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Leadership Skills to Support Improvement – An Interactive Workshop for Global Health Leaders

Leadership Skills to Support Improvement – An Interactive Workshop for Global Health Leaders. M. Rashad Massoud, MD, MPH, FACP Maina Boucar, MD, MPH USAID Applying Science to Strengthen and Improve Systems Project University Research Co. LLC. No conflict of interests. Goal.

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Leadership Skills to Support Improvement – An Interactive Workshop for Global Health Leaders

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  1. Leadership Skills to Support Improvement – An Interactive Workshop for Global Health Leaders M. Rashad Massoud, MD, MPH, FACP Maina Boucar, MD, MPH USAID Applying Science to Strengthen and Improve Systems Project University Research Co. LLC

  2. No conflict of interests

  3. Goal This full day workshop is designed for leaders to be able to support improvement in their facilities.

  4. Objectives: After this session, participants will be able to: • Set improvement priorities in their facilities • Form improvement teams in their facilities • Support their teams through the improvement process • Discuss how to be a sponsor for improvement teams in their hospital

  5. Section 1: Supporting Improvement as a Leader

  6. Team Roles and Responsibility Team Member: People who share their knowledge, experience, and expertise while working to accomplish team goals Improvement Team Leaders: People who orchestrate team activities, maintain team records and serve as communication link Coaches: People with improvement, data-analysis and team-building skills who teach and support Team Leaders and Team members Leader: Individual managers who identify needed improvements, and review and support the work of teams 6

  7. The Leader: At district and/or National levels Maintains overall responsibility, authority, and accountability Selects and defines improvement project Determines resources Selects Coach, Team Leader and Team Members Reviews progress for the team when necessary Ensures stakeholders have appropriate involvement in the project and project reviews Ensures changes made by the team are monitored and implements changes that the team is not authorized to make Feeds data and lessons learned into system for future improvements 7

  8. Leader Responsibilities Before the Project Select and define project Make team charter clear Select the Coach Select the Team Leader Select Team Members Provide resources 8

  9. Leader Responsibilities During the Project Orient the team Represent team interests to the rest of the organization Review team progress 9

  10. Leader Responsibilities After the Project Communicate the team’s results Ensure that changes made by the team are integrated into daily work Thank and celebrate the project’s conclusion 10

  11. Improvement Team Leader Team Member Coach Leader 11

  12. Question for Discussion? What is your role as a leader in supporting your teams to improve the process and test and implement changes?

  13. Section 2: Prioritization

  14. Quality Improvement Methodology Adapted from: T. Nolan et. al. The Quality Improvement Guide 14

  15. Discussion Questions Why do we need to prioritize? How do we prioritize?

  16. Why do we need to prioritize? We cannot do everything Not everything is equally as important Choose focus area 16

  17. How do we prioritize? • Political • Cultural • Technology • Demographics 17

  18. Prioritization for Improvement Depending on the scale, topics can comefrom: • Existing NHS/MOH/MOPH priorities • Data (ex: existing reports, baseline assessment studies) that show were need is greatest • Priorities recognized by donors and funders • Patients, staff, practitioners, communities, other stakeholders 18

  19. Question for Discussion What is your role as a leader in setting priorities?

  20. Section 3: Define the Improvement Aim

  21. Quality Improvement Methodology Adapted from: T. Nolan et. al. The Quality Improvement Guide 21

  22. A Good Aim Statement Has: • A defined boundary that specifies the scope of the improvement goal • Specific numerical goalsfor outcomes that are ambitious but achievable • A timeframe (how much improvement by when?) • Guidance on how the aim will be achieved 22

  23. Case Study: Example of an Aim Statement Identifies the: • Outcome • Core Process • Methods • Timeframe 23

  24. Discussion: Is this a Good Aim Statement? • In our clinic, we will reduce post-partum hemorrhage rates among women delivering at our clinic by 50% within 12 months through the application of AMTSL. Boundary: Numerical goals for outcomes: Timeframe: Guidance:

  25. Discussion: Is this a Good Aim Statement? • Our clinic will provide ART for 90% of the estimated 2500 ART eligible patients in our catchment area, • Retain 95% of patients started and expected to continue on ART, • Achieve good clinical outcomes for 95% of patients retrained on ART, • These targets will be achieved by the end of 18 months. Boundary: Numerical goals for outcomes: Timeframe: Guidance:

  26. Question for Discussion What is your role as a leader in defining your improvement aims?

  27. Section 4: Forming the Quality Improvement Team

  28. Quality Improvement Methodology Adapted from: T. Nolan et. al. The Quality Improvement Guide 28

  29. Why is Teamwork Important for Improvement? • Healthcare processes consist of inter-dependent steps that are executed by different people • Quality faults often occur in the hand-over between people • Given the opportunity, staff can often identify problems and generate ideas to resolve them. • Participation improves ideas, increases buy-in, and reduces resistance to change. • Accomplishing things together increases the confidence of each team member, which empowers organizations. 29

