1. Introducing QI Tools and Approaches Whole-Site Training Approach APPENDIX F Session C Facilitative Supervision for Quality Improvement Curriculum 2008

2. Staff Have Needs for: Facilitative supervision and management Information, training, and development Supplies, equipment, and infrastructure

3. Some Weaknesses of Conventional Training… Training and supervision are not linked. Trainees often cannot apply new knowledge to their work. Follow-up is lacking. Trainees are often selected inappropriately. Expanded needs for training cannot be met at centralized level. How can such situations be avoided?

4. When Training Is the Answer: Whole-Site Training Approach An approach to training that: Views a service-delivery site as a system and treats staff as members of the team that makes the system work. Meets the learning needs of all staff at a service- delivery site. Makes training more cost-efficient.

5. Whole-Site Training Approach Types of training Service orientations Knowledge updates Skills training Locations of training On-the-job training On-site training Regional or centralized training

6. Whole-Site Training Approach: Six Elements Linking supervisory and training systems Assessing a site’s learning needs and planning to meet them Focusing on teams, not just on individuals Tailoring the level of training to the needs of different employees Expanding the locales where training occurs Building sustainable capacity

7. Changing the Role of the Supervisor Help identify training needs Act as catalyst for change Serve as trainer or identify appropriate resources Help sites access training resources Help sites plan training Monitor training and results Follow up routinely with trainees Ensure that staff have equipment, supplies, and clients with which to apply newly acquired knowledge and skills

8. Assessing Site Learning Needs and Meeting Those Needs Site staff and supervisors identify gaps in quality of care through the use of COPE  or other self- assessment tools. On-site and off-site supervisors help to identify skills and other learning needs during supervisory visits by means of medical monitoring checklists and other assessment tools. Site staff participate in planning and organizing training, orientations, and updates.

9. Building Sustainable Capacity Supervisors routinely facilitate all aspects of training. Training follow-up becomes routine. Many staff are involved in training. Sharing of knowledge and expertise is encouraged. Problem solving becomes part of the performance improvement (PI) mindset. The impact of staff turnover is lessened.

10. Assuring Quality of Use of Whole-Site Training Approach Well-trained supervisors—effective monitoring of training and post-training performance Access to specialized training resources, when needed Adequate training handbooks and evaluation tools Type of training and training location are appropriate to learning needs Establishment of site resource libraries

11. Benefits of Whole-Site Training Approach Demystifies training Involves everyone Encourages mentoring Provides a foundation for sustainability Produces long-term benefits (change in organizational culture)

12. Inreach (1) Inreach is a strategy for informing clients and staff within a facility about other services available, and for referring clients to services in other facilities, according to the clients’ needs. “The purpose is to reduce missed opportunities for providing services to clients.” Lynam, P. F., et al. 1994. Inreach: Reaching potential family planning clients within health institutions. AVSC Working Paper No. 5. New York: AVSC International.

13. Inreach Reduce missed opportunities to provide needed services to clients Establish linkages and referrals between clinic’s departments Provide signs and information for clients

14. Inreach: How? Signs, posters, and educational materials are made available. Staff from one department provide health talks for clients in other departments. Staff share information about key services. Staff are oriented about different services so they can orient clients in turn. Other services are promoted. A system for referrals between services is established. Integrated services are made available.