1. Continuous Quality Improvement – Knowledge Management by Any Other Name Peter Hobby Director of Communications and KM Center for Pharmaceutical Management Management Sciences for Health

2. Improved Access. Improved Services. Better Health Outcomes Goal To assure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes Objective To promote and use a systems-strengthening approach consistent with the Global Health Initiative that will result in positive and sustainable health impact Health Outcomes Services Products Systems for Improved Access to Pharmaceuticals and Services

3. Improved Access. Improved Services. Better Health Outcomes Improved Access. Improved Services…

4. What is CQI? The continuous quality improvement (CQI) concept… Program management method known also as continual improvement process and plan-do-study-act. Includes reflection on processes to trim inefficiencies Adaptation through small-scale, incremental changes. Creates and codifies learning in applied settings Indicators or targets helps determine success.

5. Improved Access. Improved Services. Better Health Outcomes Why Implement CQI ? To improve quality through continual reviews and small-scale changes that do not overwhelm the staff or the system To implement self-determined changes, NOT the ones thrust in from outside To help reduce variations in practice (which are common and often have no clear reason or basis) To identify opportunities for cost containment in the current environment of escalating health care costs

6. Improved Access. Improved Services. Better Health Outcomes PLAN (Prepare the change) DO (implement the change) STUDY (monitor and analyze impact of the change) ACT (revise and standardize the change) PDSA Cycle Adapted from: CIE & Datatel – CQI 101

7. Improved Access. Improved Services. Better Health Outcomes PDSA for Jordan A multidisciplinary team conducts CQI through PDSA cycles PLAN Study the existing practice (collect data and current process) Identify issues/problems Develop action plan for change, including plan for measuring success DO Undertake the planned activities on a small scale

8. Improved Access. Improved Services. Better Health Outcomes PDSA for Jordan STUDY Examine or check the result of the action before waiting too long Look for signs of progress, constraints, or unexpected outcomes Look for any lessons brought by this small scale action ACT Use the findings (and lessons learned) from the study to identify and make any necessary mid-course modifications or adjustment Then continue the PDSA process with the next cycle, going from P to D to S to A (in an iterative manner)

9. Improved Access. Improved Services. Better Health Outcomes CQI for Antibiotic Prophylaxis in C-section: Conclusion The CQI framework has a strong potential to— Standardize processes Strengthen systems Progressively improve antibiotic prophylaxis in c-section The framework can easily be expanded later to improve prophylaxis for other surgeries Source: vzimbel.com

10. MSH has helped groups in: Afghanistan, China, Ethiopia, Jordan, Kenya, Liberia, Malawi, Mozambique, Rwanda, South Africa, South Sudan, Tanzania, and Uganda, to: Where Else has CQI Worked?

11. South Africa Example Increase in the percentage of 64 primary health care facilities that complied with national cold chain management standards from 26 to 48% 70% improvement in medicine labeling practices and a 27% increase in the number of patients who knew how to take their medication properly 17% increase in the number of prescriptions that complied with standard treatment guidelines 17% reduction in the number of medication errors recorded at four hospitals.

12. How Else has CQI Been Applied? Establish revolving drug funds in 340 NGO clinics. Help hospitals to establish Drug and Therapeutics Committees to address service delivery bottlenecks Use in HIV/AIDS training to improve inventory management and increase use of SOPs by 50% Create action plans to improve antibiotic prophylaxis practices for C-sections, including practice profiles, baseline data, and self-monitoring indicators Applied at 44 hospitals now scoring above 70% on indicators of inventory management, storage management, and supply chain management.

13. Thank You