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Volumc 4Number ISummon 1995

(0 N E N I s From the Director

QA Plannini and SltrLtulrc

swe progtss throth th fifth and tiial vcarof NthtIInMls 601 SCtC- IIIOi 7 ICt- (aIU NtVASSli raniL L tt Ct-it IlS hCt-OtMt ill-Q uallity P R AlCII 7S lI)Oll

bull lcasilm ly 1l111)ltilli(tM Sttk M)it lCtlL(t

hr 11)(ltiII IUSSOIIS IL-MAK-d I1111 ()lr-ctiWr MQW1101il Im m e ts td shill(_l11IJIE rov

poits itnd NlC RUcsult NMunit(nh ()idI tV Itprnvt-mtiitS [Inlik soIte VI itl incltcttit iMs with car tll-l

rinI-1z1 10()li ISIIil(U II 1 VIllI I HLM MII()l 1I I

(Ial nity L-nlhnt 11 dist IaishCd lIW thirCIltitiy]M QA I(ru~ ()tal itV is an i-Vt-i hlinlti li(tiittcpt As t-tit oltputltS

ilnterview wihIi Richard Morrow lIMSAt011l11 VtIV SU (Aeuro) l(Clth Iliilnll anti)r M(Mt tilt hLII t l

and l)r(IiltC-rt 51irnhai chai~ipound rld lnwhidh WelhVC itld012 la~tIrt+ltI lit V the

ntat it tzniLnii tcxartiatt in)IIo s i~tt~tl ltvth~lpittg

()ther loj-It Ai tivitics ll ( ( ( Illi rIVlWITtt 1ivc v-wtlot attte l t iltthis

[11)2 11 (I (+fliltbutt Vixsal lt1 h ssonst ji nid ttliti i-t)ninUm ttti prolUt tu vts l t110htI xxill lo~tustruths about di

)isst-c ii ititMI 2t0tt2( Iirntd our still iii -pii I n i trv s Vc have

C(ttll (th t I c t1Wt+ t tlitAI t1l11ClV Ltlt 1gtIIS 111 ilnuvT+

ls itt huh atixitit-M at l -Cihangue Sonitc St rittc-ic s bIr nrc-tt-r viritiino I tni- s

22 (dri 1r1i) S 1nd 1)iV- Irtmt-ns hospishyiLt N i i - ot I CI-h i

tals prinlar ianc tuto i Hi - iatu ll vct iittrlti1+(lis

I titit tilixatitn J~ssts b~r r heiliont+ ini tIst h1asi-hitit iiliti A ni-l tetltiishy

l (jiilit v SSlIrutle Protram s 2 i

c Iu I to(-llll

d ik)tldl Irm all IlK(d ill]1ivIt v (prni2) an hillpinu tlcm IISi 1 C tI lattS ItIts tilat blrtiil111 tot lithtr

17OAIBrielbi ilh

1]h vt-t tlCfhfhtl 1 IoIo i c JI(tnlls has bc-c-i at sntiultltt-tr[t t tim latiy

thi s +iipproach(] lurct xi -sn hT bt-ccn atlii t-ucd is in

o h I1 ()1a1 1ll Assurance ThstcutnI pInlIh_ solvi ng has bt-t-n wilIv atctptld in I (ip i 1olbi poisiti i tsut

QA Brief I

tI e I LIIntricS ii1d sit t ins WIiIT LiCiIizCd TIiS

iSSIC (it Il OA Ilis1 thiS llh Ihrlos-I(L lhi II SMIlS ltlntd i lLill Snr (tifiCC01tlntrv illt(rATlltiO)nS

in QA p l a lnii iii t ccts IiUJm -(cIvt tI l i n1Ii ia Iiss iflht il id int it[it loll NIhr wiilll ii willi

t(0lW In li tis W t V Iltof lIi iM tc 11hi ti i (amp

~

This isite (fthe QA IBri(etttCVni tif e u tdi o h contributions 1hfalmost all sttifoln the Q u l t

Qality Assurance Proect ticle t5 an(itli)t I) uoklalt theirIniIlIV

ViewpoiltS aiid eli)ui nd r the )1(1ior headinor isues which eniiited

Yet this was bY In ans intended to he

the (1efinitive piece on Lessons Learned

fir the prectl nor aid weLo wish to prsellt

(iii over idealistic vie ofollr work illQA

Rathet i e wished tofetatinr somie ldhe

many experiences and ifjlections our

stafand colleagtues over the )sastfew ycars

as they have worked to appv Q1 intheir

progranm

The Editors

2 QA I3ritf

c

Quality Assurance Planning and Structure

ianning ij()r thiltl (iItrti nit implitIfl1ltl- knowVludge (dtolt pro~itis insight ilotiLt Viltro and Cioll illd iISLlXIlltt ~ilJVl- IloV to) ill(-LrIL CltltQ A 1( to~ I i tSLIt tplo mttantCidCoIil~

tilts IIaSI -I itn is fro Iht H o(ampStICCCSS QA 1programS inl jridinl Mnd boi-giL~llla kt-V I t11(M )~lI

1wpr~j ) it m I)t -(i(IL t LopoiMnllingt Withi itll-StAitC i~il011 ISCSSHtL-11S Ilt ( ilt-I C 11 1 I I)

()I s I I If I i I)

(MIM t 1tt ~ LAI TI lith dwtL illS IM 0 - l() IIAST S( (( Ii aHI IsIggi wo

sd il I I L I II li( t i I It LtI L() II)i n w u ic (amp Il i cr m - i - (d thiz o l

551iriK an Iii~ti Citll SsysemII C~ 1(111 igS

u t S10 i t r

t11l -11it (di 11ltiihd l i tl(IM Itrts 1l1t1t 61ii liltUOfId SI~I L11ill0 It RIts~ ti oh sip o h 111 ll (I W s(Rl1( C(prH)11 C I L hLl I J I II 1) )it ( AwI kfi- It(s it ll(I 11 ts stf Iml ponrx

