Performance Based Financing at Hospital - Performance Management for Continuous Improvement

1. Performance Based Financing at Hospital- Performance Management for Continuous Improvement July 12, 2013 Shun Mabuchi

2. 6 monthly counter verification Success of the project hinges on whether we can establish robust performance management systems for continuous improvement Initial investment funds Quality Improvement activities Quarterly quality assessment Business/ Operational Plan Performance management System • Clear set of performance indicators • Robust data collection and verification system • Rigorous review of performance data and use for planning 3 month Operational Plan Performance bonus 1

3. Building multiple levels of accountability and performance management system is critical • Overall oversight of performance trend and project implementation • Resolve project-level issues Technical Committee • Provide oversight to hospital management • Make SMT accountable for results and implementation of business plan • Community involvement and grievance Hospital Board • Develop business plan with supervisors • Hold supervisors accountable for quality indicators • (At least ) monthly performance review with QI team • Support QI team implement their plans Senior manage- ment Team Hospital QI team • Responsible for improving specific quality indicators • Carry out weekly/monthly self-quality assessments and track results at each ward • Provide feedbacks, coach and train health workers

4. Sample activities of Maternity QI team and LMDC coach Areas Responsible Example of Activities • Waste disposal • Use of patograph • Delivery room maintenance • Basic supplies • Monthly self-assessment using checklist and feedback ward/SMT • Plan, support and monitor specific activities of health workers (e.g., supplies tracking, waste disposal) Management and structural checklist QI team will motivate health workers to improve key indicators through tracking and coaching (1/2) • Obstructed labor • PPH • Sepsis • Eclampsia • Weekly chart review, scores on wall, feedback to health workers • Training to health workers • Checklist on wall, attached to chart Process of care checklist • Complicated and assisted delivery Normal deliveries of at risk referrals • Training • Ensure home address of patients in the register • Monthly recording to invoice • Put monthly numbers on a wall • Plan training with faculties Quantity Checklist 3

5. Self-Assessment Tracking and Feedback 1 2 QI team will motivate health workers to improve key indicators through tracking and coaching (2/2) • Weekly/daily chart review • Monthly management and structural checklist review • Post scores on a wall • Provide detailed feedback to staff Support to Improvement QI Activities 3 • Support improvement activities (e.g., standardize chart, waste disposal, cleaning) • Training on the treatment protocol and chart writing 4

6. SMT will create continuous improvement system in the hospital and support QI team Indicator • Assign all indicators and checklists to specific wards and QI teams SMT Tracking system • Provide QI team with graph, etc. for tracking • Run monthly performance review meetings to hold QI team accountable • Establish healthy competition and recognition by QI team • Provide QI team financial and other support (e.g., on-time investment based on B-plan) Support QI Team QI Team QI Team • … Trans-parency • Ensure full transparency of use of funds to the Board

7. Performance dashboard will provide the SMT with trend views of critical quality indicators • Total Bonuses • Quality Bonuses • Quantity Bonuses Perfor-mance Bonuses • 1. General mgmt • 2. HR for Health • 3. Hygiene & Waste Quality Scores Image • 4. Drugs mgmt • 5. Equipment & Supply • 6. Process of Care

8. Reporting to the Hospital Board Sample Agenda of Quarterly Hospital Board Meeting Hospital Board Follow up of the action items at the previous Board Meeting; Key implementation progress of the quarter; Review of Quality and Quantity performance trend (Dashboard); Discussion of key performance gaps and issues; Operational plan for the next quarter Grievance and patient feedback Financial report of the quarter Health worker performance evaluation AOB Hospital Board will provide oversight and hold SMT accountable for results and process Patient satisfaction B-plan, finance, performance report, etc. Community SMT Grievance Health Workers 7

9. What are critical to make the Hospital Board fully functional? • What should the SMT do to best support the QI team and Ward Supervisors? • What should the coach from the Liberia Medical and Dental Council (LMDC) do to support the SMT and QI team? • What assistance from the MOHSW would be necessary to make the performance management work at hospitals? Discussion Questions 8