Overview of Self Assessment Tool Dr. Ashek Ahmed, MD, MPH Smiling Sun Franchise Program (SSFP)

Quality Monitoring System of SSFP Three tiers: 1. Central level -Clinical Quality Council (CQC) -Regular SSFP Monitoring -External Quality Audits -Mystery Client -EmOC Preparedness Audit 2. NGO level -Quality Monitoring and Supervision -Monitoring of Clinic level Quality Circle 3. Clinic level -Clinic Level Quality Circle -Self Assessment

Inception: January 2010 Objectives To aid the clinic staff (and Monitoring Officer) in assessing the level of quality of care they provide To help monitoring the progress of quality for developing action plan for improvement Assessment of three dimensions of quality (Technical competence, Marketing & Community Linkage, Management)

Mode of use All clinic staff (members of CLQC) particularly Clinic Manager, Medical Officer, Paramedic, Counselor, Lab tech. Conduct on quarterly basis. Based on findings/results, develop action plan that examines identified-

Mode of use gaps and resolves any issues raised during implementation of the tool. Action plan reviewed monthly by staff themselves (in conjunction with Clinic Manager) to track set tasks. Clinic Manager briefs Monitoring Officer on issues and progress.

Mode of use Monitoring Officer reviews self assessment questionnaires with the staff and is likely to observe the provider in performing some of the tasks for the purpose of providing on job training and providing ‘supportive supervision” to the staff members.

Indicators The degree to which staff provide care as per set standards is assessed. Developed to track meeting of process / performance indicators for services provided at clinics: ■ Counseling ■ Infection Prevention Practice

Indicators ■ Maternal Health: ANC, Safe delivery, PNC, AMTSL, PAC ■ Family Planning ■ Infant and Child Health ■ STIs/RTIs ■ Communicable Diseases ■ Limited Curative Care ■ Diagnostic Services

Self Assessment Tool

Changing the mindset for ensuring quality was a difficult task at clinic level providers which was earlier laid upon the NGO HQ. Switching of ownership for regular monthly review, quarterly action plan and follow up from HQ level to self level, thereby creating sense of ownership on quality maintenance & improvement Quarterly assessment of strength of the providers in delivering quality of care in all aspects is on board. Challenges

Challenges Changing the mindset for ensuring quality which was a difficult task at clinic level providers which was earlier laid upon the NGO HQ. Switching of ownership for regular monthly review, quarterly action plan and follow up from HQ level to self level, thereby creating sense of ownership on quality maintenance. Quarterly assessment of strength of the providers in delivering quality of care in all aspects is on board.

Results Commendable improvement in overall quality management occurred due to positioning of self assessment tool guided by the values of ownership since last two years. Major shift in indicators towards positive trend aimed at achieving the set standards. Culture of quality gradually implanted within the whole system resulting in overall improvement. Customers’ satisfaction augmented over time reflecting the improvement of quality of care that took place towards required standards.

Comparative benefits Acts as a niche influencing outcome for the critical mass of overall Quality Improvement tools Service providers have the flexibility to assess their level of quality anytime without HQ support. Minimum supervision required following commissioning of tool, thereby minimizing the degree of external effort , time and cost that might occurred otherwise. However, culture of regular practicing the tool and properly addressing the identified gaps should be taken into account for galvanizing the effort in positioning effective quality improvement system making full functionality towards optimization.

Thank You