Improving health care Nigel Livesley MD, MPH Regional Director, - - PowerPoint PPT Presentation

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Improving health care

Nigel Livesley MD, MPH

Regional Director, South Asia USAID ASSIST Project University Research Co., LLC (URC)

USAID Applying Science to Strengthen and Improve Systems

50% of women attending an ANC clinic did not get their BP and Hb measured

68.50% 40.80%

0% 25% 50% 75% 100%

BP Measured HB Measured

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USAID Applying Science to Strengthen and Improve Systems

Implementation interventions (Tuncalp et al)

http://www.qualityofcarenetwork.org

• 1. Leadership and governance of quality
• 2. System re-design for implementation and scale up
• 3. Financial strategies to support improvement
• 4. Assessment and provision of resources
• 5. Engaging women, families, communities in their care
• 6. Education, training and supportive supervision for clinical and system

activities

• 7. Data to support improvement
• 8. Learning communities for accelerating improvement

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USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death

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USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death Provider-patient interaction

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USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death Provider-patient interaction

Appropriate resources Appropriately skilled and motivated healthcare workers Appropriate processes to deliver care 6

USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death Provider-patient interaction

Leadership and governance

Appropriate resources Appropriately skilled and motivated healthcare workers Appropriate processes to deliver care 7

USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death Provider-patient interaction

Financial strategies

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Leadership and governance

Data to support improvement

Learning communities System redesign Provide resources Education and support

Appropriate resources Appropriately skilled and motivated healthcare workers Appropriate processes to deliver care 8

USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death Provider-patient interaction

Engaging women, families, and communities in their care Financial strategies

$$

Leadership and governance

Data to support improvement

Learning communities System redesign Provide resources Education and support

Appropriate resources Appropriately skilled and motivated healthcare workers Appropriate processes to deliver care 9

USAID Applying Science to Strengthen and Improve Systems

What approach should we use to improve this problem?

68.50% 40.80%

0% 25% 50% 75% 100%

BP Measured HB Measured

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USAID Applying Science to Strengthen and Improve Systems

Poll 1: What strategy would you suggest we use to improve care at this hospital?

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• 1. Leadership and governance of quality
• 2. System re-design for implementation and scale up
• 3. Financial strategies to support improvement
• 4. Assessment and provision of resources
• 5. Engaging women, families, communities in their care
• 6. Education, training and supportive supervision for clinical and system

activities

• 7. Data to support improvement
• 8. Learning communities for accelerating improvement
• 9. I don’t know

USAID Applying Science to Strengthen and Improve Systems Provider-patient interaction Appropriately skilled and motivated healthcare workers 50% reduction in maternal and newborn death Appropriate resources Appropriate processes to deliver care

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USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

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Resource problem Individual performance problem Process problem

USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

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Nurses lack equipment or supplies

Resource problem Individual performance problem Process problem

USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

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Nurses lack equipment or supplies

Resource problem Individual performance problem Process problem

Approaches

• Provide resources
• Financing

USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

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Nurses aren’t doing their job

• Lack knowledge
• Lack skills
• Lack respect/empathy
• Lack motivation

Nurses lack equipment or supplies

Resource problem Individual performance problem Process problem

Approaches

• Provide resources
• Financing

USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

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Nurses aren’t doing their job

• Lack knowledge
• Lack skills
• Lack respect/empathy
• Lack motivation

Nurses lack equipment or supplies

Resource problem Individual performance problem Process problem

Approaches

• Provide resources
• Financing

Approaches

• Training
• Involve women
• Supervision
• Financing
• Leadership

USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

The way service delivery is organized makes it hard for nurses to do their job

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Nurses aren’t doing their job

• Lack knowledge
• Lack skills
• Lack respect/empathy
• Lack motivation

Nurses lack equipment or supplies

Resource problem Individual performance problem Process problem

Approaches

• Provide resources
• Financing

Approaches

• Training
• Involve women
• Supervision
• Financing
• Leadership

USAID Applying Science to Strengthen and Improve Systems

The approach to fix this depends on the cause of the problem

The way service delivery is organized makes it hard for nurses to do their job

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Nurses aren’t doing their job

• Lack knowledge
• Lack skills
• Lack respect/empathy
• Lack motivation

Nurses lack equipment or supplies

Resource problem Individual performance problem Process problem

Approaches

• Provide resources
• Financing

Approaches

• Training
• Involve women
• Supervision
• Financing
• Leadership

Approaches

• System redesign
• Use data

USAID Applying Science to Strengthen and Improve Systems

What approach should we use to improve this problem?

