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TECHNICAL REFERENCE MATERIALS 2014 · PDF file 2017. 12. 7. · QA Quality assurance . QAP Quality Assurance Project . QI Quality improvement . TRM Technical reference material . UNICEF

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  • UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT

    BUREAU FOR GLOBAL HEALTH

    OFFICE OF HEALTH, INFECTIOUS DISEASES AND NUTRITION

    & OFFICE OF HEALTH SYSTEMS

    CHILD SURVIVAL AND HEALTH GRANTS PROGRAM

    TECHNICAL REFERENCE MATERIALS

    2014

    QUALITY IMPROVEMENT

  • USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 i

    Acknowledgements This Technical Reference Material on Quality Improvement was prepared by the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project for the Child Survival and Health Grants Program. The USAID ASSIST Project is made possible by the generous support of the American people and is managed by University Research Co., LLC (URC) under the terms of Cooperative Agreement Number AID-OAA-A-12-00101. URC’s global partners on USAID ASSIST include EnCompass LLC, FHI 360, Harvard University School of Public Health, HEALTHQUAL International, Institute for Healthcare Improvement, Initiatives Inc., Johns Hopkins University Center for Communication Programs, and Women Influencing Health Education and Rule of Law, LLC. For more information on the work of the USAID ASSIST Project, please visit www.usaidassist.org or write [email protected] This Technical Reference Material on Quality Improvement was coordinated and published by the Maternal and Child Health Integrated Program. The Maternal and Child Health Integrated Program (MCHIP) is funded by the United States Agency for International Development, Bureau for Global Health’s Office of Health, Infectious Diseases and Nutrition (USAID/GH/HIDN), Cooperative Agreement #GHS-A-00-08-00002-000. For further information on MCHIP, please contact: ICF International, 530 Gaither Road, Rockville, MD 20850, USA. Email: [email protected]; Internet: www.mchipngo.net Recommended citation: USAID Applying Science to Strengthen and Improve Systems Project. 2014. Quality Improvement. Technical Reference Material. Published by the Maternal and Child Health Integrated Program for USAID.

    DISCLAIMER The contents of this report are the sole responsibility of the USAID Applying Science to Strengthen and Improve Systems Project and do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

    http://www.usaidassist.org/ mailto:[email protected] mailto:[email protected] http://www.mchipngo.net/

  • USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 ii

    TABLE OF CONTENTS ABBREVIATIONS AND ACRONYMS ..................................................................................................................... iii INTRODUCTION TO THE TECHNICAL REFERENCE MATERIALS ............................................................................... 1 INTRODUCTION ............................................................................................................................................... 2 1. WHY QUALITY? ............................................................................................................................................ 2

    1.1 THE QUALITY GAP ............................................................................................................................ 2 1.2 QUALITY IS A FUNCTION OF THE HEALTH SYSTEM .............................................................................. 3 1.3 WHAT DO WE MEAN BY QUALITY IN HEALTH CARE? ........................................................................... 3

    2. HOW DO WE IMPROVE QUALITY?.................................................................................................................. 6 2.1 A MODEL FOR IMPROVEMENT .......................................................................................................... 6 2.2 INTEGRATING EVIDENCE-BASED PRACTICES INTO CARE PROCESSES..................................................... 8 2.3 IMPROVING HEALTH SERVICES AT THE COMMUNITY LEVEL ................................................................ 8 2.4 MAJOR IMPROVEMENT APPROACHES ............................................................................................... 9

    2.4.1 AUDIT AND FEEDBACK ................................................................................................................ 10 2.4.2 SUPERVISION ............................................................................................................................. 11 2.4.3 PROCESS IMPROVEMENT, DESIGN AND REDESIGN ....................................................................... 12 2.4.4 COLLABORATIVE IMPROVEMENT ..................................................................................................... 14 2.4.5 ORGANIZATION OF WORK .......................................................................................................... 16 2.4.6 REMINDERS ............................................................................................................................... 18 2.4.7 STANDARDS AND EVIDENCE-BASED GUIDELINES .......................................................................... 19 2.4.8 REGULATORY APPROACHES ........................................................................................................ 21 2.4.9 PERFORMANCE-BASED INCENTIVES............................................................................................. 23

    3. MEASURING QUALITY TO DRIVE IMPROVEMENT .......................................................................................... 24 3.1 WHY IS MEASUREMENT IMPORTANT? ............................................................................................. 24 3.2 MEASUREMENT METHODS ............................................................................................................. 24 3.3 DEFINING QUALITY INDICATORS ..................................................................................................... 27

    4. CONCLUSION ............................................................................................................................................. 29 HYPERLINK REFERENCES ................................................................................................................................. 31 REFERENCES .................................................................................................................................................. 32

  • USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 iii

    ABBREVIATIONS AND ACRONYMS AIDS Acquired immunodeficiency syndrome

    ANC Antenatal care

    ASSIST USAID Applying Sciences to Strengthen and Improve Systems

    BTS Breakthrough Series

    CME Continuing medical education

    HCI USAID Health Care Improvement Project

    HIV Human immunodeficiency virus

    HMIS Health management information systems

    iCCM Integrated community case management

    IHI Institute for Healthcare Improvement

    IMCI Integrated management of childhood illness

    LMIC Low- and middle-income country

    MCHIP Maternal and Child Health Integrated Program

    MDGs Millennium Development Goals

    MOH Ministry of Health

    PBI Performance-based incentives

    PDQ Partnership Defined Quality

    PDSA Plan-do-study-act

    PEPFAR U.S. President’s Emergency Plan for AIDS Relief

    QA Quality assurance

    QAP Quality Assurance Project

    QI Quality improvement

    TRM Technical reference material

    UNICEF United Nations Children's Fund

    USAID United States Agency for International Development

    WHO World Health Organization

  • USAID/GH/HIDN/Child Survival and Health Grants Program—TRM—QUALITY IMPROVEMENT —2014 1

    INTRODUCTION TO THE TECHNICAL REFERENCE MATERIALS The Technical Reference Materials (TRMs), products of the United States Agency for International Development, Bureau for Global Health, Office of Health, Infectious Diseases, and Nutrition (USAID/GH/HIDN), are a series of guides to help program planners and implementers consider the many elements in a particular technical area of the Child Survival and Health Grants Program (CSHGP). These guides are not an official policy for practice; rather, they are basic everyday summaries to be used as field reference documents. They also may be accessed in the form of electronic toolkits on the Knowledge for Health website.

    The TRMs are organized in modules that correspond to the primary interventions and key strategies that are central to CSHGP. Each module covers the essential elements that need to be considered during implementation, resources for nongovernmental organizations (NGOs) and others implementing community-oriented programs to consult when planning interventions, and examples of tools most commonly used among CSHGP grantees to collect baseline population- level data.

    The TRM modules cover the following topics:

    Technical specialists in the USAID Collaborating Agency community, CORE Group Working Groups, USAID technical staff, and community-oriented practitioners all contribute to updating the TRMs on an ongoing basis. The revision date for each TRM module is at the bottom of each page. The modules are living documents, and we depend on readers to tell us of the usefulness of the information, the need for additions or amendments, and general comments. This feedback will help us keep the modules alive and responsive to readers’ needs. Please share comments with the Maternal and

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