1. How to sustain Quality Improvement activities over time
A brief introduction to Quality Management

2. Objectives Understand why there is a need for Quality Management (QM)
Understand key aspects of QM to start building into clinic operations.
Discuss ways to sustain and spread QI efforts

3. Scenario
You’ve trained all of your staff in QI, everyone is enthusiastic and in the first 6 months you’ve done 3 successful QI projects.
However, now the head nurse is pregnant, the counselor is going back to school, and the doctor is transferred to another OPC
How can you keep your QI effort going?

4. Sustainability
Once QI is successful in one project, one clinic or one department how can it be sustained?
How can it spread across a clinic, hospital or health system?

5. Quality Management (QM)
An organization’s overall vision and strategy for sustaining QI efforts
Reflects an organization’s goals of quality and plans for quality improvement over months to years
Provides leadership and supports culture of quality
Ensures training and resources are in place
Sets priority areas for quality improvement
Increases likelihood of sustainability and spread

6. Quality management programs are important at all levels
Area of focus
Ministry of Health
Sets national standards for quality
Province
Leadership and support for ensuring strong provincial systems and addressing cross site issues.
Hospital
Coordinates and leads quality of care initiatives throughout the hospital
Clinic
Addresses clinic specific issues

7. Quality management plan outlines how the QM program will work
A written vision for quality and QI
Annual goals for quality
The QI infrastructure:
A team with multidisciplinary staff involvement
Dedicated time to meet
Plans for measurement
Documentation
of meetings
of QI work at the site
Resources for training and monitoring progress

8. Quality Management Plan example (1) Hospital ABC
Quality vision: Hospital ABC will maintain high standards and ensure medical care is given in accordance with MOH guidelines in all departments. It is our vision that every staff person in Hospital ABC has the responsibility to maintain patient safety and provide the highest level of care.

9. Quality Management Plan example (2)
Hospital ABC Quality goals for fiscal year 2013 (listed for each area). Examples:
HIV: By 2013 routine CD4 testing will be increased by 15% and missed visits will be decreased by 20%.
Vaccination: up to date vaccinations will be increased by 15%
Pharmacy: Errors in medication dosing will be reduced by 20%

10. Quality Management Plan example (3)
Plan for implementation:
Dr. Huong, Nurse Thuy, Vice Director of Planning Hung and Patient representative Hai will lead the hospital effort. They will meet monthly and minutes will be shared with the hospital staff.
Each clinic will establish a QI team to focus on quality issues in that area.
Measurement will be done in each clinic every 6 months.

11. Hospital ABC Quality Management Plan example (4)
Education: All staff working at hospital ABC will be trained in quality improvement. New staff training will be available on the first Friday of every month at 10am in the auditorium along with weekly quality rounds open to all staff to share lessons learned.
Monitoring:
Every clinic should keep a record of measurement, QI projects and results in a 3 ring binder
Hospital wide results will be shared on an annual basis
Quality improvement goals will be reviewed and adjusted on an annual basis

12. What does quality management look like at the clinic level?
Supports work to build the clinic’s capacity for improvement
Provides leadership in implementation of measurement and improvement in hospital/MOH priority areas
May choose additional priority quality areas
Includes representatives from different disciplines (doctors, nurses, counselors, leaders, patients)
Helps coordinate quality related work across the clinic
In small clinics QM team may be almost the same as QI project team.

13. Exercise -
Is there a quality management program at your facility or province?
Can you think of some next steps in starting a QM team at your sites?
Do you have other ideas for how to sustain QI?
10 min
Be ready to share
This slide and exercise is to recognize that it may take some time to implement QM.
It is an exercise to get staff thinking both about how to implement QM as well as other ways to sustain QI which will be the next few slides.

14. Some ideas for sustaining QI efforts even before a QM program is in place

15. Ideas on how to sustain QI (1) Make quality important
Include quality as an agenda item in meetings
Recognize staff for their QI efforts
Ensure process for feedback and open discussion of performance data
Suggestion box: Take suggestions from staff and patients on areas to improve

16. Ideas on how to sustain QI (2) Document quality work
Provides important tracking and can be used to measure progress, learn from what has been done, teach new staff
Example: A 3 ring binder that includes:
Quality Management Plan
Performance measurement plans and results
Priority areas to improve
Notes from gap analyses
QI Project plans and results
Copies of trainings
Notes from QM meetings

17. Ideas on how to sustain QI (3) Spread the word about quality
Organize workshops to promote quality
Share lessons learned with other departments or clinics
Celebrate and share successes
Post improvement results on the walls
Newsletters

18. Summary
After a successful QI project next steps include sustaining and spreading QI
A quality management program provides important leadership and vision for an organization’s QI efforts
Until a QM program is in place, there are many ways a clinic can begin to spread and sustain QI efforts

19. Thank you