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