1. Warm up

2. Case Your OPC has recently had many patients without CD4 counts in the last 6 months When you ask the staff, they are able to list many reasons for this including: – Patients live very far – Many patients miss appointments – CD4 test is only run twice per week – The reagents ran out one time last month – The lab is slow to send the results back

3. They are very sad but also think that there is no hope to make things better You try to get some ideas to improve, but everyone says nothing can help What can you do?

4. Reversing the trend* How can we make CD4 testing WORSE? Everyone be ready to provide one idea *adapted from HIVQUAL Games workbook

5. Why do we do this? If doing something makes it worse, would doing the opposite make it better?