1. Module 3 Improving Quality

3. Quality Improvement QI is achieving the best possible results with the available resources Includes any activities or processes that are designed to improve acceptability and effectiveness of service delivery and contribute to better health outcomes as an on-going and continuous process

4. What do we mean by best possible results Meeting standards Meeting targets – compliance with norms and standards Reliable implementation of best practice guidelines

7. Tools for quality improvement

8. Process mapping

9. Flow diagram – visual tool Care pathway is a good example Looks at a series of activities in order to identify gaps – barriers, bottle necks, duplication of effort, waste, unnecessary steps Must reflect reality – not what you want!

11. The five steps for PMCT care Counsel Test for HIV Counsel Test for HIV HIV+ Rapid referral for HAART: Start FDC HIV+ Rapid referral for HAART: Start FDC HIV – Retest every 6 weeks Infant gets NVP at birth and then daily for 6 weeks 1 3 5 2 4 CD4 >350 and no breastfeeding stop CD4<350 continue FDC CD4 >350 and no breastfeeding stop CD4<350 continue FDC Late bookings status unknown test status HIV + Late bookings status unknown test status HIV + P C R @ 6 weeks P C R @ 6 weeks

12. Case - study: Example flowchart Mother to be arrives Reception to midwife Examination by midwife Monitoring of labour Serial examinations Delivery care Referral PP proble ms PP proble ms App care Post natal care BF and HE etc Discharge procedures Discharge procedures Discharge Yes No Yes Adapted from USAID Health Care Improvement Project

13. COMPLAINT RECEIVED COMPLAINT RECORDED AND CODED INVESTIGATION COMMENCED RESPONSE TO COMPLAINANT REMEDIAL ACTION COLLATING DATA ANALYSIS AND FEEDBACK From National and Provincial sources and individuals and media May be received by: Health Care Institutions, National or Provincial structures COMPLAINT ACKNOWLEDGED Within 3 working days of receipt by complaints manager or provincial office if received there Within 5 working days of receipt of complaint Institutional complaints committee set terms of reference, appoints investigator & suggests process By institutional complaints committee unless delegated to complaints manager By complaints manager Within 12 working days of receipt of complaint As decided by Instit. Complaints Committee e.g. closure of case, changes in systems, training, purchase of equipment etc. Referral within 14 working days of receipt of complaint to SAEC or other relevant structure Information on all complaints entered into data base and sent to Region by 5 th of every month. Regions to QAD by 12 th day of month in required quarter On institutional, regional and central level To SMS & institutional managers each quarter REFERRAL TO OTHER STRUCTURE This document must be read together with the policy guidelines for the management of complaints

14. Root cause analysis

15. Understanding the root cause of problems Once you have identified your problem – need to explore under-lying causes Root cause analysis Cause and effect diagram Five why’s

19. Action plan

21. PDSA Cycle

22. How do you eat an elephant?

23. Start small to end big

24. ACT PLAN What are we trying to accomplish? How we will know that a change is an improvement? What change can we make that will result in an improvement? DO STUDY The model for improvement Langley, Nolan, Nolan, Norman & Provost 1999

25. The only man who behave sensibly was my tailor; he took my measurement anew every time he saw me, while all the rest went with their old measurements and expect them to fit me. (George Bernard Shaw)