Post on 03-Feb-2016
description
Partnership Defined Quality: an Overview
November 18, 2009Beth Outterson, Director, Adolescent Health
Save the Children
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By The End of this session, participants will be able to: Describe the PDQ methodology
Know when and how PDQ can be used to strengthen quality and access to services
Know how to plan and design a program that incorporates the PDQ methodology
Be familiar with lessons learned from PDQ projects
Know how to evaluate the PDQ process and its outcomes
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Partnership Defined QualityPartnership Defined Quality
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“Go in search of Your People
Love them, learn from themPlan with them, serve them;Begin with what they have;Build on what they know.But of the best leaders,When their task is accomplished,Their work is done,The People all remark:‘We have done it ourselves’”
Lao Tzu
Ancient Chinese Proverb
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A methodology to improve quality and accessibility of services with greater involvement of the community in
defining,
implementing and
monitoring
the quality improvement process.
What is PDQ?
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There is an actual partnership between users and nonusers of the community AND health care providers.
This collaboration promotes improved communication and empowerment for problem solving using locally available resources
How is it different from other quality improvement methods?
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When use PDQ?
When action is needed not just information.
When both providers and community want change.
When there is a willingness to be flexible.
When use PDQ?
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When?
When there is support from key stakeholders.
When there is enough time to properly implement process.
When Use PDQ?
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PDQ can be a complementary strategy to other QI. Usually embedded within larger projects
Creation of Quality Improvement Teams (QITs)
Emphasis on mutual responsibility for problem identification and problem solving
Features of PDQ of PDQFeatures of PDQ
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Value Added of PDQ
Beyond Quality Improvement…
Helps eliminate social and cultural
barriers to better health
Strengthens community’s capacity to
improve health
Creates mechanism for rapid mobilization
around health priorities
Value Added of PDQ
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PDQ ProcessBUILDING SUPPORT
WORKING IN PARTNERSHIP FOR
QUALITY IMPROVEMENT
COMMUNITYDEFINEDQUALITY
HEALTH WORKERDEFINED QUALITY
Better Health
Improve provider job satisfaction
Improve client satisfaction
Increase communities’ sense of ownership of health facility
Increase community capacity for social change
Shared rights and responsibilities for better health outcomes
BRIDGING THE GAP
Pre-phase: Planning and Design
Make sure you have willingness of stakeholders
Need adequate dedicated staff and volunteers
Need people with skills in facilitation, community mobilization, PRA techniques, focus group methodology, monitoring and evaluation
Pre-program: Planning and Design
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Develop the support necessary to implement the PDQ process from the health system and the communities involved.
Phase 1: Building Support
Meet with stakeholders and influentials
Need willingness by providers to make changes
Need management support of changes
Phase 1: Building Support
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FGDs to explore perceptions of quality from service providers, those that use health services, and those that never or no longer use them (FGD for each subgroup)
Use market analogy to help define health “quality”
Phase 2: Exploring Quality
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The “community” may vary
Explores quality from previous experience
Initiates rights discussion
CDQ –Community Defined Quality
CDQ –Community Defined Quality
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Explores “what is in it for me”
Allows all levels of providers to have a voice
HDQ- Health Worker Defined Quality
HDQ- Health Worker Defined Quality
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Phase 3: Bridging the Gap
Provides and understanding of the varying perspectives of quality and integrates those perspectives into a shared vision of quality.
Together groups hear each others views
Can validate what was presented
Establishes a QI Team
Phase 3: Bridging the Gap
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A quality improvement team comprised of providers and community determine causes, solutions and create a joint plan of action.
Phase 4: Working in Partnership
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Examples:
PUENTES - Peru PDQ – Nepal PDQ – West Bank and Gaza
PDQ in Peru: Puentes
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Explores “what is in it for me”
Allows all levels of providers to have a voice
HDQ- Health Worker Defined QualityPDQ in Action
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Despite having a “quality” facility, community members were not utilizing services
The Problem
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Innovating PDQ
Videos produced and shared among community members and health center personnel
Developed action plans together for improving quality Jointly implemented &
evaluated project activities
Innovating PDQ
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Results MOH and community members report
increasing utilization of health services
Joint committees coordinate, monitor and document activities
Tangible results include: expanded hours of service additional resources (human and physical) community participation in improving health
centers
Results
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Why PDQ for Nepal?
Centralized QI effort based on national standards had not reached peripheral facilities
Low utilization rates even after 6 years of health service strengthening
Need to reach the minority groups and other non-users of the Health Facilities
Despite training and QI efforts, improvements were not sustained at the local health posts
Why PDQ for Nepal?
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Significant Results
Increase in sick children seeking treatment
Increase in service utilization by adults
Increase in FP utilization
Increase in appropriate infection prevention
Increase in health worker presence
Increase in service utilization from lower caste children
Significant Results
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PDQ in West Bank and Gaza
THE PROBLEM:
Facilities were over service capacity, there was wasted resources and antibiotics were over prescribed.
PDQ in West Bank and Gaza
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Results
Decrease in waiting time.
Greater client satisfaction with services
Lower use of antibiotics
Results
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PDQ: Challenges
Time commitment from the participants
Maintaining political will
Gaining true community representation and participation at all levels
Keeping the process flexible to meet local needs
Replication and scaling up
Challenges
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PDQ: Lessons Learned
Does not require huge investment of additional resources when built into existing system improvement efforts
PDQ can be a catalyst for other initiatives
Dialogue often yields solutions – e.g. allows misconceptions to be clarified
Skilled and impartial facilitators are essential
Lessons Learned
Partnership Defined Quality for Youth: a process manual for improving RH services through youth-provider collaboration
Differences in PDQ-Y manual
Socio dramas and mapping instead of FGDs PRA and Games Stronger M and E components More country level examples Youth-Adult Partnership skill-building
sessions included
How is PDQ-Y Different?
Next Steps for SC
Seeking funds for case-control studies to measure impact of PDQ and PDQ for youth
Measure community capacity with CC indicators now in M and E toolkit
Improve and populate documentation database
Build regional PDQ expertise
Next Steps for SC
Ideas for discussion: PC can link with existing SC PDQ
implementation efforts; and consider new ones
PCVs can co-facilitate PDQ process, especially by monitoring QIT meetings, train QIT for improved function, and completion of action plans
PCVs can document, evaluate and disseminate
How can PC and SC work together on PDQ and PDQ (Y)?
Resources
11 PDQ Monographs PDQ M and E Toolkit - December 2009 PDQ Technical Advisory Group includes
trainers and PDQ experts Recent PDQ/PDQ-Y experience includes:
Bolivia (Y), Pakistan (MNCH), Kenya (AMREF), Indonesia, Philippines (SHN), Burkina Faso (Nutrition 2010), Guatemala (FP), Vietnam (MNCH), Armenia (MCH), Nepal (Y), Ethiopia (Y), Republic of Georgia (Y)
Resources
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Resources (cont’d)
PDQ Manual: http://www.savethechildren.org/publications/programs/health/PDQ-Manual-Updated-Nigeria.pdf
PDQ for Youth Manual: http://www.savethechildren.org/publications/programs/health/PDQ-Y-Manual.pdf
PDQ Facilitator's Guide http://www.coregroup.org/diffusion/Save_PDQ_Facil_Guide.pdf
Resources (cont’d)
THANK YOU!!