Facilitative Supervision for Improving the Quality of FP/RH Services Anna Kaniauskene, MS, Betty Farrell, CNM, MPH, Erin Mielke, MPH, Henry Kakande, MD, Nizamul Haque, MD, Mizanur Rahman, MD, Mahboob-E Alam NOTE: I’ve been asked to keep the presentation to 15 minutes rather than 20 to allow for more Q&A time. APHA, Washington D.C., 2007 Facilitative Supervision for Improving Quality of FP/RH

Session Objectives Define facilitative supervision List the fundamentals of care Describe ACQUIRE’s approach to strengthening supervision systems Describe the benefits of facilitative supervision

Facilitative Supervision (FS) Emphasizes mentoring, joint problem-solving, constructive feedback and two-way communication between supervisors and supervisees

Fundamentals of Care CHOICE Ensuring informed and voluntary decision making SAFETY Assuring safety for clinical techniques and procedures QUALITY Mechanism for ongoing quality assurance and management

Strengthening Supervision Systems: ACQUIRE’s Approach Developed, tested, and adapted curriculum to different services and settings (FP/RH, Integrated FP/HIV services) Incorporated FS in pre-service training curricula Conducted leadership workshops Training for all levels of supervisors (off- & on-site, medical & non-medical) There is widespread agreement among those in the international health community that supervision is a critical part of human resource management for the delivery basic health services. Supervision is one of the key approaches to improving the quality of health care and the performance of health care providers. NEED to describe what leadership workshops means vs. FS training Facilitative Supervision for Improving Quality of FP/RH

Strengthening Supervision Systems: ACQUIRE’s Approach (2) Build local training capacity in FS Develop tools & establish mechanisms for monitoring & evaluation (M&E) Introduce related tools & approaches to improve quality of care and provider performance Advocate for supportive policy changes There is widespread agreement among those in the international health community that supervision is a critical part of human resource management for the delivery basic health services. Supervision is one of the key approaches to improving the quality of health care and the performance of health care providers. Facilitative Supervision for Improving Quality of FP/RH

FS Curriculum (Selected Topics) Quality of care Data for decision-making Leadership and communication skills Links between supervision and other support systems Practice supervisory visits There is widespread agreement among those in the international health community that supervision is a critical part of human resource management for the delivery basic health services. Supervision is one of the key approaches to improving the quality of health care and the performance of health care providers. Facilitative Supervision for Improving Quality of FP/RH

Results and Benefits of FS Azerbaijan Bolivia Bangladesh Cameroon Uganda The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Teambuilding in Bolivia

Action Plans in Azerbaijan Facilitative Supervision for Improving Quality of FP/RH

Supervisors’ New Attitudes and Practices Inform staff about upcoming supervisory visits Provide constructive feedback Participate in COPE® exercises & support staff in their QI efforts Conduct regular staff meetings to discuss issues for improvement Consider staff as internal customers Cameroon: after two COPE exercises at a FP center in Douala, the Manager said: “I was the biggest problem for my staff. I did not understand what do they want and why they want to change something. Now I know what QI means and what can we do together. I support my staff and help them to find additional resources to improve services” Facilitative Supervision for Improving Quality of FP/RH

Supervisors’ New Attitudes and Practices (2) At the end of the supervisory visit, meet with the staff to discuss findings and to help develop an action plan “My attitude towards service providers has changed. It has enabled me to focus on systems….I have become creative in using available resources to ensure clients are served…. It has helped me to be able to give constructive feedback without hurting anybody…” Manager, TASO Mbale Center, Uganda Cameroon: after two COPE exercises at a FP center in Douala, the Manager said: “I was the biggest problem for my staff. I did not understand what do they want and why they want to change something. Now I know what QI means and what can we do together. I support my staff and help them to find additional resources to improve services” Facilitative Supervision for Improving Quality of FP/RH

Manager, Douala FP Center, Cameroon “I was the biggest problem to my staff. Now I am different. I support my staff in their QI efforts” Manager, Douala FP Center, Cameroon Facilitative Supervision for Improving Quality of FP/RH

Changes in Organization of Work Off-site supervisors conduct regular supervisory visits On-site supervisors apply medical monitoring checklists to assess quality of services Supervisors provide coaching Supervisors organized visiting surgeons to provide weekly access to sterilization services Discuss and analyze service statistics with the staff The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Uganda – Plans from Medical Monitoring

Changes in Organization of Work (2) Redistributed contraceptive supplies based on local demand Conduct educational sessions for clients in 3 languages (vs. just one language) Rearranged facility to ensure privacy and confidentiality during counseling Use medical monitoring assessment to identify staff’s learning needs The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Facilitated Use of QI and PI tools and Approaches Medical monitoring is being conducted Supervisors support COPE® activities and participate in exercises QI activities institutionalized Community COPE® will be introduced this year FS skills trainings for national level MOH staff The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Facilitated Policy Changes Supervision Guidelines being updated/developed National Strategy for FP/RH developed Infection Prevention Guidelines adapted and institutionalized by NGOs National Strategy for Quality under development The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Improved & Integrated Health Systems Human Resources – job descriptions revised Training - providers are linked with training resources based on needs Finance – advocacy among communities for funding of health services The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Improved & Integrated Health Systems (2) Logistics – contraceptive supplies ensured; improved inventory systems M&E – medical monitoring checklists adapted and used, findings analyzed and action plans developed, service statistics forms adapted/updated The facilitative supervisor realizes that staff cannot provide quality services unless their needs are met. A facilitative supervisor works to ensure that staff work within an environment that enables them to perform well. They help make sure staff have clear job expectations, receive feedback on their performance, are motivated, have sufficient equipment and supplies, and have necessary knowledge and skills. Facilitative Supervision for Improving Quality of FP/RH

Analyzing Areas for Improvement in Bangladesh

Benefits to Supervisors Feel more welcomed by staff because they help staff to solve their problems, rather than criticize them for their faults They have the satisfaction of working as a team member, watching staff learn and grow and seeing quality improve Facilitative supervisors gain a reputation as leaders and enablers Expected results of implementing facilitative approach to supervision: Service delivery sites provide access to quality services that clients want and need Service providers and institutions continuously seek ways to improve the quality of their services Service providers and institutions are responsive to client rights and needs Service providers and supervisors continuously improving their own performance, have opportunities for increased job satisfaction, and see their work as part of a larger picture, Supervisors provide support and encouragement to providers in continuously improving the quality of services Supervisors are able to help sites translate institutional goals into services, help to bring additional resources needed for quality service provision, able to influence policies Supervisors are able to provide management with information about the quality of services being provided and help identify constraints to improving quality There is a reduction in the cost of poor quality “Facilitative Supervision: A Vital Link in Quality Reproductive Health Service Delivery”, AVSC Working Paper #10, 1996 Facilitative Supervision for Improving Quality of FP/RH

Benefits to Staff & Clients Staff feel empowered to solve routine and simple problems “Supervision is more humanized” – provider in Bolivia “The doctor was very good. She said: ‘I will take care of everything. You are all my patients and I have a lot of love for my patients’” – client in Bolivia Tell that facilitative approach to supervision may seem to them like a lot more work than when traditional approach to supervision is used. While this approach requires an initial investment of extra time, after starting using FS approach, they will find that it benefit them and may actually free up time to devote to other, more appropriate responsibilities. Facilitative Supervision for Improving Quality of FP/RH