Advancing MSI’s Quality Assurance approach under SIFPO Dr Pritha Biswas, MD Senior Advisor MSI SIFPO I EOP Meeting 18 September 2015

Quality Assurance at MSI Advancing MSI’s Quality Assurance approach under SIFPO “It’s a like riding a bicycle… the moment you stop pedalling you fall off ” Marie Stopes International2

MSI Quality Assurance - Principles Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International3 ‘One World One Standard’ Simple but Excellent Client Centred Outcome Focussed Enhance Business

The Quality Assurance Pyramid Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International4 Clinical Quality Information Provision of Assurance Accountability and Ownership Clinical Governance International Clinical Governance Committee Country Medical Advisory Team Country Clinical Team MSI Executive Team Medical Development Team International Operations Country SMT Centres, Outreach and SF

MSI QA Cornerstone – The MSI QTA Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International5

QTA - Quality Technical Assistance Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International6 An External Quality Assessment visit conducted annually in every MSI country program Led by MDT responsible for clinical quality assurance within MSI Objectives - assess and improve clinical quality during the visit, identify gaps for follow-up action, innovations and best practises to be shared Output – an overall percentage score ( benchmarked at 90% ) broken down by service delivery channel and service type to focus attention and resources where most needed

Limitation and Way Forward Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International7 Annual QTA provided a snap shot of quality rather than a true picture of ongoing quality in a program MSI needed a system of ongoing quality assessment and supportive supervision leading to continuous quality improvement Countries needed to own, monitor and improve their own quality More focus on outcomes than inputs

Evolution under SIFPO Demystify Quality – it is ‘E.S.E’ Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International8 E ffectiveness S afety E xperience Effectiveness - not audit and compliance but asking - Did our clients get what they need ? Safety - following the principle – Avoid and minimize harm. Learn from clinical incidents Experience - ensuring clients have a positive experience by asking – What did clients think of our service?

Develop a live ‘ESE’ Dashboard Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International9 Highlight quality in the program or a service delivery site at a glance Generated from automated client data ( CLIC ) RAG rated indicators to measure performance against benchmarks Action oriented - Red indicating need for urgent action, amber - a need for surveillance and green indicating satisfactory performance Help to focus attention and resources where it was most needed

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Evolution of the QTA under SIFPO Advancing MSI’s Quality Assurance approach under SIFPO Tool RAG rated Penalty scoring/deductions for ‘red flag’ quality concerns and failure to meet minimum standards Representative sample of sites selected for QTA using methodology developed by the MSI research team Recognition of consistently high QTA scoring programs through Quality Accreditation Marie Stopes International11

Quality Accreditation Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International12 Stage 1 Accredited Achieve >90% in 3 annual Peer-to-Peer Quality reviews Remain enforcement notice free through the Peer-to-Peer review period Full Accreditation No QTA for a maximum of 3 years, subject to continually improving performance ? Centres of excellence and best practise Qualification for Stage 1 Accreditation Achieve >90% on 3 consecutive QTAs Achieve >90% in clinical governance and infection prevention for 3 consecutive years Achieve >90% in quarterly clinical audit Remain enforcement notice free for 2 years Validation every 3 years by MDT Consistent QRP reporting Demonstration of clear action on risks Produce annual internal quality assessment report Random spot checks/ QTA by MDT Change in CSM or CD could result in additional reviews

Moving towards Quality Accreditation – Slowly and Surely Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International13 Total number of country programs - 34

Supporting initiatives developed under SIFPO Advancing MSI’s Quality Assurance approach under SIFPO Master Trainer Development Program Supportive Supervision Policy Incident Management and Reporting System Other guidelines and policies updated with peer-review by SIFPO partners like Engender Health Marie Stopes International14

Master Trainer Development Program Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International15 MDT RMAs ( MTs) identify talented clinical trainers in link programs Selected clinical trainers co-train on TOTs with MDT MTs RMAs assigned CTs to coach and mentor RMAs assess competencies and sign off CTs as in- country MTs In-country MTs provide in country and regional ToTs, coach and mentor CTs to build capacity in country programs Capacity Building and CQI

Supportive Supervision Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International16 Competency based Continuous Quality Improvement Competency based Training Competency based Coaching/ post-training support Competency based Quality assessments Competency based Supportive Supervision to address Performance Gaps

Incident Management and Reporting System Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International17 Clinical Incident RAG Rating Incident Notification Investigation and Action Plans MDT Incident Review Panel (RED INCIDENTS) Incident Panel Feedback

In summary, the evolved QA approach under SIFPO.. Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International18 Quality benchmarks Competency based systems to ensure objectivity and standardization RAG ratings to track quality and identify services and channels to strengthen Master Trainer Development, Supportive Supervision and Quality Accreditation initiatives to support CQI in programs

Striking the right balance between compliance and support … Advancing MSI’s Quality Assurance approach under SIFPOMarie Stopes International19

Thank You Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International20