Marquez Collaborative Improvement


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CORE Group Fall Meeting 2010. Improvement Basics and an Introduction to Collaborative Improvement. - Lani Marquez, University Research Co.

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Marquez Collaborative Improvement

  1. 1. Improvement Basics and an Introduction to Collaborative Improvement CORE Group Fall Meeting: Collaborative Improvement Approaches at the Community Level Lani Marquez, MHS Director of Knowledge Management USAID Health Care Improvement Project University Research Co., LLC (URC)
  2. 2. Outline of the session <ul><li>Basics of quality improvement in health care and the improvement collaborative approach (Lani) </li></ul><ul><li>Case study: Community malaria collaborative in Benin (Judy) </li></ul><ul><li>Case study: OVC collaborative in Ethiopia (Nicole) </li></ul><ul><li>Plans for a community collaborative in Senegal (David) </li></ul><ul><li>Discussion </li></ul>
  3. 3. How have we traditionally tried to improve health programs? <ul><li>Standards and guidelines </li></ul><ul><li>More or new staff </li></ul><ul><li>Training </li></ul><ul><li>Supervision </li></ul><ul><li>More supplies and equipment </li></ul><ul><li>Regulations—licensing, accreditation </li></ul>Evidence indicates that all are necessary… but not sufficient to achieve desired results
  4. 4. Traditional approaches have often failed to address processes of care Inputs Outcomes Process Mali MOH community maternal newborn program Standards developed CHWs and traditional birth attendants trained Community health associations formed Mali community collaborative baseline 13% of women reported ANC home/ community visit last pregnancy 25% of CHWs provided birth preparedness counseling 42% women knew 2 newborn danger signs No health commune had a community birth emergency plan
  5. 5. The fundamental concept of improvement <ul><li>“ Every system is perfectly designed to achieve exactly the results it achieves” </li></ul><ul><li>“ So if we don't change, we can't expect a different result.” - President Barack Obama July 22, 2009 </li></ul>
  6. 6. Quality improvement: Making changes in systems and processes to improve outcomes <ul><ul><li>Understand the program in terms of processes and systems </li></ul></ul><ul><ul><li>Implement high-impact interventions </li></ul></ul><ul><ul><li>Teams develop solutions </li></ul></ul><ul><ul><li>Focus on client needs </li></ul></ul><ul><ul><li>Test changes to see if they yield improvement </li></ul></ul><ul><ul><li>Teams manage data to measure results </li></ul></ul>
  7. 7. Source: Langley et al. (1999), The Improvement Guide
  8. 8. 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
  9. 9. There are many improvement approaches out there; all have produced good results <ul><li>Client-Oriented, Provider-Efficient (COPE) </li></ul><ul><li>Facilitated Accreditation </li></ul><ul><li>Fully Functional Service Point </li></ul><ul><li>Improvement Collaborative </li></ul><ul><li>Partnership Defined Quality (PDQ) </li></ul><ul><li>Performance Improvement </li></ul><ul><li>Quality Design/Redesign </li></ul><ul><li>Standards-Based Management and Recognition (SBM-R) </li></ul>
  10. 10. Common elements of effective improvement strategies <ul><li>Standards </li></ul><ul><li>Champions </li></ul><ul><li>Analysis of gaps </li></ul><ul><li>Specific aims </li></ul><ul><li>Choose interventions </li></ul><ul><li>Implement interventions </li></ul><ul><li>Monitor and document results </li></ul><ul><li>Involve the community/clients </li></ul><ul><li>Use incentives and motivators </li></ul><ul><li>Plan for scale-up </li></ul><ul><li>Plan for sustaining the gains </li></ul>
  11. 11. Basics of collaborative improvement Site-level summary Site-level testing of changes and analysis of results Collaborative-level sharing and synthesis of best practices Multiple sites simultaneously testing changes, common indicators, peer learning about how to improve that area of care QI team representative
  12. 12. Demonstration Spread Paths to scaling up improvements
  13. 13. Key concepts in collaborative improvement <ul><li>Harnesses the efforts of many teams making changes, aimed at same objectives </li></ul><ul><li>Common “change” or implementation package </li></ul><ul><li>Common set of measures to determine, are these changes yielding improvement? </li></ul><ul><li>Learning sessions—encounters for teams to share and learn from each other </li></ul><ul><li>Coaching and support to maintain the pace </li></ul><ul><li>Synthesis of what was learned by teams </li></ul><ul><li>Strategy for spread </li></ul>
  14. 14. 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%
  15. 16. Community EONC Collaborative in Guatemala (16 districts in 7 health areas) Pregnant women who recognize at least 3 danger signs during pregnancy, delivery, post-partum N=304 Prioritized communities that have health commission with emergency plan N=180 <ul><li>Interventions: </li></ul><ul><li>Community mobilization: assemblies and training </li></ul><ul><li>Home visits </li></ul><ul><li>Mass media (radio, posters) </li></ul><ul><li>Group talks, </li></ul><ul><li>Posters in public places </li></ul><ul><li>Pregnant women clubs </li></ul>
  16. 17. How can collaborative improvement be applied to community level programs and services? What are the benefits? What are the challenges?
  17. 18. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: