Assuring Safety for Clinical Techniques and Procedures

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 READINESSand 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. 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) Supervisory System

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 • Review the site’s and the last supervisory visit’s report and action plans. • Review previous agreements and a list of recommendations from the last supervisory visit. • Communicate with the facility the date of the visit, the purpose of the visit, and the planned activities. • Develop and agree on an agenda.

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

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

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

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

17. Off-Site Supervisor’s Action Plan Format Problem Action/ Resources Needed Timeframe Follow-up Notes

18. Exercise: Using Checklists for Medical Monitoring Group A: CounselingGroup B: Infection preventionGroup 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 Follow-up/ evaluation Action plan development and prioritization Implementation

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

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