  30. Patient Arrives Registration Take Temperature Doctor’s Exam Collect Tests Specialists Exam Patient Leaves Patient Receptionist Nurse Physician Lab technician Specialist Patient Teamwork Steps and participants in a patient visit to the clinic 30

  31. Exercise: Form Your Improvement Team Using your workbook: 1) Referring back to the aim statement, consider the process that you want to improve. • Think of those responsible for each step in that process. A representative of each function should be on your improvement team. • Think about who else would be important to include on your improvement team, such as: management, practitioners, patients or groups representing patients, or other people involved in the system of care. In group discussions at your table, discuss who you should have on your team. 31

  32. Question for Discussion? What is your role as a leader in forming the improvement team?

  33. Section 5: Understanding the Current System

  34. Quality Improvement Methodology Adapted from: T. Nolan et. al. The Quality Improvement Guide 34

  35. Quality Improvement Methodology STEP 2. Analyze the problem • Understand the process(es)/ system that yield this aim for improvement • Determine the indicators which enable us to know that we have made the improvement we are seeking • Analyze the available data and information • Collect additional data (as needed) 35

  36. Understanding Work as Processes and Systems Process: a sequence of steps through which inputs from suppliers are converted into outputs for customers. System: the sum of all the total elements (including processes) that interact together to produce a common goal. 36

  37. How to Create a Process Flowchart • Decide on the beginning and end points of the process to be flowcharted • Identify the steps of the process • Link the steps with arrows showing direction • Review the draft to see whether the steps are in their logical order 37

  38. How to Create a Process Flowchart:Symbols of a flow chart Document Storage Flow lines Connector a Begin or End Step Decision Delay Cloud (unclear step) 38

  39. How to Create a Process Flowchart:Flow lines One flow line out of a step Step Two flow lines out of a decision Must ask a yes / no question YES Decision NO 39

  40. Example: Process for prescribing antibiotics in surgery before changes Patient arrives at the hospital No No Ambulatory care Surgeon’s consultation Emergency state Waiting Yes Yes Hospitalization for Surgical procedure Deliver emergency care Doctor Delivering emergency care prescribes Antibiotics Surgeon Prescribes antibiotics on His recommendation No No No Surgeon prescribes antibiotics No antibiotic prescribed Yes Yes Yes Specialist prescribes antibiotic Doctor Delivering emergency care prescribes Antibiotics Antibiotics prescribed by surgeon are put in the procedure list for the doctor delivering emergency care Surgeon prescribes antibiotics 40 Ministry of Health, Palestine

  41. Section 6: Indicators and Measurement

  42. Quality Improvement Methodology Adapted from: T. Nolan et. al. The Quality Improvement Guide 42

  43. Why Measure? • If you don’t measure, what you are doing, how will you know if it is an improvement? • If you don’t measure, how will you know what led to the improvement? Ask: What is the minimum amount of measurement that you need in order to answer these questions? 43

  44. How Measurement Should Work: Should be linked to aims Should be used to guide improvement and test changes Should be integrated into the team’s daily routine. Will allow QI teams to learn Should concentrate on keymeasures—don’t overwhelm teams with endless data collection and analysis! 44

  45. Types of Indicators Patient arrives Short-Term Result Long-Term Result Patient moves through system OutputIndicators OutcomeIndicators Input Indicators Process Indicators # of staff trained in neonatal resuscitation # of resuscitations done % compliance with resuscitation guidelines Proportion of neonates arriving to NICU with hypothermia Proportion of neonates alive on 7th day after initial resuscitation Reduction in neonatal mortality 45

  46. Qualities of a Good Indicator • Clear and unambiguous (teams will not confuse what is meant by the indicator) • Quantifiable • Identifies the source of the data and the person responsible for collecting it • Identifies a clear numerator and denominator • Identifies the frequency with which the data should be collected 46

  47. Questions for Discussion? What is your role as a leader in defining indicators and measurement? 47

  48. Section 7: The Time Series Plot

  49. Quality Improvement Methodology Adapted from: T. Nolan et. al. The Quality Improvement Guide 49

  50. Elements of a Time Series Chart Clear and well-defined title that includes what is being shown, where the data is from and when it occurred X and Y axes have clear scale and include indicator label Tested changes are annotated Numerator and denominator values shown for each month Numerator defined, including data source and sampling strategy Denominator defined, including data source and sampling strategy 50

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