LON-AAA123-20110705- Performance Based Financing at Hospital - Performance Management for Continuous Improvement July 12, 2013 Shun Mabuchi Highlight Using the case study of the health sector to understand opportunities for Poverty Targets and working collaboratively across the WBG

Performance management System Success of the project hinges on whether we can establish robust performance management systems for continuous improvement LON-AAA123-20110705- 6 monthly counter verification Quarterly quality assessment Business/ Operational Plan Initial investment funds Quality Improvement activities Performance management System Performance bonus Clear set of performance indicators Robust data collection and verification system Rigorous review of performance data and use for planning 3 month Operational Plan Highlight Inequities in outcomes 1 1

Building multiple levels of accountability and performance management system is critical Technical Committee Overall oversight of performance trend and project implementation Resolve project-level issues Hospital Board Provide oversight to hospital management Make SMT accountable for results and implementation of business plan Community involvement and grievance Senior manage- ment Team Develop business plan with supervisors Hold supervisors accountable for quality indicators (At least ) monthly performance review with QI team Support QI team implement their plans Hospital QI team Responsible for improving specific quality indicators Carry out weekly/monthly self-quality assessments and track results at each ward Provide feedbacks, coach and train health workers

QI team will motivate health workers to improve key indicators through tracking and coaching (1/2) LON-AAA123-20110705- Sample activities of Maternity QI team and LMDC coach Areas Responsible Example of Activities Management and structural checklist Waste disposal Use of patograph Delivery room maintenance Basic supplies Monthly self-assessment using checklist and feedback ward/SMT Plan, support and monitor specific activities of health workers (e.g., supplies tracking, waste disposal) Obstructed labor PPH Sepsis Eclampsia Weekly chart review, scores on wall, feedback to health workers Training to health workers Checklist on wall, attached to chart Process of care checklist Complicated and assisted delivery Normal deliveries of at risk referrals Training Ensure home address of patients in the register Monthly recording to invoice Put monthly numbers on a wall Plan training with faculties Quantity Checklist Highlight Inequities in outcomes 3 3

QI team will motivate health workers to improve key indicators through tracking and coaching (2/2) LON-AAA123-20110705- Weekly/daily chart review Monthly management and structural checklist review 1 Self-Assessment 2 Post scores on a wall Provide detailed feedback to staff Tracking and Feedback 3 Support improvement activities (e.g., standardize chart, waste disposal, cleaning) Training on the treatment protocol and chart writing Support to Improvement QI Activities Highlight Inequities in outcomes 4 4

SMT will create continuous improvement system in the hospital and support QI team Assign all indicators and checklists to specific wards and QI teams … Indicator Provide QI team with graph, etc. for tracking Run monthly performance review meetings to hold QI team accountable Establish healthy competition and recognition by QI team Tracking system Provide QI team financial and other support (e.g., on-time investment based on B-plan) Support Ensure full transparency of use of funds to the Board Trans-parency SMT QI Team QI Team QI Team

Performance dashboard will provide the SMT with trend views of critical quality indicators Total Bonuses Quality Bonuses Quantity Bonuses Perfor-mance Bonuses 1. General mgmt 2. HR for Health 3. Hygiene & Waste Quality Scores Image 4. Drugs mgmt 5. Equipment & Supply 6. Process of Care

Hospital Board will provide oversight and hold SMT accountable for results and process LON-AAA123-20110705- Hospital Board Community SMT Health Workers Grievance Patient satisfaction B-plan, finance, performance report, etc. Reporting to the Hospital Board Follow up of the action items at the previous Board Meeting; Key implementation progress of the quarter; Review of Quality and Quantity performance trend (Dashboard); Discussion of key performance gaps and issues; Operational plan for the next quarter Grievance and patient feedback Financial report of the quarter Health worker performance evaluation AOB Sample Agenda of Quarterly Hospital Board Meeting Highlight Inequities in outcomes 7 7

Discussion Questions LON-AAA123-20110705- What are critical to make the Hospital Board fully functional? What should the SMT do to best support the QI team and Ward Supervisors? What should the coach from the Liberia Medical and Dental Council (LMDC) do to support the SMT and QI team? What assistance from the MOHSW would be necessary to make the performance management work at hospitals? Highlight Inequities in outcomes 8 8