Performance Improvement
USAID’s experience improving the quality of
care in low and middle income countries
Applying Science to Strengthen and
Improve Systems (ASSIST) Project
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Approaches to Improving Health Care Processes (Quality)
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Training
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Human resources/performance management
Well-defined interventions
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Audit & feedback
Decision aids
Educational materials
Academic detailing
Regulatory approaches: Accreditation, certification, licensing
Performance-based incentives
Proprietary approaches
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Pre-service
In-service
Standards-based Management & Recognition (SBM-R)
Client-oriented, Provider Efficient (COPE)
Continuous Quality Improvement (CQI)
Collaborative Improvement
IOM Workshop Report on Improving Quality
in LMICs
Compared 6 quality improvement (QI)
methods
Found training and supervision have
positive effects on provider performance
Found insufficient information on COPE,
SBM-R, and accreditation affecting
provider performance
Recommended expanding the body of
evidence for all 6 QI methods
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Donabedian model of a system
• The sum of all elements (including processes) that
interact together to produce a common goal
• Traditional approaches have failed to address
processes of care
Inputs
Resources
necessary to
carry out a
process
Process
A series or
sequence
through which
inputs are
transformed
into outputs
Outcomes
The outputs
(services/products)
and outcomes (health
outcomes) result
from the inputs &
processes
Salzburg Global Seminar 2016
How do we learn about improvement?
Purpose:
• Bring together thought leaders to collaborate and
identify appropriate evaluation methods for
improvement
Product:
• Develop statement to provide guidance on how we
learn about improving the quality of care
Case Book of
Improvement Stories
(Under Development)
Purpose of case book:
– Document how quality improvement interventions have been carried
out in low-resource settings
– Describe the rationale for what teams did to improve
– Describe QI implementation activities in enough detail that the reader
could carry out a similar activity
– Give decision makers and supervisors a clear understanding of
quality improvement as it was actually carried out
– Include a candid treatment of obstacles and problems
Target audience:
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Health managers
Academia
Practitioners
Host country government leaders
What we have learned from improving processes?
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Frontline providers can analyze and use data to make decisions,
not just collect and report up
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Leadership needs to be involved from the beginning and should
lead scale up
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Scaling up appears to increase cost-effectiveness compared to
the pilot phase—but more studies are needed
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Need to define roles of external assistance and jointly plan
transfer of technical assistance to host country counterparts
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Sustainability depends on making improvements/best practices a
permanent, integral part of health services