Advancing MSI’s Quality Assurance approach under SIFPO

Dr Pritha Biswas, MDSenior Advisor MSI

SIFPO I EOP Meeting18 September 2015

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Quality Assurance at MSI

Advancing MSI’s Quality Assurance approach under SIFPO

“It’s a like riding a bicycle… the moment you stop pedalling you fall off”

Marie Stopes International

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MSI Quality Assurance - Principles

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

• ‘One World One Standard’

• Simple but Excellent

• Client Centred

• Outcome Focussed

• Enhance Business

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The Quality Assurance Pyramid

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

Clinical Q

uality Information

Pro

visi

on o

f A

ssur

ance

Acc

ount

abili

ty a

nd O

wne

rshi

p

Clin

ical

Gov

erna

nce

International Clinical GovernanceCommittee

Country Medical Advisory Team

Country ClinicalTeam

MSI Executive Team

Medical Development Team

International Operations

Country SMT

Centres, Outreach and SF

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MSI QA Cornerstone – The MSI QTA

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

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QTA - Quality Technical Assistance

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

• An External Quality Assessment visit conducted annually in every MSI

country program

• Led by MDT responsible for clinical quality assurance within MSI

• Objectives - assess and improve clinical quality during the visit , identify

gaps for follow-up action, innovations and best practises to be shared

• Output – an overall percentage score ( benchmarked at 90% ) broken

down by service delivery channel and service type to focus attention and

resources where most needed

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Limitation and Way Forward

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

Annual QTA provided a snap shot of quality rather than a true picture of

ongoing quality in a program

MSI needed a system of ongoing quality assessment and supportive

supervision leading to continuous quality improvement

Countries needed to own , monitor and improve their own quality

More focus on outcomes

than inputs

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Evolution under SIFPO

Demystify Quality – it is ‘E.S.E’

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

•Effectiveness

•Safety

•Experience

• Effectiveness - not audit and compliance but asking - Did our clients get what they need ?

• Safety - following the principle – Avoid and minimize harm . Learn from clinical incidents

• Experience - ensuring clients have a positive experience by asking – What did clients think of our service?

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Develop a live ‘ESE’ Dashboard

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

• Highlight quality in the program or a service delivery site at a glance

• Generated from automated client data ( CLIC )

• RAG rated indicators to measure performance against benchmarks

• Action oriented - Red indicating need for urgent action , amber - a

need for surveillance and green

indicating satisfactory performance

• Help to focus attention and resources where it was most needed

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Q1 Q2 Q3 Q4 OfferingC linical

Effectiveness

Red amber green

% Family P lanning uptake by day 14 <50% 50-80% >80

% Family P lanning that is Long term 20% 21-39 40%

Short term discontinuation rate >5% >1, <5% <1%

Short term unintended pregnancy rate >5% >1, <5% <1%

Short term - clients returning >5% >1, <5% <1%

Injectables discontinuation rate >5% >1, <5% <1%

Lomg term methods discontinuation >1% equals 1% <1%

Long term methods unintended pregnancy >5% >1, <5% <1%

Long term methods - clients due to return who do return >1% equals 1% <1%

IUD discontinuation rate >5% >1, <5% <1%

Implant discontinuation rate >5% >1, <5% <1%

P ermanent unintended pregnancy rate >5% >1, <5% <1%

Centre and outreach QTA Score ≤70% 71 - 89% ≥90%

S/F QTA score ≤65% 66-79% ≥ 80%

Q1 Q2 Q3 Q4 Client Safety

Commodities - medicine management supply chain Approved

SupplierApproved/Unapproved

Unapproved Supplier

Adverse events / near misses

> last month < last month nil

Enforcement notice in place new notice

in quarter open noticeno notices in place

Work force - staff experience/skills( (task shifting or vacancies)

> last month < last month nil

Q1 Q2 Q3 Q4 Client Experience

Client Exit Surveys ( on the day) <85% >85% >95%

Client follow up ( post service provision) <85% >85% >95%

Community experience ( CHW) <85% >85% >95%

Complaints > last month

same as last month < last month

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Evolution of the QTA under SIFPO

Advancing MSI’s Quality Assurance approach under SIFPO

• Tool RAG rated

• Penalty scoring/deductions for ‘red flag’ quality concerns

and failure to meet minimum standards

• Representative sample of sites selected for QTA using

methodology developed by the MSI research team

• Recognition of consistently high QTA scoring programs

through Quality Accreditation

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Quality Accreditation

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Stage 1 Accredited

• Achieve >90% in 3 annual Peer-to-Peer Quality reviews

• Remain enforcement notice free through the Peer-to-Peer review period

Full Accreditation

• No QTA for a maximum of 3 years, subject to continually improving

performance

? Centres of excellence and best practise

Qualification for Stage 1 Accreditation

• Achieve >90% on 3 consecutive QTAs• Achieve >90% in clinical governance and

infection prevention for 3 consecutive years

• Achieve >90% in quarterly clinical audit• Remain enforcement notice free for 2

years

Validation every 3 years by MDT

Consistent QRP reporting

Demonstration of clear action on

risks

Produce annual internal quality

assessment report

Random spot checks/ QTA by

MDT

Change in CSM or CD could result in additional reviews

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Moving towards Quality Accreditation – Slowly and Surely

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

Total number of country programs - 34

2011 2012 2013 2014 2015-1

4

9

14

19

24

29

34

18

2628

25

00

8

13

17

12

8

QTA >90%P2PAccreditation

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Supporting initiatives developed under SIFPO

Advancing MSI’s Quality Assurance approach under SIFPO

Master Trainer Development

Program

Supportive Supervision Policy

Incident Management and

Reporting System

Other guidelines and policies

updated with peer-review by SIFPO

partners like Engender Health Marie Stopes International

Master Trainer Development Program

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MDT RMAs ( MTs) identify talented

clinical trainers in link programs

Selected clinical trainers co-train on

TOTs with MDT MTs

RMAs assigned CTs to coach and mentor

RMAs assess competencies and sign off CTs as in-

country MTs

In-country MTs provide in country and regional

ToTs , coach and mentor CTs to build capacity in

country programs

Capacity Building and CQI

Supportive Supervision

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International16

Competency based

Continuous Quality

Improvement

Competency based

Training

Competency based

Coaching/ post-training

support

Competency based Quality assessments

Competency based

Supportive Supervision to

address Performance

Gaps

Incident Management and Reporting System

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Clinical Incident

RAG Rating

Incident Notification

Investigation and Action

Plans

MDT Incident Review Panel

(RED

INCIDENTS)

Incident Panel Feedback

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In summary, the evolved QA approach under SIFPO ..

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

• Quality benchmarks

• Competency based systems to ensure objectivity and standardization

• RAG ratings to track quality and identify services and channels to

strengthen

• Master Trainer Development, Supportive Supervision and Quality

Accreditation initiatives to support CQI in programs

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Striking the right balance between compliance and support …

Advancing MSI’s Quality Assurance approach under SIFPO Marie Stopes International

Thank You

Advancing MSI’s Quality Assurance approach under SIFPO

Marie Stopes International20