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Assuring Safety for Clinical Techniques and
Procedures
MODULE 5
Facilitative Supervision for Quality Improvement Curriculum
2008
Assuring Safety
Skilled providers
Updated, evidence-based standards and guidelines
Infection prevention control
Appropriate supplies, equipment, and infrastructure
Supportive supervision
Medical Monitoring Is:
A medical QI intervention that entails the objective and ongoing assessment of the READINESS and the PROCESSES of service delivery.
Conducted to identify gaps between actual practice and clinical standards, and leads to recommendations for improvement.
Exercise: Work in Four Groups
Groups 1 & 3: What do you usually do to assess readiness? What tools do you use?
Groups 2 & 4: What do you usually do to assess processes and procedures? What tools do you use?
Assessing Readiness of Care
Staffing
Facility, infrastructure
Equipment, instruments and supplies
Essential drugs and contraceptives
Range of available services
Functioning support systems
Functioning referral system
Assessing Processes of Care (1)
Observation of services and procedures– Medical techniques– Clinical examinations and procedures– Ensuring informed and voluntary decision making– Client-provider interaction
• Counseling
– Infection prevention
Client interviews
Staff interviews
Self, peer, and supervisor assessment
Assessing Processes of Care (2)
Data collection systems– Analysis of relevant medical data and reports – Management information systems– Use of data for decision making
Linkages to other services– Within the site– To other health sites/institutions– To clinical and nonclinical trainers– To headquarters
When and by Whom?
Ongoing– Performed regularly by on-site
staff and supervisors
Periodically– Performed by onsite and off-site
supervisors
Supervisory System
On-sitesupervisors and staff
Facility level
Department or ward level
Peers
Off-sitesupervisors
National/central level
Regional/area level
State/district level
Peers (supervisors)
Medical Monitoring Tools
Used by on-site and off-site supervisors and staff
Checklists for– Observation of services/procedures– Record review– Facility audit– Assessment of provider knowledge and skills
Client and staff interview guides
Supervisory Visits: Exercise
Small Group Work (10 minutes): Discuss the assigned question with your group, record the results on a sheet of flipchart paper, and present the results to the entire group
Group 1: What should an off-site supervisor do before the supervisory visit?
Group 2: What should an off-site supervisor do during the supervisory visit?
Group 3: What should an off-site supervisor do after the supervisory visit?
Supervisory Visits: Before the Visit
1. Review the site’s and the last supervisory visit’s report and action plans.
2. Review previous agreements and a list of recommendations from the last supervisory visit.
3. Communicate with the facility the date of the visit, the purpose of the visit, and the planned activities.
4. Develop and agree on an agenda.
Supervisory Visits: During the Visit
1. Meet with staff and on-site supervisors
2. Follow-up on previous visits and action plans
3. Observe services and audit the facility
4. Review records
5. Provide constructive feedback
6. Provide on-the-spot technical assistance and coaching
7. Teach the staff to conduct self-assessment activities and to use the results
Supervisory Visits: During the Visit (2)
8. Update staff on changes in national standards
9. Recognize achievements and motivate staff
9. Discuss findings with the staff and record them in the site’s supervision notebook
10. Help to develop solutions
11. Help staff to identify external resources
12. Agree on follow-up
Site Action Plan Format
Problem Cause(s) RecommendationsBy
Whom?By
When?
After the Supervisory Visit: Off-Site Supervisors
1. Write a report and send a copy to the site.
2. Integrate the findings into the off-site supervisor’s ongoing action plan.
3. Follow up with the site on implementation of a site’s plan.
4. Provide assistance with problems that the site’s staff cannot solve on their own, by following up with district/ regional/national levels, as needed.
5. Evaluate the quality of services provided by a site.
6. Plan and conduct follow-up visits.
Off-Site Supervisor’s Action Plan Format
ProblemAction/
Resources NeededTimeframe Follow-up Notes
Exercise: Using Checklists for Medical Monitoring
Group A: Counseling
Group B: Infection prevention
Group C: Facility audit
Guiding Principles for Supervisors
Be Facilitative Work as a team member to model FS
Talk and listen to all levels of staff
Recognize jobs well done
Solve problems on the spot, when possible
Provide feedback in a constructive way
Involve staff in decision-making process– Never criticize staff in front of a client or other staff
Supervisors Should Promote:
Creating a mechanism for ongoing quality assurance Encouraging self- and peer-assessment by site staff Strengthening on-site medical monitoring
mechanisms to improve quality of services and to ensure the fundamentals of care
Following up on the site’s action plan and providing support
Analyzing relevant medical data and reports for service improvement
Strengthening support systems involved in health care provision: supervision, training, finance, human resources, logistics, and monitoring and evaluation
The QI Process
Information gathering and analysis
Action plan developmentand prioritization
Implementation
Follow-up/evaluation
Planning for Action (1)
ConsolidatedSite
Quality/Performance
Improvement Plan
Site Training Plan
Off-SiteSupervisor’s Input
Community Action Plan
COPE® Action Plan
Cost Analysis Plan
Medical Monitoring Plan
Off-Site Supervisor’s Pre-Visit Plan
The QMT Plan
InformationGathering
Planning for Action (2)
ConsolidatedSite
Quality/Performance
Improvement Plan
System (Headquarters/
Region/District)
Consolidated Quality/
PerformanceImprovement
Plans