1. Assuring Safety for Clinical Techniques and Procedures MODULE 5 Facilitative Supervision for Quality Improvement Curriculum 2008

2. Assuring Safety Skilled providers Updated, evidence-based standards and guidelines Infection prevention control Appropriate supplies, equipment, and infrastructure Supportive supervision

3. Medical Monitoring Is: A medical QI intervention that entails the objective and ongoing assessment of the READINESS and the PROCESSES of service delivery. Conducted to identify gaps between actual practice and clinical standards, and leads to recommendations for improvement.

4. Exercise: Work in Four Groups Groups 1 & 3: What do you usually do to assess readiness? What tools do you use? Groups 2 & 4: What do you usually do to assess processes and procedures? What tools do you use?

5. Assessing Readiness of Care Staffing Facility, infrastructure Equipment, instruments and supplies Essential drugs and contraceptives Range of available services Functioning support systems Functioning referral system

6. Assessing Processes of Care (1) Observation of services and procedures –Medical techniques –Clinical examinations and procedures –Ensuring informed and voluntary decision making –Client-provider interaction Counseling –Infection prevention Client interviews Staff interviews Self, peer, and supervisor assessment

7. Assessing Processes of Care (2) Data collection systems –Analysis of relevant medical data and reports –Management information systems –Use of data for decision making Linkages to other services –Within the site –To other health sites/institutions –To clinical and nonclinical trainers –To headquarters

8. When and by Whom? Ongoing –Performed regularly by on-site staff and supervisors Periodically –Performed by onsite and off-site supervisors

9. Supervisory System On-site supervisors and staff Facility level Department or ward level Peers Off-site supervisors National/central level Regional/area level State/district level Peers (supervisors)

10. Medical Monitoring Tools Used by on-site and off-site supervisors and staff Checklists for –Observation of services/procedures –Record review –Facility audit –Assessment of provider knowledge and skills Client and staff interview guides

11. Supervisory Visits: Exercise Small Group Work (10 minutes): Discuss the assigned question with your group, record the results on a sheet of flipchart paper, and present the results to the entire group Group 1: What should an off-site supervisor do before the supervisory visit? Group 2: What should an off-site supervisor do during the supervisory visit? Group 3: What should an off-site supervisor do after the supervisory visit?

12. Supervisory Visits: Before the Visit 1. Review the site’s and the last supervisory visit’s report and action plans. 2. Review previous agreements and a list of recommendations from the last supervisory visit. 3. Communicate with the facility the date of the visit, the purpose of the visit, and the planned activities. 4. Develop and agree on an agenda.

13. Supervisory Visits: During the Visit 1. Meet with staff and on-site supervisors 2. Follow-up on previous visits and action plans 3. Observe services and audit the facility 4. Review records 5. Provide constructive feedback 6. Provide on-the-spot technical assistance and coaching 7. Teach the staff to conduct self-assessment activities and to use the results

14. Supervisory Visits: During the Visit (2) 8. Update staff on changes in national standards 9. Recognize achievements and motivate staff 9. Discuss findings with the staff and record them in the site’s supervision notebook 10. Help to develop solutions 11. Help staff to identify external resources 12. Agree on follow-up

15. Site Action Plan Format ProblemCause(s)Recommendations By Whom? By When?

16. After the Supervisory Visit: Off-Site Supervisors 1. Write a report and send a copy to the site. 2. Integrate the findings into the off-site supervisor’s ongoing action plan. 3. Follow up with the site on implementation of a site’s plan. 4. Provide assistance with problems that the site’s staff cannot solve on their own, by following up with district/ regional/national levels, as needed. 5. Evaluate the quality of services provided by a site. 6. Plan and conduct follow-up visits.

17. Off-Site Supervisor’s Action Plan Format Problem Action/ Resources Needed TimeframeFollow-upNotes

18. Exercise: Using Checklists for Medical Monitoring Group A: Counseling Group B: Infection prevention Group C: Facility audit

19. Guiding Principles for Supervisors Be Facilitative Work as a team member to model FS Talk and listen to all levels of staff Recognize jobs well done Solve problems on the spot, when possible Provide feedback in a constructive way Involve staff in decision-making process –Never criticize staff in front of a client or other staff

20. Supervisors Should Promote: Creating a mechanism for ongoing quality assurance Encouraging self- and peer-assessment by site staff Strengthening on-site medical monitoring mechanisms to improve quality of services and to ensure the fundamentals of care Following up on the site’s action plan and providing support Analyzing relevant medical data and reports for service improvement Strengthening support systems involved in health care provision: supervision, training, finance, human resources, logistics, and monitoring and evaluation

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

22. Planning for Action (1) Consolidated Site Quality/ Performance Improvement Plan Site Training Plan Off-Site Supervisor’s Input Community Action Plan COPE ® Action Plan Cost Analysis Plan Medical Monitoring Plan Off-Site Supervisor’s Pre-Visit Plan The QMT Plan Information Gathering

23. Planning for Action (2) Consolidated Site Quality/ Performance Improvement Plan System (Headquarters/ Region/ District) Consolidated Quality/ Performance Improvement Plans