VII ll

te ghN1In~ st ( I IIIl (d CA(dII ( ll () (1)t I and Sl 1d i trLT tls

xs111Ca L IA11 M I 1111-Si it i l t JCllrtilll dNI ill(ido (iW If I I MitilCS5 dI 11CS~ls11 tXg l

l i tis i l I 5C IEIt f ti t11111 itvt ofP 11Iiillil l Illith g tt- t I ll I 1l i t tICSt OIf s a t ( fI t tI l l

oE2I11ItlIll1 ISS iIik lti lhat iotii M-cII lil I I S of 1 1t iICt

CinIV11il 3wgIlztola~ ~ ilIP~ ~ ~ ~ ~~~~QA 13iiefdint~ ~~~~ ~ tegh~ ~ n

a9IllLn[ inl ELador and measles immunllliZaltion inl

Nqigor

Assigtinig I-CSj)OfSibilit)V 150r CiUILMIt

Qtlalirv asstiiaiiitt I-jIimrT-S ail oMVnti that is anl illdiidlltIM jt ()iiC liidiiaiS 0iCCMlalCiatioili

iiiiiirisii anti StIppINW tjtilaimtv Csirit a tiCtit5tSI~(L Il

stVCtrm ((Chill nt-s Itis has hi-tnl aiiTd~ tilnngh (]ti

(tlt ioCCC(amp l(t iitilS anidt ()Illllitttt5S anid~ itP t

miSSitlIil CCIciCC)(rtimiiliiCIrs anid 0)i Ttr iltdim~itiaiS

In (ii ita QA IDt-pit it-il has ht-ci utasih il-t

flat( mitCi tS tI ittl It ictit Hith CVLH[-

IT cI Is m-N ll5i tl -I]~i- ~ iv itits t[CillI(i tfiiS it Stitilltt- biT]i S itr

Inlmditiil tc ICiii la)s a QA tiirinlI ta

with ltihl-tiiit QPA stall 1i(1itfit iity It-vt-mi

pM~Iitpliit~ iMi~iitaCian (t (PAC ciiiims iiit(

ttaiis iC tidt-rIikt- l -1Vi aC]VitilS(~li111 lmii

JtdLV(iiC-idi ttlst (PA

StiiciLf iit aiii tit iilvSS

10rtiali is UNVIiCt4mitt

t lVdiImi itVCis iif itl

Dircoim-atQualtyandOnncil ithi thi

(lint~Iici timiVa[ittCtStm 0lii il-t an C i lcaiiipitii

wArho io 11 NIitalic mHnttwCaituct ani( ili-is1S

Ill hC ilh~litDUIM111~ll aid NgcA

[in tit-l LAmll (Ii (PC RmC SitIL-1vp Q ito it

QAvJ) stmillmultrio t j ami litpmiltIStaniod

4 tgoQAa 1Iitf V(U taf11P1(S A IC(itdh-

lnionrwith an actii-ri tdsirtva

dhrcc levtels A (PA Boamrd t liti ctlltrmii N101)I ltvt VCWasS AhiSIt-i Ii) CivSct-(PA lli K ronl rti-Cint activi rit-s Q A ( M~ii iitts vtltC cr-al at

ailmillistixi it- mllil itii (CliippC Ci I() i[h-QA t-l01is A[ t]it(jLIA ltti l (iiU istl-i ) it-VCIif

MCI -t ll- toti iit ttlil I i tl 1111)11 anid lu iV

mt-lit Act ivitit-s

SCCLiig tOp)-lCNC1I llitilitgC1mCIlt StIl)I)Ott

An tSStitiai ilgTdrimtIlI ill tiitStItttSS (dally 1)iC-

Tis stippi)(int is iicctitd tio Itt-gi hlim aCiIV ciimiitgtS

Whi-u miV 1(1 ill nii)dict-J iiV lit- QPA pIRCtSS Nirtshy

iiIstc st iQ atl iitsat- i11-I cti

tlt IOng tLinllit ( (ii n cnmnlliiishyi V ilC iiiil

l tsiictsiml lti iis mtiiiitt i

it higitl itVti

W hile bviiti-lic I-vti NI0I I stall iinl etr

damCIC tmimtCvilic IIS iiimC iWmVS bh tmiSihit o1-N l 1

iitttSSMil kt-y NI 1 I li imiis SILII m I itmSl tiitiiilSt)I Llt

atoa ii i t-s QI tdI1L til mitis-CAtrmiS tCll

d-imU ndt~lt l Otit Ci tuItihit~dI Cmiithii to mSVSti i ll

Iii li mippIim (PAP )inmit] lItt]CIi is shyp LaI i-sW

traltitmo11C is-vt- wua cIi Dtclit-Ct lit-t Iii

priiiiits miditi iitiiitiailit it CaWt titmi i-

Itiitt to1 m IiitiitiLtlivtA(-t~iii Was bshy

l IL ~CIS(IL(IV W M HL1 a i

lanc 1roum C-NIternliI SOnrecs Fur two new QAlJ) [p-dowvn or hottoinl-Uf) AitLs 1ittciertakeo at tis tile t licr is HlOW~ hen jnt roiucIng itltl1(ial ml n OriiztOhs

a tstit itlitlit~ h tccscrta1xt e tItIL Ixici VS hittoun-II)Aii Itt-S Of top-cuI(VIl

(Iit Iwhh1111 I1t IMt Ilocal atth t RC itc aS t~lC cL is liiexce I Mu S IR Iw- ]V- t~ ISonI 11 IAtix(ii s bcc I Iec t Il II 1) )i I S [ VIx I ts IL~i i CS iI l itt Ii t t~It t L ) Soxi tc Ai VCSI ) ~ i l ( KA - cit O V IS I( ( i Si tt ( 1 t1u( t il

hilII 5sI Citl pr~d)lill1s was StIl IltI~l I ti j Viii 110 W be-s1to HSiLsjII It-

rIicTrSMItti) illli ix Knowledge aboilt howv an organizationst ill Still H) it(I1 1 t1ie Uc Oixl

pdl(Yaolcid operatesand what is possible within the xi i iI 1e1S top gnzton

(I [II IIfVtliet NI( I Ii epe opuliut J6nZ liO 1 l

Ii~l 1YIist [IL IILct OACk sustainableQA program

Im1lur)t Nl tcIpecon c is the found-ation of a

Itti iit tlriakeii lhv jpilh i alth _________

ilci ititCSJs pi (4 tlie ( iist IReutcry lfio Iclu i1riijCtt I ail I I itttIitl11~ C-T SOI~tl IlV W1 Il111 d -Ccl~C(di attVIIIS wsxhidh ctlprise tihe ilhiriiiticnts 1l1ls eesiiaihiit ~lu ntuncerln

hutvitoirimats~ ~~ ~ ~ieeritc~ ~ ~ ~ to actcii is to beLtakcn1 healt iiiwer levelS OIftIL ieai utitretNluusrvxitiiu ii (i~- (C-ltes with iuruentat out andc praSth ww sNystem1 eil

li aN4 litita ( )A iicraitn ItIll rIIOVe-InltI It t t field xvuuriktrI cxcTIi tid laLtr I WxOr-k toxvaii( Stc-( nc p)osit xV( tL-MD-ClorsIletlt anid

