1. STAKEHOLDER MEETING Selecting Interventions to Improve Utilization of the IUD City, Country Date Insert MOH logoInsert Project logoInsert USAID logo (Note: Photos have been removed to keep the file size manageable.)

2. 2 Introductions  As we go around the room, say: –Your name –Your position –Where you work

3. 3 Meeting Objectives  Share and discuss results of performance assessment data results  Discuss performance gaps and analyze root causes of the performance gaps  Identify and select interventions to address performance gaps

4. 4 Agenda  Welcome and opening remarks  Review of PIA and results of stakeholders workshop: desired performance statements  Presentation of assessment data results  Break  Actual performance and performance gaps  Lunch  Overview of root cause analysis  Group work: conduct root cause analysis Day 1—Date

5. 5 A Quick Reminder of Performance Improvement Approach

6. 6 What is Performance?  The tasks that people do and the results of those tasks

7. 7 What is Performance Improvement?  A step-by-step methodology for finding out what is needed to ensure good performance, and delivering it

8. 8 Factors Influencing Performance 1.Job expectations 2.Performance feedback 3.Environment and tools 4.Motivation and incentives 5.Skills & knowledge Organizational Support: Using Performance Factors

9. 9 PI Framework PNA

10. 10 CONSIDER INSTITUTIONAL CONTEXT MISSION GOALS STRATEGIES CULTURE CLIENT AND COMMUNITY PERSPECTIVES OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT MONITOR AND EVALUATE PERFORMANCE DEFINE DESIRED PERFORMANCE FIND ROOT CAUSES WHY DOES THE PERFORMANCE GAP EXIST? SELECT INTERVENTIONS WHAT CAN BE DONE TO CLOSE THE PERFORMANCE GAP? DESCRIBE ACTUAL PERFORMANCE GAP IMPLEMENT INTERVENTION PNA

11. 11 Define Desired Performance  What the organization would like to see happening - what the providers should be doing  Is defined by stakeholders through consensus  Use specific, measurable terms

12. 12 Desired Performance Statements Desired Performance IndicatorsTarget Level 1. 2. 3. Note: insert desired performance statements developed at stakeholder agreement meeting

13. 13 CONSIDER INSTITUTIONAL CONTEXT MISSION GOALS STRATEGIES CULTURE CLIENT AND COMMUNITY PERSPECTIVES OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT MONITOR AND EVALUATE PERFORMANCE DEFINE DESIRED PERFORMANCE FIND ROOT CAUSES WHY DOES THE PERFORMANCE GAP EXIST? SELECT INTERVENTIONS WHAT CAN BE DONE TO CLOSE THE PERFORMANCE GAP? DESCRIBE ACTUAL PERFORMANCE GAP IMPLEMENT INTERVENTION PNA We are Here

14. 14 Actual Performance Statements  Actual performance measured with same indicators as desired performance  One actual performance statement for each desired performance statement

15. 15 Data Collection Methodology  Describe methodology, sample size, and tools used

16. 16 Performance Data  Present text, tables, and figures of performance data collected via facility audits, provider and client interviews, provider observations, and any other methods used

17. 17 Performance Factor Data  Present the information gathered regarding the performance factors/ quality assurance and management elements, such as information on supervision, job expectations, motivation, knowledge and skills, etc.

18. 18 Do you have any questions or comments?

19. 19 CONSIDER INSTITUTIONAL CONTEXT MISSION GOALS STRATEGIES CULTURE CLIENT AND COMMUNITY PERSPECTIVES OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT MONITOR AND EVALUATE PERFORMANCE DEFINE DESIRED PERFORMANCE FIND ROOT CAUSES WHY DOES THE PERFORMANCE GAP EXIST? SELECT INTERVENTIONS WHAT CAN BE DONE TO CLOSE THE PERFORMANCE GAP? DESCRIBE ACTUAL PERFORMANCE GAP IMPLEMENT INTERVENTION PNA We are Here

20. 20 What is a Performance Gap? Desired Performance — Actual Performance — Actual Performance___________________________________________ GAP GAP

21. 21 Performance Gaps Desired Performance Indicators Actual Performance Percentages Performance Gap 1. 2. Note: insert the actual percentages determined via data collection and present the corresponding Gap for each desired performance statement or indicator

22. 22 Prioritize Performance Gaps  We cannot work on every gap at once –Resources are limited –We need to focus our efforts for greater success  Must define criteria for prioritizing gaps:  Largest gaps  Critical area of performance  Place in priority order (1, 2, 3, ….)  Let’s discuss….

