Recording and materials from the third webinar on point of care quality improvement: Step 2- analysing the problem and measuring quality of care

18.05.17

The Quality of Care Network organised a webinar on 'Point of care quality improvement, step 2: analysing the problem measuring quality of care’ on 17 May, 2017.

Listen to the recording of the webinar.

Pierre Barker, Chief Global Partnerships and Programs Officer at the Institute for Healthcare Improvement explained how the Quality of Care Network is designed to support quality improvement. He presented possible frameworks to organize change ideas, measurement systems, and tools to help quality improvement teams prioritize issues and get to their root causes.

Bennett Nemser, WHO Monitoring and Evaluation consultant, presented the role of monitoring and evaluation in support of quality improvement and learning. He emphasized how point-of-care measurement plays a role in the broader learning agenda of the country and how the strengthening of monitoring systems should take into consideration other users at the district / regional and national level.

See their joint presentation here.

This is the third webinar in a series on point of care quality improvement. See here details of the first and second webinars.

(Photo: Four day-old baby boy, Godfred Ackon, during a post-natal check-up at the Elmina Urban Health Centre in the Central Region of Ghana  in May 2012. ©UNICEF/Quarmyne)

Comments

Article on the importance of perceptions of quality -- Understanding and measuring quality of care: Dealing with complexity: www.who.int/bulletin/volumes/95/5/16-179309.pdf

Do you think that it will also be helpful in the quality of care that the following two components are included:

  1. Have at the facility, simulated practice/rehearsals with health workers that on what they have to do in these emergency situations and make it mandatory to check at each relevant place that items are available and functional.
  2. Families in the community and at ANC also need to be given clear guidance  on  having key items ready and plan ahead how they need to get to the facility

ANSWER

I agree that simulated practice is a highly effective at technique and we will be discussing this at an upcoming seminar on implementation interventions.

Getting mothers and families involved in the care in upcoming care has always been a challenge. I think this is the opportunity for some exciting work that we could do in better preparing mothers for delivery and providing them with scripts and scenarios as of that they are prepared to encounter unfamiliar and challenging situation in the Labor Ward.

 

How is the network functioning towards uniformity of measurement across the nine countries? Uniformity and consistency is becoming an issue. Even in the same country, different facilities have different tools.

ANSWER

We are having a meeting in June to discuss exactly this issue around uniformity of measurement. This is an extremely important issue to resolve sense we can learn best from each other if we are using a similar language around measurement. I agree that developing standard work around measurement within countries is a key issue.

 

How does the intervention deal with health workers motivation, very often a major obstacle to good quality of care?

ANSWER

The crucial issue of motivation was covered during the presentation.

Would it be an idea to include quality of the community based maternal newborn health on follow up and referral of pregnant women by community health workers in charge. E.g. The first problem in the example (in Pierre Barker’s presentation) was delayed referral from the community.

ANSWER

Timely referral of mothers from the community is a key factor and this again was covered in the presentation.

There are a lot of low hanging fruits that can be addressed at the health facility levels. The problems are the high hanging fruits whose solutions are outside the health facility and require politicians inputs. How do you address such matters-lack of political will and poor accountability?

ANSWER

The issue of availability of resources is an absolutely essential aspect that needs to be dealt with in any systems approach. We discuss this a bit in the seminar and just to emphasize how important it is to include resolution of resource issues as part of the overall approach.

Block grants for hospitals to implement the action plans that is recommended by the assessment would also encourage the health workers, when there is no flexible fund to address the small issues then the sustainability of the process will be an issue as the health workers get discouraged after sometime if they can't bring any changes.

ANSWER

As discussed in the presentation, allocation of finances and autonomy to local facilities is an interesting idea which we should definitely test and hopefully the network will provide such an opportunity.

Great presentation and thanks for sharing all the exciting work. In my experience working with use of data at local levels, the culture of data use work best. In addition to the outcome measurements will there be focus learning on such indicators?

ANSWER

Thanks. Yes, the use of data is a key part of the quality improvement process. Keeping indicators simple and getting the right measures is an essential part of the process.

 

How do we sustain improvements in healthcare service provision made at facility-level; especially in the face of human resource constraints?

ANSWER

We will be talking about sustainability in a future seminar but just to mention how important it is to develop the habits of Quality improvement at a facility level as part of their sustainability process

Hi and thanks for a great presentation. Q: what is your thinking of QoC engagement in educational programs, meaning pre-service education? We need to include the future generation somehow. Thanks.

ANSWER

Pre-service education will become an increasingly important part of the use of a quality improvement methods in clinical practice. Right now there is very little in the way of formal preservice education that includes QI but that is also changing. Many medical schools in nursing schools are now using QI as part of their curricula. An example of this move is the courses offered through the IHI Open School in their pre-service curricula (http://www.ihi.org/education/Pages/default.aspx)

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