StIppuIMt fIii thelIl(NhItIslirV Of 1lealtlita liaspteiiit1it 6I ltIStt ttc-up sh tit 1e

S il I th mtl itctIucs IllF[Itilud ritls howe-ver that ito wirk tain be started IfilIgit-htvel litiped]10MIIL( Sio fI IitproIucv lem1 its Itttiun imikLrs at ~ siwtet MH -(IOl Iv OIpp)(-i (IOIe Oft ll itt0iieiii tILc proce--sse-s RiLd (0iilIIouSIS treatllt ai( QA apprI-iiatItc-S)

uivcllTI i~~icto ( (Iot-a witiit [lttshytct ic1)1 itl pci ttIltl -LS- fft Wits nlic nlitiatct uiii Itrthl ii~in JOi-rclit aitels to

he10cx1 i tts iuiti f MRJ xitits i iil(-i t otei)~i-Ol t c ~ilci (CV (io tQA struLc ture- an l(ti~lt1 1 InthetI~~~~ vtc~ ~ ~~~ ~~~~M waIst ~ o(rirlclhI0 )l-UII~oi0QI ltvt~lxiii le-ss (ICAieru (IlcC(iieiat tilt

eIludI-vel

1 it c Ii i jitil-ttO - a l p i - rtni l hh1 Idpart ic i ated I i t i c x a i i d ap prlait s is u sedt Ii

iiitic in lt acilit iiiVita l

pIo)Jc St ticO it- npti -SOittVtIm work tiilIIl

ic saf ith-CIll

i dt 01 itll vutiktti t lIIlIL- i1) aS cT(eer Vt1(il

res xI tl il iait ptow i l i l i

niiti t o

cup ntilll izcihtu i -c WAislvL -t-Il Q

IllL-IllbL-I- ~~~ll(S]i ~LI~lll ~ ~0e ~WNV~llk ~ QA 5

l

tIii IV ill)1)1(CI ItCI I t alli tIIII I )stafftIS firm

a iv utrvampnt i try tvIn uldt-nakurs

I Living112 wel I-defle p121jriorlitiesan

Tht tV nat nit Of L1S ta

~ ~1)1111S JiMn l LtflLxNbit aS1 pfl)jt(LS Wvillpi Sl

staffL111liIM hIalit prj iJi tah-~~il ]i t[

at hCdi tt i IiV(~i~ia iiltC151tsoi d1- It IILT~S I t lilt 1~~~~~~~~~~~~ iItis m t )It~ i IIld pil

611 BIS C2I d ACf)

FIGURE I

Systems Model for Control of Diarrheal Disease Activities at the Local Level

Morbidity

Knowledge nseling tality

lientBasic spplEcons Cour Mor C Coinical Care Clients LowttitudesA

Knowledge idem iological

NonsEp sSurveillances r

N

Methaods foelioPractices Case-Fatality

i_ j Level Prevenlltion Covere s n J

GeographicCultural

Idcn LolfftmEconomic

Methods for Selection of Quality Problems

leo li n t i l t1~ ~~~A1~l x1111pil )IlR iiiic Wsr ttjitllltiic li t t i i l t l l rlt i l l t t i i b

h1 (QUilit ASSUI-iri)(C II~ 1md bttiIlta istl s Analysis vhich enables it s torn

il tik1iI1i)LS12 r t1f t l 1t tt(Ii Iin Si- i iti t d id tilinllk1v I li-ri(S i ICtlhhirILiyl vOrIsltsrshyitSIpIt M11Lw]i 11LA[ 11dSrtntiltiiItIiw (Lil]m tn

ha( r1n1Ld tt-011 tl lu litv 111t h Ol ( ISIIllli Inirt0h SOMlI_ itiu- i l tIa i 0t t_SSU1 dialiltI lh iIaVI+h dif_()A i 7sshydtP)1 t _ htlvi (W Mitdx

i- t l_ m1111 ( h nt-CHLrAIi1 11111i n +l

111)[11 (11CHISn i tt( lIilHL- H6 a

IxSt 0_(rr~ lu Hit11o11111(W Mitpti ( pli+uh1111u lI h ILMIS StIR1 C (d11111Y1It n t111 t

tlitl(111d bt Al ilWith-1 1S(()n 11ll11I M SSVIL il i MCIi~ S 110

ll I-1 [ Ottn+ Q lkA MlI1I1(Viie(i

t-A kill and th ti-1

tf dJUlI+Lbrth+ hd +Iil t Il[rit IV(dI+di Slillf

II( lt i()ll lt+ l~r lhi( 1

tttml tl trodgtlr~ (()S[ SSC~SSshy i Hllity ) bl I1 TlhvIM

T ()t iChtOfI tr mVampr pn l-1 ()M iI1

thi ll - ( U thIlfm+ S li It-A i1WItt

( 1 -CACtt ityiltL-h1 (MAl11 l111Vtl t 111111 _XlI shy11t id Sut qua tll-+irltMI)~ 1 tlitC M Wtlt rlI-L- +11( 11

r(l(1 d il lity Itit SVtcI1lliA dRlt tllIwc Muli t r( I) 11 Ln(v ll-h01d lhprimt Mtrt tLll t th(IC(dll~ 1- L1011tHII i tl 11Y -CA l Alii ill lll iMi 0h IttltIttm (()Im)lA tutdl)(IltWi 1h+ 1i lrt QA

t1 ht (11 lU -ill 1-JI lw II n i

111(111r IWd~llt Stittill lIctII (irallIi ll11II 11~t-

1I eRura at+ t ~ill

I) vl~ h 1ClCiflFi t~r iM 1tt~m ll-lltlIt1It lt)1l~li -I S (ll]llllS(( I(Ill wr

Iri cl 1 7

Priiar- cv rb (ul~Strv icCIu

in11L iCILI it sst ssnIiiit Iuufn r ia- I rv ChIt-klist 1111 tAljtlIS H i i ttA iOun prut)ram A A l l

fit L I i II (LI it111d kt l Is II liI c II Ii s(SS 1tsc t l l uv (()lti trv ttitIt ll t-I illlt[] l ii-rJ h S ~ r i

