1. Introducing QI Tools and Approaches Taking QI & PI Approaches and Tools to Scale APPENDIX F Session G Facilitative Supervision for Quality Improvement Curriculum 2008

2. The QI Process Information gathering and analysis Action plan development and prioritization Implementation Follow-up/ evaluation

3. INFO Community assessment Client interview CFA Observation of services Data review Facility audit Record/ case review INFO Staff interview COPE ® Information Gathering Identify gap between actual practice and best practice Quality Measuring Tool Cost analysis PNA

4. Action Plans (examples) INFO District Supervisor’s Plan Community Action Plan COPE ® Action Plan Site Training Plan

5. Taking QI/PI Approaches to Scale Replication? Diffusion? Expansion? Institutionalization?

6. Taking QI & PI Approaches to Scale Process: –of planning, implementation and evaluation of strategies and activities –designed to increase and expand the use of the QI approaches

7. Taking QI & PI Approaches to Scale Endpoint is institutionalization -- sustained use leading to sustained improvement Other systems are created or adapted to support its use

8. From Pilot to Institutionalization Site selection Orientation for managers and staff Training Range of facilitators, supervisors, staff involved Funding/other support for activities and solutions Systems and management Partnerships Communities Supporters and Leadership

9. Site Selection Starting with “best potential for change” Moving beyond to “real” Need to go everywhere - eventually Choosing sites - by interest, by supportive supervisors

10. Orientation and Training Orientation for managers Orientation for staff Training for facilitators, participants Involve a range of supervisors, facilitators, staff to address staff turnover problem

11. Resources For conducting activities For implementing interventions Needs will be raised during assessment (COPE exercise) Focus on local solutions, local resources Identify external sources of support Link action plans with cost-sharing

12. Systems and Management Inclusion of QI approaches and tools (COPE & other) in quality assurance policies and guidelines Monitoring and supervision systems in place Emphasize role of supervisor as liaison to sources for support Incorporate review of QI action plans in regular meetings

13. Partnerships MOH, other NGOs, private sector to support the process Other sectors - Education, Development, Social Services Local businesses Other funding organizations

14. Communities Use COPE for Community Involvement Educating communities about their rights Empowering community members to articulate their needs Local decision-making for health funds through Health Sector Reform Combine resources and efforts for problem- solving

15. Supporters and Leadership Site level Institutional level Charismatic leaders How to build support and enthusiasm at a national level? Share “success stories” and lessons learned

16. Environmental Context Health Sector Reform National policies Other organizations Other sectors Other actors (donors, insurers, etc.) New or well-known ideas (BTC)

17. Example: Taking COPE to Scale Strategies for taking COPE to scale Planning and conducting activities to introduce COPE Planning and conducting activities to expand use of COPE within an institution Evaluation of strategies and activities to expand use of COPE Evaluation of impact of COPE Update strategies, share lessons learned

18. What Systems Support the Use of COPE? Supervision --- Facilitative Supervision Training --- Whole Site Training, Inreach Monitoring --- Medical Monitoring, MIS Evaluation --- QMT, Annual Reporting, etc. Community level --- Community COPE, PLA, advocacy for Informed Choice, MAP, PAC, etc.

19. The Goal of Taking Approaches to Scale COPE and other QI/PI approaches used throughout a program/institution Quality Improvement process sustained over time -- ultimately sustained when our (others) assistance is withdrawn