1. Mobilizing Teams for Change: The Power of Improvement Collaboratives in MNCH Programs Youssef Tawfik, MBBCH, MPH Sr. Quality Improvement Advisor, MNCH University Research Co., Reconvening Bangkok: 2007 to 2010 March 6-11, 2010.

2. What are the quality obstacles? ResourcesProcessesResults (Outcomes) Non-compliance with standards Poor organization of care (inefficiency) Not sensitive to client needs Inadequate health services delivered Negative health outcomes Poor client satisfaction Lack updated standards HR shortage Poor Providers’ skills Weak Infrastructure Weak Health systems Poor access to care

3. The Basic Principles of Quality Improvement Understand client needs Understand the system and processes of care Teamwork Measure results MAKE CHANGES

4. Definition of an Improvement Collaborative An Improvement Collaborative is an organized network of a large number of sites (e.g. districts, facilities or communities) that work together for a limited period of time, usually 9 to 24 months, to rapidly achieve significant improvements in a focused topic through shared learning and intentional spread methods. The system, processes, quality and efficiency of care are to be improved.

5. Components of Improvement Collaboratives Network of participating organizations/sites involved in shared learning Quality Improvement (QI) team at each site Focused on one clinical/public health topic Work to find better ways to implement best practices and achieve better results Regular communication between sites Common key indicators reported and shared monthly

6. Two Types of Collaboratives Demonstration collaborative: 15-60 sites who work intensively for 9 to 24 months to adapt to their local situation a best model of care. Spread collaborative: 40 to 150 sites who work for 12 to 24 months to spread to their sites the best practices and solutions developed in the demonstration collaborative

7. What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo From: Associates in Process Improvement

8. Accelerating Improvement for Rapid Results

9. PharmacistNurse(s) Physican Lab technician Manager Who would be a member of the quality improvement team? All the people who are involved in the particular process of care at each site Midwife

10. Spread of MNCH interventions through collaboratives Demonstration slice Collaborative = multiple sites working simultaneously and learning together to improve specific MNCH services’ and systems’ indicators. Regional QI team District QI team District 2 District 3 District 1 National QI team

11. Case example: Russia - Organization of Tula Oblast Intentional Spread Collaborative after Demonstration Collaborative Arrows show expansion from initial sites to neighboring spread sites

12. Results of collaborative improvement related to MNCH care: 14 applications in 8 countries for 92 indicators Average absolute improvement over baseline values – 92 indicators Speed of improvement – time to Reach 80% or 90% of patients Receiving care according to standards

13. Were gains maintained over time? Niger MNCHRussia MNCHEcuador MNCH

14. Thank You