Ci WISCIC I t I CI tlliI ILVC-I Ii I( I It ()tI )llk N tIlll itt it It i)IiriI tilt1111r(-xkrs Im ii

x l t i lti I I R1 CdiII Lt iti)itIiiiiiW IiiSI 1(nn1A SitC I S i r [)~ n NN hIli ii t i l vi~ kc i t iit lifi I I i lt I i

tai t tmr CltIu t+Ii s tr tt u ii t iii AV~rl iilt t CC)i( k~lCil C I Ii lItM l - I LI l f tLdrH l I +I a k t o I) V I rS N ) + ~ i I + [ i t +rlI tt IIrIl- A il iN i n sir ilva IfiIilttlil ttSoMi itit diilisirni

TiWS 1S11C it Y i d IViSMtlenI QV Blii tf I Is t gtl H r x + r+ fi t l pro lls ) l l r It+ r l l Il

)(1RI d W I-- II (r Lr IiSid e ltl t IitIlg ])( l I l 111 HhIII 1 lgt1

ittviti it ])L i ru t U l t jttn NIl1t 1tI I t CH timesS l up roWv id ll lt it i s itV hit[)ic iii in ln - n v i~ ~l rx it t~il

lll ll( JId~l+ISll[lS() Rii C utI 11Il l

f IIL) ll Ii h I -I

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L-11 IIR iS(t Ill I N S S )t itI Itli~ hC 1 t

ti~ll~hlllW IS l l~I- d W - Mi t t 1L v il~ IHMtn l Sil I) i It IhUSU I I Ct Ihttt s ~hi t( ss

t+ t RI HtI CL1) Ill USITti i( II IIC( )R b [Cil I)i t tI C II Hi M ti 1 )i(IU -A I Lct~0fc Ii t I IIIICLiSlli 1t tit s ii liikiltW bullT C IJt 1 - tIX I g II II (IItII IIII 11C Ii [ ) 1111iltu~tiT t1 iiH 111i 1 ) IhiC iil l +gth C i-V~I Li I It h lSort L AS) tsi t i i I ItIIV irSll t lCS LIII)lt 11CrM-b it N~lt it~ l CCti lirnil r itShi~ill A ll 1141111 i l ii 11111 JSCldCgSLI I -- rtl( 1I fU i ll ( i NIW r ifS HU11((6 1111) 1 I LI I~S (I L

ti tt )[itt I i~1CHSlC I ampIl~l u t 1 1 1i l 6 C I S Lt 1 - I)P ) 1 oIIV CH I lIU IU lA

li 11tt~hc ilh it Is tliill StiMSIlt Ill IIM llS ll lhdu ld c ttrill t t~~~~~litlitt~~~~~~~~~~ 10ltl+l(~ l~rlti ILr-111utlt[I( I 1 1111111Ill a ilml I1ithI m lic Litti tl t+

WVt ut tITjI( IIrt il 1ll It (1 (llit AIM t Itt1 ISilllt(tt tIIIIItI ~lt11I 1 1r( M Iti( M ( 1 11illW (II_(h )lrltut +iiMtoiW l ttI t I_(tl( s L L lil 01I) s Ihl l c atlp ullil liltwl l Ill ta

I( l It Iut lS ()I- 11) 11 Aill +1+~ thM Ii ltI I it 111(clli] 111 dviltl a es a d di a v ntgc ( M id P1i1ttl LV~lJIill [11Cl n lt+(li(k diii~

tW mill[+ It tuI Vif cSt cr t tlSwS CO+dtllIh)ltE~ ievt clg 121ISnor hv11lt RIM~ ~~ iII ~ ~ ~llSlilgw-~~~IIC Id ~~~slt~cTl l-Ct-tidIILUr Mvih rMlt+ull il tift ititCM-CNi ifII(b

twc i ri i m ai nii4 l lti n ltt ~gt li t t i I1~ il m- it nr ijilm 1nllUSt t i (nd rc Ist al iit lIt~nt

+il~i8 i~ Q 11 ilt( lletil i +lxt iii i~

icwaltih lprtvIdllrs acknowlict proble~ms anti moivc

I~tOii ill Hnit ill d tIll Of tt [lttt tifr tualiity i1i-

w t T ThI-etttSStSStILtIs t A SO Iitl 1filt its IS tQ-

t SoIli tiitR ll ili rela ted o0n tntilatelIlt-li itS i i l h Illh ()ll mt L-l(ll~l IIlllnt- AltilS

1li1d ris Jitd litlit o R to)1n I-tl -l k 11 Mir )V

p ItI pIot t

I tll(tl ti

tt Ill d t [livt IotiL- Mtiitli ItICS sitart tInt

lit 1 i st st ltlitM iS iilt it hit lmtitH risk

tiiiilt idit fit1I it oo(rll i tt11of bct

t)lH (IS11 1 11 Ill 1 1I~iil t itt ( M lt bL-i tl lIII III I li t id 1-Mt) I1111ktst 11C t Mtt 1ittt shy

li tllu issts llt~ttl a I t I tol it st l aid poIlI l~lidtisrp Ihi i -V 1 1 ri1SStitto rstiItIiUtwit It so iltR t o(I fear

at it i it i llt (

I ofISottso amcoil ittse [It Vt lI() S Mdt C ()lIt t II ll Ht i I iVtI Iti n t L-(II()A P

ias iin lstitt ktV lot1l stift illtt itliitIS t(ittttrlllllg

l it ssiCi i IlIV ItillCn tein iltld tLOttil t IO hI i ts shyltIll

it i ttisr at a11t1nivli ilns usd I icol it t c r sltff ( Itiettifk l rbitti lit dit

