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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

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Assuring Safety for Clinical Techniques and Procedures

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Assuring Safety for Clinical Techniques and Procedures


Facilitative Supervision for Quality Improvement Curriculum


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 READINESSand 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


supervisors and staff

Facility level

Department or ward level




National/central level

Regional/area level

State/district level

Peers (supervisors)

Supervisory System

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

  • Review the site’s and the last supervisory visit’s report and action plans.

  • Review previous agreements and a list of recommendations from the last supervisory visit.

  • Communicate with the facility the date of the visit, the purpose of the visit, and the planned activities.

  • Develop and agree on an agenda.

Supervisory Visits: During the Visit

  • Meet with staff and on-site supervisors

  • Follow-up on previous visits and action plans

  • Observe services and audit the facility

  • Review records

  • Provide constructive feedback

  • Provide on-the-spot technical assistance and coaching

  • Teach the staff to conduct self-assessment activities and to use the results

Supervisory Visits: During the Visit (2)

  • Update staff on changes in national standards

  • Recognize achievements and motivate staff

  • Discuss findings with the staff and record them in the site’s supervision notebook

  • Help to develop solutions

  • Help staff to identify external resources

  • Agree on follow-up

Site Action Plan Format




By Whom?

By When?

After the Supervisory Visit: Off-Site Supervisors

  • Write a report and send a copy to the site.

  • Integrate the findings into the off-site supervisor’s ongoing action plan.

  • Follow up with the site on implementation of a site’s plan.

  • Provide assistance with problems that the site’s staff cannot solve on their own, by following up with district/ regional/national levels, as needed.

  • Evaluate the quality of services provided by a site.

  • Plan and conduct follow-up visits.

Off-Site Supervisor’s Action Plan Format



Resources Needed




Exercise: Using Checklists for Medical Monitoring

Group A: CounselingGroup B: Infection preventionGroup 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 development

and prioritization


Planning for Action (1)


COPE® Action Plan


Performance Improvement


Site Training Plan

Medical Monitoring Plan

Community Action Plan

Cost Analysis Plan

The QMT Plan

Off-Site Supervisor’s Pre-Visit Plan

Off-SiteSupervisor’s Input

Planning for Action (2)

System (Headquarters/



Consolidated Quality/

PerformanceImprovement Plans


Performance Improvement


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