Performance Improvement USAID’s experience improving the quality of care in low and middle income countries

Applying Science to Strengthen and Improve Systems (ASSIST) Project 2

Approaches to Improving Health Care Processes (Quality) Training –Pre-service –In-service Human resources/performance management Well-defined interventions –Audit & feedback –Decision aids –Educational materials –Academic detailing Regulatory approaches: Accreditation, certification, licensing Performance-based incentives Proprietary approaches –Standards-based Management & Recognition (SBM-R) –Client-oriented, Provider Efficient (COPE) Continuous Quality Improvement (CQI) Collaborative Improvement

IOM Workshop Report on Improving Quality in LMICs 4 Compared 6 quality improvement (QI) methods Found training and supervision have positive effects on provider performance Found insufficient information on COPE, SBM-R, and accreditation affecting provider performance Recommended expanding the body of evidence for all 6 QI methods

Donabedian model of a system Resources necessary to carry out a process Inputs A series or sequence through which inputs are transformed into outputs Process The sum of all elements (including processes) that interact together to produce a common goal Traditional approaches have failed to address processes of care The outputs (services/products) and outcomes (health outcomes) result from the inputs & processes Outcomes

How do we learn about improvement? Purpose: Bring together thought leaders to collaborate and identify appropriate evaluation methods for improvement Product: Develop statement to provide guidance on how we learn about improving the quality of care Salzburg Global Seminar 2016

Purpose of case book: –Document how quality improvement interventions have been carried out in low-resource settings –Describe the rationale for what teams did to improve –Describe QI implementation activities in enough detail that the reader could carry out a similar activity –Give decision makers and supervisors a clear understanding of quality improvement as it was actually carried out –Include a candid treatment of obstacles and problems Target audience: –Health managers –Academia –Practitioners –Host country government leaders Case Book of Improvement Stories (Under Development)

What we have learned from improving processes? Frontline providers can analyze and use data to make decisions, not just collect and report up Leadership needs to be involved from the beginning and should lead scale up Scaling up appears to increase cost-effectiveness compared to the pilot phase—but more studies are needed Need to define roles of external assistance and jointly plan transfer of technical assistance to host country counterparts Sustainability depends on making improvements/best practices a permanent, integral part of health services