improving health care - who
TRANSCRIPT
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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
5
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
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USAID Applying Science to Strengthen and Improve Systems
50% reduction in maternal and newborn death
Provider-patient interaction
Financial strategies
$$
Leadership and governance
Data to support
improvement
Learning communities
System redesignProvide resources
Education and support
Appropriate resources
Appropriately skilled and motivated
healthcare workers
Appropriate processes to deliver
care
8
USAID Applying Science to Strengthen and Improve Systems
50% reduction in maternal and newborn death
Provider-patient interaction
Engaging women, families, and communities in their care
Financial strategies
$$
Leadership and governance
Data to support
improvement
Learning communities
System redesignProvide resources
Education and support
Appropriate resources
Appropriately skilled and motivated
healthcare workers
Appropriate processes to deliver
care
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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
10
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 resourcesAppropriate 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
15
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
17
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
19
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
0
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
0
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 Systems24
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 Systems25
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 Systems26
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 Systems27
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 Systems28
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…
0
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%)
0
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
30
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 redesignProvide 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 ImprovementAuthored 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
StructuresQI 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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