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Quality Improvement Collaboratives GH Mini University October 27, 2006 James Heiby Medical Officer GH/HIDN/HS
Session Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
A scenario: ,[object Object],[object Object],[object Object],[object Object],[object Object]
A Systems View of Quality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Impact of an EBG for Diarrhea in malnourished children in Dhaka (Ahmed, et al, Lancet, 1999) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How well do providers follow evidence-based guidelines? ,[object Object],[object Object],[object Object]
JHU Uganda Performance According to Standards Survey (2001) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How do programs traditionally try to improve compliance with EBGs? ,[object Object],[object Object],[object Object]
The Basic Principles of Continuous Quality Improvement (CQI)   ,[object Object],[object Object],[object Object],[object Object]
Basic Principles, continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How do we change the system?  The Model for Improvement What are we trying to accomplish? What change can we make that will result in an improvement? How will we know that a change is an improvement? 1. 2. 3. PLAN DO STUDY ACT
Standards for Neonatal Resuscitation will be Applied at Each Delivery
Mpumalanga TB Data: Case finding per quarter  (Data from 30 clinics: 10 per district) QI started
Salima: Improving Patient Compliance - Malaria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Result: Decreased  Re-attendant Malaria Patients % re-attendant malaria pat DOT implemented
Why isn’t everyone doing this?: Evaluation of Zambia QA Program ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Improvement Collaborative Methodology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Value Added of Multiple Teams Working on a Single Problem: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Collaborative Improvement Model as Adapted by QAP Country and Province  Selection Orientation  of Country  Leader Teams Baseline Assessment Identify Country Team CQI Teams Finalize Technical Content/ Change  Package Conclusion of Collaborative Ongoing exchange of experiences: -- Website/Extranet -- Coaching visits -- Periodic meetings of teams -- Telephone calls Expert Meeting  LEARNING  SESSION  2 LEARNING  SESSION 3 LEARNING  SESSION  4 LEARNING  SESSION  1 Preparatory Stage at local level 18-24  months Monthly reporting on indicators A D P S A D P S A D P S
Rwanda   Malaria Collaborative Overview ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exampless of Findings from Initial Assessment (2 district sample) ,[object Object],[object Object],[object Object],[object Object]
Key Changes ,[object Object],[object Object],[object Object],[object Object],[object Object]
Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RWANDA MALARIA COLLABORATIVE: IMPROVEMENTS IN CARE-SEEKING BY MOTHERS (19 HEALTH CENTERS)
Changes tested by the teams ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RWANDA MALARIA COLLABORATIVE: IMPROVEMENTS IN CASE MANAGEMENT OF CHILDREN < 5 YEARS (19 HEALTH CENTERS)
Changes tested by the teams ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Niger Pediatric Hospital Improvement Collaborative
Equipe de PMTCT de Kicukiro
KICUKIRO Health Facility: Percentage of partners tested  Changes tested: -Home visits and meetings by couples involved in the PMTCT program -Home visits by health providers  -IEC on responsible paternity LS1 LS2
Gihundwe Health Facility:  % of partners tested Send invitation letters to partners Reinforce counselling
Rwanda PMTCT—Data Exported from Extranet Percentage of partners of prenatal care women who were tested for HIV
Evolution of the Collaborative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Successful Collaboration-Identify and Make Use of the “Early Adopters” Late Majority Early Majority Early Adopters Tradition-alists Innovators 2% 13% 35% 35% 15%
Active Management of the Third Stage of Labor
Some issues for discussion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Improvement Collaboratives

  • 1. Quality Improvement Collaboratives GH Mini University October 27, 2006 James Heiby Medical Officer GH/HIDN/HS
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11. How do we change the system? The Model for Improvement What are we trying to accomplish? What change can we make that will result in an improvement? How will we know that a change is an improvement? 1. 2. 3. PLAN DO STUDY ACT
  • 12. Standards for Neonatal Resuscitation will be Applied at Each Delivery
  • 13. Mpumalanga TB Data: Case finding per quarter (Data from 30 clinics: 10 per district) QI started
  • 14.
  • 15. Result: Decreased Re-attendant Malaria Patients % re-attendant malaria pat DOT implemented
  • 16.
  • 17.
  • 18.
  • 19. Collaborative Improvement Model as Adapted by QAP Country and Province Selection Orientation of Country Leader Teams Baseline Assessment Identify Country Team CQI Teams Finalize Technical Content/ Change Package Conclusion of Collaborative Ongoing exchange of experiences: -- Website/Extranet -- Coaching visits -- Periodic meetings of teams -- Telephone calls Expert Meeting LEARNING SESSION 2 LEARNING SESSION 3 LEARNING SESSION 4 LEARNING SESSION 1 Preparatory Stage at local level 18-24 months Monthly reporting on indicators A D P S A D P S A D P S
  • 20.
  • 21.
  • 22.
  • 23.
  • 24. RWANDA MALARIA COLLABORATIVE: IMPROVEMENTS IN CARE-SEEKING BY MOTHERS (19 HEALTH CENTERS)
  • 25.
  • 26. RWANDA MALARIA COLLABORATIVE: IMPROVEMENTS IN CASE MANAGEMENT OF CHILDREN < 5 YEARS (19 HEALTH CENTERS)
  • 27.
  • 28. Niger Pediatric Hospital Improvement Collaborative
  • 29. Equipe de PMTCT de Kicukiro
  • 30. KICUKIRO Health Facility: Percentage of partners tested Changes tested: -Home visits and meetings by couples involved in the PMTCT program -Home visits by health providers -IEC on responsible paternity LS1 LS2
  • 31. Gihundwe Health Facility: % of partners tested Send invitation letters to partners Reinforce counselling
  • 32. Rwanda PMTCT—Data Exported from Extranet Percentage of partners of prenatal care women who were tested for HIV
  • 33.
  • 34. Successful Collaboration-Identify and Make Use of the “Early Adopters” Late Majority Early Majority Early Adopters Tradition-alists Innovators 2% 13% 35% 35% 15%
  • 35. Active Management of the Third Stage of Labor
  • 36.