProcess
Mali MOH community maternal newborn program
Standards developedCHWs and traditional birth
attendants trainedCommunity health associations
formed
Mali community collaborative baseline13% of women reported ANC home/
community visit last pregnancy25% of CHWs provided birth preparedness
counseling42% women knew 2 newborn danger signsNo health commune had a community birth
emergency plan
USAID HEALTH CARE IMPROVEMENT PROJECT
The fundamental concept of improvement
“Every system is perfectly designed to achieve exactly the results it achieves”
“So if we don't change, we can't expect a different result.”
- President Barack Obama July 22, 2009
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USAID HEALTH CARE IMPROVEMENT PROJECT
Quality improvement: Making changes in systems and processes to improve outcomes
– Understand the program in terms of processes and systems
– Implement high-impact interventions– Teams develop solutions– Focus on client needs– Test changes to see if they yield improvement– Teams manage data to measure results
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Source:Langley et al. (1999), The Improvement Guide
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Example: QI process followed by team in Uganda
Tracked results: Improved enrollment in HIV care from 33% to 100% in 5 months
Analyzed process, identified and
tested changes: peer escorts, daily cross-check of patient registers,
better counseling
Created aim: Increase follow-up
care for HIV-positive pregnant women
USAID HEALTH CARE IMPROVEMENT PROJECT
There are many improvement approaches out there; all have produced good results
• Client-Oriented, Provider-Efficient (COPE)• Facilitated Accreditation• Fully Functional Service Point• Improvement Collaborative• Partnership Defined Quality (PDQ)• Performance Improvement• Quality Design/Redesign• Standards-Based Management and Recognition
(SBM-R)
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USAID HEALTH CARE IMPROVEMENT PROJECT
Common elements of effective improvement strategies
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1. Standards
2. Champions
3. Analysis of gaps
4. Specific aims
5. Choose interventions
6. Implement interventions
7. Monitor and document results
8. Involve the community/clients
9. Use incentives and motivators
10. Plan for scale-up
11. Plan for sustaining the gains
Basics of collaborative improvement
QI team
site
Site-level summaryQI team
LearningSession
representative
Site-level testing of changes and analysis of results
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Collaborative-level sharing and synthesis of best practices
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Multiple sites simultaneously testing changes, common indicators, peer learning about how to improve that area of care
USAID HEALTH CARE IMPROVEMENT PROJECT
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Demonstration
Spread
Paths to scaling up improvements
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USAID HEALTH CARE IMPROVEMENT PROJECT
Key concepts in collaborative improvement
• Harnesses the efforts of many teams making changes, aimed at same objectives
• Common “change” or implementation package
• Common set of measures to determine, are these changes yielding improvement?
• Learning sessions—encounters for teams to share and learn from each other
• Coaching and support to maintain the pace
• Synthesis of what was learned by teams
• Strategy for spread
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USAID HEALTH CARE IMPROVEMENT PROJECT
Results from analysis of 135 time series charts from 27 collaboratives in 12 countries
Indicator Average for 135 time series charts
Reached 80% 88%
Reached 90% 76%
Absolute improvement 52%
Relative improvement 210%
Time to achieve 80% 9.2 months
Time to achieve 90% 14.3 months
Percentage months above 80% once reached 80%
69%
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USAID HEALTH CARE IMPROVEMENT PROJECT
USAID HEALTH CARE IMPROVEMENT PROJECT
Community EONC Collaborative in Guatemala(16 districts in 7 health areas)
2436
5365
0
20
40
60
80
100
feb-10 may-10
Pregnant women who recognize at least 3 danger
signs during pregnancy, delivery, post-partum
N=304
Prioritized communities that have health commission with
emergency planN=180
Interventions:-Community mobilization: assemblies and training-Home visits-Mass media (radio, posters)-Group talks,-Posters in public places-Pregnant women clubs
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How can collaborative improvement be applied to community level
programs and services?
What are the benefits?
What are the challenges?
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USAID HEALTH CARE IMPROVEMENT PROJECT
The preceding slides were presented at theCORE Group 2010 Fall Meeting
Washington, DC
To see similar presentations, please visit:www.coregroup.org/resources/meetingreports