23. 23 CONSIDER INSTITUTIONAL CONTEXT MISSION GOALS STRATEGIES CULTURE CLIENT AND COMMUNITY PERSPECTIVES OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT MONITOR AND EVALUATE PERFORMANCE DEFINE DESIRED PERFORMANCE FIND ROOT CAUSES WHY DOES THE PERFORMANCE GAP EXIST? SELECT INTERVENTIONS WHAT CAN BE DONE TO CLOSE THE PERFORMANCE GAP? DESCRIBE ACTUAL PERFORMANCE GAP IMPLEMENT INTERVENTION PNA We are Here

24. 24 Root Cause Analysis—Multiple Whys Why? 3 W’s

25. 25 Root Cause Analysis Technique  For each gap, ask “why is this occurring?”  For each answer, ask “why” again? –Chart multiple answers if they come up  Keep asking “why?” until no more answers are available –Stop when you have to say “I don’t know”  The root cause is the lowest-level cause you can do something about.

26. 26 Gap: Supervisors are not making appropriate number of supervision visits Did not know how many visits were expected No transport No one told them Have no job description No funds No one developed a Job description No one’s job to tell them Did not request funds Did not know how to complete the funding request form Were not trained Root Cause Analysis Example Have no supervisor No support system for them Not in their training Example: Ghana, 2000

27. 27 Remember the Performance Factors  Organizational Support: Using Performance Factors –Job Expectations –Performance Feedback –Physical Environment and Tools –Motivation and Incentives –Skills and Knowledge to do the job Note: Categorizing root cause by performance factor helps us to better identify the appropriate interventions for addressing the root cause

28. 28  In your group begin by reviewing assessment results related to your assigned gap.  Conduct root cause analysis for the performance gaps. Ask why-why-why for each gap.  Choose a facilitator for your group and write the multiple why trees on flipchart paper so your whole group can see.  Identify the root causes for each gap by placing a star (*) by it.  You will have 60 minutes. Then we will present and discuss. Group Work

29. STAKEHOLDER MEETING Selecting Interventions to Improve Utilization of the IUD City, Country Date Welcome to Day Two!

30. 30 Agenda  Presentation of root cause analysis group work in plenary  Overview of steps for intervention selection  Group work: brainstorm and select interventions  Break  Presentation of group work on intervention selection in plenary  Conclusion and next steps Day 2—Date

31. 31 Plenary: Root Cause Analysis  Let’s share your group’s work!

32. 32 CONSIDER INSTITUTIONAL CONTEXT MISSION GOALS STRATEGIES CULTURE CLIENT AND COMMUNITY PERSPECTIVES OBTAIN AND MAINTAIN STAKEHOLDER AGREEMENT MONITOR AND EVALUATE PERFORMANCE DEFINE DESIRED PERFORMANCE FIND ROOT CAUSES WHY DOES THE PERFORMANCE GAP EXIST? SELECT INTERVENTIONS WHAT CAN BE DONE TO CLOSE THE PERFORMANCE GAP? DESCRIBE ACTUAL PERFORMANCE GAP IMPLEMENT INTERVENTION PNA We are Here

33. 33 Select Interventions—The Steps  Define intervention criteria –Make a list of criteria for judging possible interventions, some examples include: Affordable Feasibly Timely  Brainstorm possible interventions –Generate as many possibilities as you can –Do not evaluate them yet

34. 34  Prioritize and select interventions –Compare each intervention to criteria list –Cross out those that do not meet the criteria –Prioritize the interventions  Select the best intervention to fix the root cause in question  Aim for one intervention per root cause (if possible) Select Interventions—The Steps

35. 35  Make a list of criteria for judging possible interventions  Identify “must” criteria—those criteria that are absolutely essential  Prioritize the other criteria Define Intervention Criteria

36. 36 What will be our Criteria?  Ideas?  Let’s discuss

37. 37 Group Work  For each root cause identified earlier, –Brainstorm possible interventions –Compare interventions to selection criteria –Select the interventions you propose to address each root cause  Record your interventions on flip chart paper using the table format.  You will have 60 minutes. Then we will present and discuss.

38. 38 Presentation Format

39. 39 Group Work—Define Action Plans  For each intervention your group selected, identify the: –Activities/steps –Responsible person –Timeline  Use the following table format and record your action plan on flipchart paper.  You have 60 min. Then we will present and discuss.

40. 40 Action Plan Format Intervention Activities/ Steps Person Responsible Timeframe

41. 41 Next Steps  Add next steps as appropriate