Achieving scale up in healthcare quality provision: Case study from Ghana Nneka Mobisson-Etuk Institute for Healthcare Improvement (IHI)

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Alan Silvester Rodgers
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Fostering Quality and Quality Improvement (QI) in the

International AIDS Conference (AIDS 2014) Melbourne,

healthcare quality provision: Case study from Ghana

1 Fostering Quality and Quality Improvement (QI) in the Context of HIV Scale Up Pre-meeting to the 20 th International AIDS Conference (AIDS 2014) Melbourne, Australia July 18-19, 2014 Achieving scale up in healthcare quality provision: Case study from Ghana Nneka Mobisson-Etuk Institute for Healthcare Improvement (IHI)

ACCELERATING GHANA S EFFORTS TO REDUCE U5 MORTALITY BY 66% IN 5 YEARS

and with greater impact than other methods?

faith-based network to anchor and spread the initiative?

the gains after external support is withdrawn?

2 ACCELERATING GHANA S EFFORTS TO REDUCE U5 MORTALITY BY 66% IN 5 YEARS Design Questions: To achieve the Aim Does QI lead to faster improvement and with greater impact than other methods? Can you spread the project across all of Ghana in 5 years Can you use a faith-based network to anchor and spread the initiative? Can you build sufficient internal capacity and capability to sustain the gains after external support is withdrawn? Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in

3 THE ENGINE FOR CHANGE Will Ideas Execution Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in

4 THEORY OF CHANGE Outcome 1 o Drivers 2 o Drivers Process Measures Reducing Under 5 Deaths in NCHS Hospitals Delay in Seeking Care Delay in Providing Care Unreliable use of Protocols Mobilizing Community Cultural Barriers Financial Barriers Referral from 1 o facility Attractiveness of services Knowledge of 1 o caregiver Emergency response Syst. Outpatient services Staff Issues Admission Process Staff Knowledge and Skills Data Systems to feedback perf. Availability of Drugs, supplies and equipment Access to Protocols Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in Average time of 1st encounter with hospital after onset of symptoms for children U5 Average cervical dilatation of women in labour arriving at Hospital Average Time critically ill U5 identified in hospital to time first treatment is commenced Average Time spent by woman in labor from registration until assessment by midwife or doctor Average stock out for antimalarial, blood and oxygen Percentage adherence to selected protocols

5 DESIGN: PHASED RAPID SCALE UP, LARGE LOCAL NGO PARTNER, PROGRESSIVE MOH ENGAGEMENT Project staff:

6 INNOVATIONS IN INTEGRATED SOLUTIONS Improvement teams that bring together community leaders and health facilities

7 JAN '09 MAR '09 MAY '09 JUL '09 SEP '09 NOV '09 JAN '10 MAR '10 MAY '10 JUL '10 SEP '10 NOV '10 JAN. '11 MAR. '11 MAY '11 JUL. '11 SEPT. '11 NOV. '11 JAN. '12 MAR. '12 WORKING AT MULTIPLE LEVELS OF THE HEALTH SY STEM C Chart Showing diagnosis of malnutrition at the Child Welfare Clinic: Jan 09 Jan &3 4& Training for doctor 3. Radio education 4. 2 nd Training of nurses 5 Intensified radio education 2. 1 st Training for nurses 1.Training for doctors 2. 1 st Training for nurses 3. Radio education 4. 2 nd Training of nurses 5. Intensified radio education 6. Radio education

8 Mortality rate (per 1000 admissions) CALCULATION OF LIVES SAVED IN 9 HOSPITALS SEPT 09 TO DEC 12 Start of QI intervention Lives saved U5 deaths Sept 09 Dec 12 Predicted: 3451 Actual: 2880 Est. lives saved: 571

9 WHAT DOES IT TAKE TO SCALE-UP? Locate Will (align interests, find early adopters, build off existing programs) Develop the Scalable Unit (find, test and assemble implementation ideas) Use change package and understand how to achieve success at scale Spread over broad geographic region and embed into existing system Set-up Prototyping Scale-up Spread & Sustain

GOING TO FULL SCALE: CHALLENGES Phase 4: National Scale up 1800 facilities Maintaining the pace of improvement during scale up with increasing reliance on MoH.

10 GOING TO FULL SCALE: CHALLENGES Phase 4: National Scale up 1800 facilities Maintaining the pace of improvement during scale up with increasing reliance on MoH. Working at the pace and with priorities of the MoH Resolving conflicting demands for MoH time selling QI as a routine way of undertaking health care (not added) Building sufficient systems capacity for QI implementation Attribution of success (what else is leading to improvement?) Uneven progress (geography, neonatal mortality)

11 Pre-meeting to the 20th International AIDS Conference (AIDS2014) HIV and Health Systems: Fostering Quality and Quality Improvement (QI) in

IMPROVEMENT COLLABORATIVE REPORT January 1, 2011 to August 31, 2011

IMPROVEMENT COLLABORATIVE REPORT January 1, 2011 to August 31, 2011 Table of Contents Page No. Introduction 1 Project Design 1 Implementation Highlights 1 Wave 2 Northern Sector 2 Wave 3 Southern Sector