lriti s lit ri i t ll5i 5 i r it lt il i i t t

i I i iatiS citllias a ii ti Il attt Sysshyitw i

totna ilt tihtisot1itsut in itil t i c t iAiity

r) t I-llinMI IM1 111d dtQA

III adtlitioin tilt nVIlvCntutIt (if lIcil stilff in the

assessmillt trlt(iSS g1e iItcd coinsit ittabti

inlttst allI Stt llt a oiilt ti ait iCIpaints as

well SsiPR i airiiand )it levl staft helping I Irt III tl III l (amp I lit It i I iill 1-ltr AL Iin ]dLl lI

t-tillll it I)r)n it I t ttitI I omIt t tcitV

( I 1lk 2 J

Ihtet1 I I(iihllr1 titr ii (2 P s t( in iAxihlt

aSuitiliini i andidapt Ill - iri l i tllltit I SSiltll

+IiIiItiIiipRiltl()U r vdit iV Sit l it dtie hiop-

Mgtr( Mti l ] in r lt thtM (l CnMv-4lIt A 11 Stt L-Id II-IT 11 L1I(H S [- -IIliC -1 LIIV A CS(amp t 1c l

i iait in n t tit lVn anti ltVfltittlg iltlual itsv pllillshylellto a i il t tt 1ia itit ViIterlldV it ti(ir Ianshy

aRttStil oI Riltit Io ( )

ItiiQAI H d IIeitIiII (

(niIdao Ih inhto1) ) ri llICKlti PYII It7 ~ ZH r MS4 I P P l u

A t )IoT

Brif

QA B~rielf 9

Monitoring Quality Improvements and Measuring Results

i iitorinii Isthe ci C c4 htt 4( and 2 ianalysis (d Sclc1 wcd iIldi4t4s I4ciilIh

l4llIa tgIs 1 t l4ttili lit w hct c l-N

ctlitics drtr l~cini ampLrri+ 44(414 I+IHii4I iiil 0rc 11d iili tc ic tI ()tii I(Vi rl t shy 11 C i lI4 4515s ll tl)ri itL c1c lci mll-i l 111 ) 15(i1ht1 t44

MilICS IS (IitlIL Ililitr S 14mitc ()r 11h 1rviC+

( itidI l 4it4)1 () 111itS-

t4l11 Si StCIIIS nllV [t(1 111111C I SCI~ I I 1(d ic -11shy

t4t St11s hI t ac lt tN 1 ilIampc

4vAI

h oIih MiiHg MrV YMW Ic I I 1 (itl )iIl

1tk)41t S I() t II i II I i Ii i t t4 li

PIll (1( Mil( IIC11w

hl I eC i Il4 CSC 1 I II I t t t -( k CVt11 t Ci tIt(WPS liii hIW i 111W

14(1 1t 11 m41I illlvlts 1II c t14111 1ilAf4t1ilI d1 1t l It iIcaI 11 iliSc1Il Iliht441

Id 1I t ] I Tlh4 ili I Rt 145 titgtl th 1 1ill c~h~hcl4S 1444~ uhichIs

lc 141 H LI 114-1114 14 Isl

l II I iLII 444rt lll(

Hllt5H )I V II4I ( ( Il 11i 41141Ii4 11 I41Ii1441i-L it Ill A nm lii al t t lvlist (dI Iiti limlt s toa)iI

111il l ](tdst lt1cnI gt cr Ill 11 t ~L at 1cntshcWli l)45cllt+l~ tt414tl d iIstl lth shy441

It l- r)pid ll I ili+c- (d ilu )[1t11 t ihtll c I(414[ 4fc

II s i 1IlIII r I li tiii+c45c ((4M1 40 ii 4ilI

IC ( il l s11 It 1S 41144 IrItOllsllIM ( HWIi l IY l 4ci4ll rmit(t i t(l altmi ( )thlI tclt+illtdKll

l Al~n~iit111-i-gtI l llMi~1ll thtLisltt )I

llhtv il nl I 1 Vt ( Olntll(cdlll+S l iiiti Intcr

tlblr) lt II S1IJ)CrS is(I4 541441 H)c licii 11 oI I It4CS

Keep daiaC llection Simple fHr stall with lim ited training

il Uss 1 As part (dl I II 1 c (d j( tli tNI in 1RAcIicIltL ilitli

lt IC lll III44 hC i1(h Itt 1 i (i il ITrcc 111c

ILICs (1(4 Ict 1r(1 and II lstI UIll 1 itsVi1n ItI i111 i 1ttiR + crIl1 t11L41 t li lli 1li2is (M4lISCS lllt1

IIIi 9IIii C 1 ll ampICjil 11 c II cIIt+t iC lCsS

)t ion

(( I4i It tl )i1 1)1 kliV t IJ A 1 1 l)rIi l l IC Ms sSod( i I 144 iasci IV II viV IILI I lid (it(r d(ittlScs

Ih IIt I ) l C CIA )c U i ih i) luV coM ril-IIWiiI l cxicit I(

t)111 Iicr l 1111 1 11 141t lU 1-1mI S1+ it1hWI tc[

1 WIhIa Js itshltI ( ttlIImlW h cu I (f I C( lIthaII (

W4ci irL4 t nI 61 I t1 h ciI d4(1 I iI IrIchi (jIiiI IhIC( IRT I Id IiiiiCI(ff il(HrIIii(I ISCr1( (iCiii)IJiIiSICl (ill

I)(iI ih C~iII i 11 ITi4 Ii I~C L144 ~4441 F(WIiIt4ll -lIiIc t I4V1II i c114 (I

1 Vii WNli o Iirt4d1 4cllc lii

)1 c ItIShh c( II I Itlr iII4IWIccs I4 I IlI I4I4ItsI hIW

c1c t + 111h 44 1 t 4ii l t1111 llImll ill I u~list in1]Cl tl(tllI iIIS CT sltT lS

