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

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)

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

7. Source: Langley et al. (1999), The Improvement Guide

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

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. Demonstration Spread Paths to scaling up improvements

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%

17. How can collaborative improvement be applied to community level programs and services? What are the benefits? What are the challenges?

18. The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports