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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

Assuring Safety for Clinical Techniques and Procedures


Facilitative Supervision for Quality Improvement Curriculum


assuring safety
Assuring Safety
  • Skilled providers
  • Updated, evidence-based standards and guidelines
  • Infection prevention control
  • Appropriate supplies, equipment, and infrastructure
  • Supportive supervision
medical monitoring is
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
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
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
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
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
When and by Whom?
  • Ongoing
    • Performed regularly by on-site staff and supervisors
  • Periodically
    • Performed by onsite and off-site supervisors
supervisory system

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
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
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
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
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
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
Site Action Plan Format




By Whom?

By When?

after the supervisory visit off site supervisors
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
Off-Site Supervisor’s Action Plan Format



Resources Needed




exercise using checklists for medical monitoring
Exercise: Using Checklists for Medical Monitoring

Group A: CounselingGroup B: Infection preventionGroup C: Facility audit

guiding principles for supervisors
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
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
The QI Process

Information gathering

and analysis



Action plan development

and prioritization


planning for action 1
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
Planning for Action (2)

System (Headquarters/



Consolidated Quality/

PerformanceImprovement Plans


Performance Improvement