dl Hl t 114141it1C )t ]((I HlitIVii l Icstl (ilic(4 l 4r 1

it c surval gtls () LIII cIC-VtI (l6 W U v d L1t

ts c i rv 1 4S ItII S t1r kISIUNH14 rIf

i lClIt4 li 5 IiIiI~t w h lhtIiI

rc I4i [i M t IM 11( 441 i u siIIiant sIt(u i

hIWi hiii h ilitc -t1(llllxia411t lh i i~ rcIu1 1ll 1(4ilM 110a 11lilt tS4 iTlt

IILILl to _Ct h L- I R Clt(S IlH 11(1((Itt tLiid

ilfflt vis l h 1 sgtil otih ltrsm- 1il Ilit still Ih s

SulIri H)it ]nill( Q AutCliti( iti

10 rri 11 hl Pllst A Pr(llll I Carn fl ( I il t i ll

710 Q11 Bricl

lu llitv inllm)tproCmttt CyClCs lt iigher levels of nmpxIitv tid tilktli

In stMnIt III~tdIRL cS (11C tlI tC()fil~il foir tiLCIS10 shy

ll iC tIltn lLT (d [t 111 Si u wlttI iii lII tl

iuI V l ti(tta i1 LI it W IIi itl r 1 I ti

III l 1 I st i it sti il i I tN n A titidt l i i t ast

Ira-111111Slil)IcS sW 11 C1 I ) li HIIL(( ()tA~u Ji01tii ant

illltri~~~~ltl~~lli()ll1M ~ t it lt

tl

I~) ltIL ( I i ll Itll HiSl(- 1li-1 nti ll I I ~nAI M -r

I lli l CNxLTr n1 Q Az 11I MnM(S VMlll ld hC t 1i1111 HIl)

ti i Smlt (kitI t I i i rt i h o sirwI iCilHiM

I lWlt I dL( i~AM (tl1-1 R 1l i ) liII l l I t i t 1 1()LLS (d tl

i~~tn c _ lt~t ()l v I~liltltl ht liihosi~i~ld -( d IIl lidliitt ~xitinitli()

ilt I T itI t-1it I Ltt t l I Iit tttilIitt I tS t xi shyCit hl I MI ((itIII Sll (IhCt IT I I ISit kil)I

IliltCd Hlit t (ilt tilKr IC(h11n i ll SUtIl~ )I)N Il tIS( illll

mi(hc (d1 tilt tll I (icll [ t it 111 1-1 ItlA l~

dIIllItl IfI I ) ( t IT ItlItiSt

lit+ l~lul~arud t()itnpr(it he ing c( IlCc (I

shyl(l l )vtr u illlitir 1I llIl If Utr uIli IIIv nlit Ikt r i I cr]I Il it l )n )prishy

Ill 1 m cI (IIt ()IlI 1I1 10111Ct (t II rlclllli cit - il(dt 11(11~ ( ms

Ii Ii Iit II) I()](I ( dpr)ilh()1 Ii if Il)Iiit it) H 1 [hc a lillahillif (d dtlitat S(m r(tli ff

Mllll[ IM IillllillA hr-c(( w a ld )I 1cl da ilillttc

S( MI R~L-S it IV(~ I)CC0-ipielcit~(H 1 dIIIIdIIW~ ~ ~R(i ~ ~ d IMIA( SCntxiil 1111dI ltpc( iI (h ti l ( ()11(( (lim ciltltl arc

liltlcc c It) Sliplvl d wlt11ni iil lil il fi(ll)

Ill i 11thkV ( [flill(lt A 1( ()rdt )w m htl( uldoIs

Ifl ItIllt M)l I I)SWC I Lr11 I~T R RV Ct I

lhil i W)it (tld Hl(tT(d il( iMt (VCLI ItIs[S1Ml ill

W Cl HM I h hdlVC t()nllr tlr M 11iiillilll nI)I

ctlt Iv I i ltIlt ()Ii ht IMi litits

Use the inf-mation and pr()ide timely feelb)ack

It IS t ti l t i )ulizt Il ITSulI S (df I ngI( nl(

i titl it111 I t li ltl l nit ttt i lTiit il lt (ili t I

liit11iih 4WnIiLtl i t l in tit itull1tt1h ( ail ti-ct

Slittil 11 SiiRititlciti t []I(tt)llilitlit Q Af()iItilllt ttt asth Ailtid i t l t lt i tmlQ I ttQf i t

)itlt1c In t ti ltlii ll a nll liiL Stippr tl a)l l U

mm~ilt) II p()11ltltl IInl(111iltim IMgtI

(d1 iltlt)lI(IIIIVI

Ill lB O l ivi i tI R )ihi tI V ()t Ai I ) l i l l - ) l

tlLIH t iSSIIIilll t L 11111111I C IS W( l l lt) l l i

ItWrItaMtItuitII u ) Iiiittl Il lln lI tilt

h )Sp i l t i - u I l tit1~c tl ( wr w II Ih t i i t I1

CtivIlIcS 1lttudI( Iillc m ( l ot( ()fttiltla wl tl ua lUiiili i i tt(tprttturlti s~llIto 1 iitl ic I I I il(IIR I1 ll tlU tI Wt IIll IL (d 11 ( hill S int L tlMStCS

rt Iif I d )It I l IdlItnl ll i) r ()iII S flt-llS Iilitilshyt iill 1M lCI -1tlltlMniL ( WAkrut( ()(TlV ultd JiltlitlIt

li l l v l

td 0tliil I(ill t 1 VLtCl t t IIh ttI d M ( i 0 IMt~)IC lIIM

II 1)1r() t i)t SOItlI I()MII Mtidlt l IM ict WVilSiISSLSSut

t~tthHult tS Mt(It( tlli

(QAZ tCilIIS I)itC S n C(IlI t I t-] (C Ll IrtStlI IS ti IlIfi It(it I S(()11 h ICt R I ICSiI i IVCS(l LH I I) li i] il in l h n it r lrts ltlt ts ( ul lc

idc prliItI t( t I)lltiltI I wl I i ItI f~ h c (Iilll TI n-

rT~Su I 1+th til ilt t I11t(It( QlCtt)L1 lI I n ) IVI t L Ii Iht S( mwti l~l lt it(111shy

w iht w)rlil11 lc Ica ~ d lll)li w I(lI () ( A)llIl I111CC IS WTl tl It)I_SI(nMlI(d

IT hv w hcr IilltHitihW l i l il l i11Mn1g tltlilt ~~inl~(nti 1(iim lt thicir Im~i()lklIfIll

Cnrkllijortlt lt~i llII~l~ hl

via IIP ) w ( ~ l11 l 31P I

Q11 Bl111 11

QA Iirti II -tevit wIt 1 I- RiIcI wrxI NlIf)riiwv ili IlD ( II cl tIr Ilitilu

Decentralization Under Quality Assurance Programs

Lessons Learned Fromi the Experience in Uganda

IMC IlISt dtSt i Iht tlt I Jgia ndMIn P011ran

Ietuntralizaion is ric icnerail trilinItr ni Gl A ASSLIuxinICC (0lllll1iUTtOfil urI- NL iliail Qial iv

