Partnership Defined Quality: an Overview

November 18, 2009Beth Outterson, Director, Adolescent Health

Save the Children

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By The End of this session, participants will be able to: Describe the PDQ methodology

Know when and how PDQ can be used to strengthen quality and access to services

Know how to plan and design a program that incorporates the PDQ methodology

Be familiar with lessons learned from PDQ projects

Know how to evaluate the PDQ process and its outcomes

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Partnership Defined QualityPartnership Defined Quality

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“Go in search of Your People

Love them, learn from themPlan with them, serve them;Begin with what they have;Build on what they know.But of the best leaders,When their task is accomplished,Their work is done,The People all remark:‘We have done it ourselves’”

Lao Tzu

Ancient Chinese Proverb

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A methodology to improve quality and accessibility of services with greater involvement of the community in

defining,

implementing and

monitoring

the quality improvement process.

What is PDQ?

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There is an actual partnership between users and nonusers of the community AND health care providers.

This collaboration promotes improved communication and empowerment for problem solving using locally available resources

How is it different from other quality improvement methods?

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When use PDQ?

When action is needed not just information.

When both providers and community want change.

When there is a willingness to be flexible.

When use PDQ?

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When?

When there is support from key stakeholders.

When there is enough time to properly implement process.

When Use PDQ?

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PDQ can be a complementary strategy to other QI. Usually embedded within larger projects

Creation of Quality Improvement Teams (QITs)

Emphasis on mutual responsibility for problem identification and problem solving

Features of PDQ of PDQFeatures of PDQ

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Value Added of PDQ

Beyond Quality Improvement…

Helps eliminate social and cultural

barriers to better health

Strengthens community’s capacity to

improve health

Creates mechanism for rapid mobilization

around health priorities

Value Added of PDQ

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PDQ ProcessBUILDING SUPPORT

WORKING IN PARTNERSHIP FOR

QUALITY IMPROVEMENT

COMMUNITYDEFINEDQUALITY

HEALTH WORKERDEFINED QUALITY

Better Health

Improve provider job satisfaction

Improve client satisfaction

Increase communities’ sense of ownership of health facility

Increase community capacity for social change

Shared rights and responsibilities for better health outcomes

BRIDGING THE GAP

Pre-phase: Planning and Design

Make sure you have willingness of stakeholders

Need adequate dedicated staff and volunteers

Need people with skills in facilitation, community mobilization, PRA techniques, focus group methodology, monitoring and evaluation

Pre-program: Planning and Design

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Develop the support necessary to implement the PDQ process from the health system and the communities involved.

Phase 1: Building Support

Meet with stakeholders and influentials

Need willingness by providers to make changes

Need management support of changes

Phase 1: Building Support

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FGDs to explore perceptions of quality from service providers, those that use health services, and those that never or no longer use them (FGD for each subgroup)

Use market analogy to help define health “quality”

Phase 2: Exploring Quality

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The “community” may vary

Explores quality from previous experience

Initiates rights discussion

CDQ –Community Defined Quality

CDQ –Community Defined Quality

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Explores “what is in it for me”

Allows all levels of providers to have a voice

HDQ- Health Worker Defined Quality

HDQ- Health Worker Defined Quality

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Phase 3: Bridging the Gap

Provides and understanding of the varying perspectives of quality and integrates those perspectives into a shared vision of quality.

Together groups hear each others views

Can validate what was presented

Establishes a QI Team

Phase 3: Bridging the Gap

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A quality improvement team comprised of providers and community determine causes, solutions and create a joint plan of action.

Phase 4: Working in Partnership

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Examples:

PUENTES - Peru PDQ – Nepal PDQ – West Bank and Gaza

PDQ in Peru: Puentes

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Explores “what is in it for me”

Allows all levels of providers to have a voice

HDQ- Health Worker Defined QualityPDQ in Action

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Despite having a “quality” facility, community members were not utilizing services

The Problem

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Innovating PDQ

Videos produced and shared among community members and health center personnel

Developed action plans together for improving quality Jointly implemented &

evaluated project activities

Innovating PDQ

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Results MOH and community members report

increasing utilization of health services

Joint committees coordinate, monitor and document activities

Tangible results include: expanded hours of service additional resources (human and physical) community participation in improving health

centers

Results

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Why PDQ for Nepal?

Centralized QI effort based on national standards had not reached peripheral facilities

Low utilization rates even after 6 years of health service strengthening

Need to reach the minority groups and other non-users of the Health Facilities

Despite training and QI efforts, improvements were not sustained at the local health posts

Why PDQ for Nepal?

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Significant Results

Increase in sick children seeking treatment

Increase in service utilization by adults

Increase in FP utilization

Increase in appropriate infection prevention

Increase in health worker presence

Increase in service utilization from lower caste children

Significant Results

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PDQ in West Bank and Gaza

THE PROBLEM:

Facilities were over service capacity, there was wasted resources and antibiotics were over prescribed.

PDQ in West Bank and Gaza

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Results

Decrease in waiting time.

Greater client satisfaction with services

Lower use of antibiotics

Results

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PDQ: Challenges

Time commitment from the participants

Maintaining political will

Gaining true community representation and participation at all levels

Keeping the process flexible to meet local needs

Replication and scaling up

Challenges

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PDQ: Lessons Learned

Does not require huge investment of additional resources when built into existing system improvement efforts

PDQ can be a catalyst for other initiatives

Dialogue often yields solutions – e.g. allows misconceptions to be clarified

Skilled and impartial facilitators are essential

Lessons Learned

Partnership Defined Quality for Youth: a process manual for improving RH services through youth-provider collaboration

Differences in PDQ-Y manual

Socio dramas and mapping instead of FGDs PRA and Games Stronger M and E components More country level examples Youth-Adult Partnership skill-building

sessions included

How is PDQ-Y Different?

Next Steps for SC

Seeking funds for case-control studies to measure impact of PDQ and PDQ for youth

Measure community capacity with CC indicators now in M and E toolkit

Improve and populate documentation database

Build regional PDQ expertise

Next Steps for SC

Ideas for discussion: PC can link with existing SC PDQ

implementation efforts; and consider new ones

PCVs can co-facilitate PDQ process, especially by monitoring QIT meetings, train QIT for improved function, and completion of action plans

PCVs can document, evaluate and disseminate

How can PC and SC work together on PDQ and PDQ (Y)?

Resources

11 PDQ Monographs PDQ M and E Toolkit - December 2009 PDQ Technical Advisory Group includes

trainers and PDQ experts Recent PDQ/PDQ-Y experience includes:

Bolivia (Y), Pakistan (MNCH), Kenya (AMREF), Indonesia, Philippines (SHN), Burkina Faso (Nutrition 2010), Guatemala (FP), Vietnam (MNCH), Armenia (MCH), Nepal (Y), Ethiopia (Y), Republic of Georgia (Y)

Resources

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Resources (cont’d)

PDQ Manual: http://www.savethechildren.org/publications/programs/health/PDQ-Manual-Updated-Nigeria.pdf

PDQ for Youth Manual: http://www.savethechildren.org/publications/programs/health/PDQ-Y-Manual.pdf

PDQ Facilitator's Guide http://www.coregroup.org/diffusion/Save_PDQ_Facil_Guide.pdf

Resources (cont’d)

THANK YOU!!