68.50% 40.80%

0% 25% 50% 75% 100%

BP Measured HB Measured

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USAID Applying Science to Strengthen and Improve Systems

Huge variation from patient to patient and week to week

2 4 6 8 10 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-1 W-2 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 # high-risk identified % BP measured % Hb measured

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USAID Applying Science to Strengthen and Improve Systems

Poll 2: The cause of this variation is most likely to be:

1. Due to resource constraints 2. Due to staff with poor knowledge and skills 3. Due to staff with poor motivation 4. Due to inappropriate processes

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USAID Applying Science to Strengthen and Improve Systems

THIS IS A PROCESS PROBLEM

2 4 6 8 10 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-1 W-2 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 # high-risk identified % BP measured % Hb measured

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USAID Applying Science to Strengthen and Improve Systems

24 Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station

USAID Applying Science to Strengthen and Improve Systems

25 Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station

USAID Applying Science to Strengthen and Improve Systems

26 Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station

USAID Applying Science to Strengthen and Improve Systems

27 Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station

USAID Applying Science to Strengthen and Improve Systems

28 Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station Nurse’s station

USAID Applying Science to Strengthen and Improve Systems

Improving processes of care…

2 4 6 8 10 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-1 W-2 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 # high-risk identified % BP measured % Hb measured

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USAID Applying Science to Strengthen and Improve Systems

…led to a nine fold increase in the number of women identified with risk factors

18 high-risk pregnancies identified (1.4%) 39 high-risk pregnancies identified (12.3%)

2 4 6 8 10 12 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-1 W-2 W-3 W-4 W-5 W-1 W-2 W-3 W-1 W-2 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 # high-risk identified % BP measured % Hb measured

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USAID Applying Science to Strengthen and Improve Systems 50% reduction in maternal and newborn death Provider-patient interaction

Engaging women, families, and communities in their care Financial strategies

$$

Leadership and governance

Data to support improvement

Learning communities System redesign Provide resources Education and support

Appropriate resources Appropriately skilled and motivated healthcare workers Appropriate processes to deliver care 31

USAID Applying Science to Strengthen and Improve Systems

Four steps to improve care

STEP 1: IDENTIFY THE PROBLEM, FORM A TEAM AND WRITE AN AIM STATEMENT STEP 2: ANALYZE AND MEASURE QUALITY OF CARE STEP 3: DEVELOP AND TEST CHANGES STEP 4: SUSTAIN CHANGES

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USAID Applying Science to Strengthen and Improve Systems

Point of Care Quality Improvement

Authored by AIIMS, WHO-SEARO, USAID ASSIST

http://www.searo.who.int/entity/child_adolescent/topics/coaching-manual/en/ http://www.searo.who.int/entity/child_adolescent/topics/learner-manual/en/

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USAID Applying Science to Strengthen and Improve Systems

Start with small problems and progressively solve and move on

15 18 99 33 86 183

Number of women who deliver between cases of post partum hemorrhage

post partum hemorrhage

USAID Applying Science to Strengthen and Improve Systems

Skills Structures

QI Team and leadership

Attitudes

Humility Curiosity Optimism Collaboration

Ingredients for success

USAID Applying Science to Strengthen and Improve Systems

Perinatal deaths/1000 births Jul-Nov 2013-2015

USAID Applying Science to Strengthen and Improve Systems

How a carpenter builds a chair

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USAID Applying Science to Strengthen and Improve Systems

How a carpenter builds a chair

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USAID Applying Science to Strengthen and Improve Systems

How a carpenter builds a chair

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USAID Applying Science to Strengthen and Improve Systems

How should health services care for humans?

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USAID Applying Science to Strengthen and Improve Systems

How should health services care for humans?

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