Ity II plIIII11lt LI l~ -imk -I()A CIILIII llilhgC11C I )P llII 19 11LAt 11(l llpJilrll

tort fitl higllf(Is INI 10 issist1l iiiOuliu lll C itlii v1s lri

( ~~ ~ ) ~ 111T )I~iiii IIl)[ ~ jtt ~ OfiIIIli NRoinsu I WiIS II i~tl doit( )HAM

(MC~~~ tilt ~ i1iv~ ~ C 11 IiV ti 0ii I tatiituii t~ t1on ~ )lCI ~it ~ liII WIS tr N) I 10 11 Viii

l Cfftli(Wli nt P ro hiiL lt11C~ issTi tllli AS ti SL t (dsiili(-Nv lISIltlir Ofi A ll( AM TVS

()liiiitappiiitiL SiS liCLII 550 ii Ml ft-11155 it IIIL I)t js [31 L Ill Ilt)I I nt I t i ill) AnklSASSI

151 II iJ-liiilt 155 Jisirii i t 1s I oQiiil O S 1 IM T M I 11l itin it]-(I) W W1lt fiG I

ti IHOi MC) I (i h rt f T tl I up iidlt ksSkil tlillit tuInM Zii d IO S I

05cr ~ ~ 1~ ~ ~ pi)AS~ aul Il i ISSHtS 111 O iid~ ~ uii ~uiiSO LS~ (-vi IrCn )it ptO1itl(Tnt tlt O Sith IiiiOWi hint I lultill in 1(is hu (i iA~ v ti it httl tti~liit

0

iil p11illr Intl ~~~ ~ ~tiirgtrhitii ~I ~ ~ ~ ~ atill 5i l I~ ass0 piiltiistli (IIniltls ()If ISII( tlttilluliiiI

lil iiiuiiiii 0( tirvi A Qut it ti Yi d t IiL ilyO IQuill i V 0 S iioIl SII)AI)tliti II~ Is Alltx(lIT F l

(0uk~i ~ )Igii t1lt JWi I isllCN IISt1iiilOf I IA I ll )il o(tV1-)i A 1R ilA L

_________ __________part_____Of____l____________ Ill h AII~V (lIllCl~ I hiVCoT -ltt lto ll l t~ iNR) li t I[ra l

12 a(t pridchtc ref a ~ 0 1 fisII1 VIQA iai hspoga ILH hl

cutplIl IWith invOIlvcnimn t all levels Th push ft yrOLt will find very stibstantial res stalinC [1 t u nc

icccintralizati itn Imm tilmt sectosls MiiIIV haVC CI wellin all sectoirs canmi vcrv ILaSi lieen (liL vry tinshy

top lll inlpltirtilc inlvitig otc ilte perillry dCr th Old SyVtL1 aid tilty will not wish to scc an +WIt district level) and theucILtr and bOth at tim opcn and traiulspalt atcOUintilng Ssti11 ( itlipllCl

siiulmtitime ItaS CiLtr-d itii iniicllIt with IntrI allm hiatsita lessIn c l lizatit it t to( be thill wiy

lelrned lit tI riint Lwlti with 1eiittnral thewt sgttarted lmCit+isC ittiiitieds atmuti in

ill strict s lntiaulS i liit wis b in i i iatmL-(by tl 1romll the districts andl til (listi s ilt il~ tminl itf tieshy

(IZ ti (I U a adit rtIiniit III But it wis II+LIS- mallnd It of IptOplt

irt int tol t1 t i tIS wisas a l b (in d1n- h0 hi lb Um h CC iM( Vhat our it SiwtrI 1xl11 SntI I trait itl tlstp+iritt fimlti tit itia~l Sys+tem1 At thet sinilt t ill1

Whttn wt FItt li nvolvttlath iC t illlil leVcl wI ( B The int tliOlIS iitimrcm1nttnt oflthtu QA man-

I iiii~t t1vr irl bull that witliorit Stri)itg tmphasis agenll-t approacL is Icry importanit A nothtier lessont

(III Ililiip trnI tle t01p it wasit tgiinito takc ISthat til trainingi and the awarstwss and the use tot

It Q Fn~llltilnA r MUMt ftmrmam inetlods 111iSt be Ci initedf

R I iiimt iRt ( t rIt iiI l inp rtanti to nlipi n ill (111Cire iaw hile i Itin lm er Of years lhis is iit So l shy

tot itltht~ ir( )A mtn inlliiti nIOlllistlit O thilt wherT ()t t1o a ctitile of workslhois iandliltlO(ILtC ii Q c Is (liet Olkshy(111 l+lA~ i district

ltpolet itltmat laLi lv start tl-iSil the nue loLds The SItulps RIlit ri l t Il (lt l g it X a5 ciId ld tim tinvtl~u lot al gigttreriltit t tip Ihlt+e dist rict dtive- worksh oips need t I 1fOlow ed tip itl Is lTrVisioIi

cittiltiliuilis slupport Iruill pipIc wll t know Sileshyi lie thin g4 ani teidist ric i team spI)IliLt L it tee1M dIistiCtIl iilco mm ttee abio t QA tan [wl ill

tId IeLid I) itic ian I RCI ) atnld the (listittC t tIrtivetts tlthtclil~i+Vvhlthlli otlnnl~ll hve solving tihei r iprull~tns tising (A nmtchianism~s

SU( Rt11r who ISI I w heaid of loca it I vo-ttnull have 1)(-1 iivolveLd (l t h ilt it tam in the wOrk- MCDid till start VOtl trainllc an llklilwarletSS

lhops Illty havc (littil i ntial Wxvlrkshops atn(t cOLtiSeSt tilt ttlal 01- ipriphral levcel or both

1ie paIMt icipated Intit filst tCilal Meet I lig of ill tidwhat Vild OtmciOtnside to t hebt r il shy

dlt(tnrAlized dli(t is Ite (lisuIsseci theirCxperi- proach + tilil t with dcttlit rilliitioin withl rite (A mIinage~l idt nn i tltF-R i tr iil ttlt t

CIL 1(CI-It01 1IRM We did the atdnrainit+i ilXatClI5 COUtrsci at tilt ill ti i sIt cent ral and pcriplhtral I Uve1 ia S MinLtr tliei hI lticItdtl S tie rIs h tt tIit 1oSt lashy

te itvMl]VCtItiit itf tde mistict ttiit 1 l ittitt RCOI~W Id 1C(IL ift~C(I- C~ i l hainiltnl havc bctin mtitital itltil itptit Iitnltill

Went to ll1l d istrticts wis lin aitt day Then stiited ( omnt itIt to the PIIC work ltic is getnuitt n C ( n1111 LI tI I Irt Mlli bV tIIOSc WIM lih VC iiulshySlt IIi n r swe pot ti0tit ittwOllpd sLnill it tiitLtt he

tl~I t as wdl its rct lln IhIlit ctmtcCL has had itullailntlll Meet ints tim rliovidc

(ili ()titt i lit thseSt ll isIltttS Oitita Ilt Intti iiFl SLpimO Ito tWlii i iSt( Ili oLitii d t liltIlSCVt S

sV ittl is ilit l Xil it iliglest b l v ImItniC tS t m tieil et Mil I t it ci tti fit011 till SO1 ti WO t l iltcatijtlattcrs

h(xVls ()ttti ittt fitds ia dttctrtalizitimi of ltspil- visit tacith tiistrict OiiW ctvci ith i r lliti shyx Itrx Iln ltA lh~ lb lin spli I had1)[11t i ~ Whl~lt ilt( (Ieuro elt -jira - dy has taiken part (Otd tlnit(ilatut

Of lar Ill(l h I Ofit b~ut iMS10hillIIt)cHzilhmln IS ltIMrlt ITl t Ct l ~ett ill] Sol-ISt 01 rT~StCiiH tClli Iil li d

listakts will be1ma It-itll it eila is vy iilu mIttlint lhis Ittcsctnts a tmtlitnltnt Of 2(-25 ofithe i(0 h 1vt itin Ocllti) andi [Iri pill-c+lit i t llltili SV~ltfll tin1 iI tiltC Ctllfiln l Scnh1 lr1 N10 1I Skiff + SILtlltl1nD ii

wli Iiw Ill n aiu ii S ftitt n hllit it s ilt ill past fiull wcck CVy Ot Iltr ini ntlI ill tit dist ticts If IshynOth

Ctll i w ith strong p i l w ill Ai ll tt( i it V lit 16

QA lPrief 137

Other Project Activities

Jordan Ministtr has a9i2Ct 10 th prisd Nigeria nfltlfllt ltlN ]athIS Ii Aiiih tOltr

i i n ll i l S1t1 O) I t

(Ii tt (I jI- lit tI lI I ) i-( I(iW l I ftxti IClitt sptcakc t1 I littliiV At~Of1 htl ( I S (di litL pi It

i- Vt It I t I11i (hS I liF lit) lirLll I IL s i1 t lt IFa l ttth sIr i I ISi- ii I ( ipp ttiy IiIsa (tlitit Al tJvtlttIil IiI( Ii I 1 C i t l t l hti- it t tI ll l io A mlIcl If(tIaiir - llla I hA(th rri l iiI)Iti

Iuul I()ura ItL Ii)K1ll i -1 1 I 11tJiS1 ) Hit uNnllm 5 N ll NLt R 11lT IIC Itit rI I i li (d It Ihl 1i

I Iidu~hd (l ) tlt IIu1t itN oll II u i ll l lii itltIS H MIII t U [t- I i i

ll lull it I lhS

7l i A1111F111 ( tt liW r)n tr iot l I i i tilItl Ih lttNI It I V I I I t lil tI

1n1try i i I itk II i I lt L I Ill t (S ) Ica l it11i ltli s(i t t I llt i l III) I I it - 1ibull

IIIt ItIof I I (l li IIVC lti t Il titR I SIt-I(A ITI H II I li I l Iitll Iit rtiIIt d

Ii I I iu t nilt IllAi Clil ta s i it

iR l I (t I al lii th()[ i ith t tllit ii l lthI-i tiC I- nl liitl it t 111I 111 it it ( tit t i ili tt 5 i

Itcaki it iiii iiitI ( I tiItllll i1 tlt 1111 i itt ll ii ili lilt- 1- us l

i1ull lt I t li i 11wti t 1 it - 11tti1 i-111 l im-i Iiii litt l ittii t-iliittill

J ll l ll lit lu ~dt II n r1MIII]- ti w(l i i IMl TIICfi bY LRLHAl 10i IrIX1tli )aIL )SdSll(( ItI) 11

I Miln Ill iv i~ltr Thl Pn rl~ll Ill b( I V( 1tliJZtUt bV NRl)I1 ()111i iIIlS iisrtt i~t ()I)iI t llll~ii htli ll i o t tflilltl c lti111tA IM 1n-M A HI (Ir(ItLntu Cl - (() l tt1gtll+ v i F ~ ~ u i xlt

+ill+il n ~ iiI il i~tiil1+ t lunil thili Ill 1r11-Mtik t Ho~il tt 1 Std

ass stII(C( it it blxLL l(Iuc ti~ lld11~ IM ll tii

tcnilmliniii too tIlI( ( wnlil+ili t(M

ru Ill 1)1()( tIil l rI w ltall AIlI E i) tN ig rudit

Egyp N ige urun it wamp hl [((lu taI ll) mIiI I (I (

In t( iu l h

E l4Xltlln S((it flM ThtJ Jr ll i W lltd N ll)l HltI tilt( 1[11111lh~ll

01)(111(r ukt n1111 t I( IIk Ih11

tC+ l 1i0MI

Ll i ll C C ti )[i r m N I1- I Il ca i tl lII I I t l h t rc~ d l i l i rn u SI tIl l 1 i11t i l titd

Q Ll il l l t vA re t )g lI ~ +I( t Ii t r lIth t tIl i I IJ t i t shy

o m A t (i f~Sc~ri ~t S ) li n h u l l - 1 t1nt (di Il t i ( 11 ( t

01I I I IIF M1 1]tl11 I H t) t tHlCltrl Ithi hY Pl ltttit

lp()i t( Itlt nl tII (ll 11 tlH101 r ( d i lllt to1(wi iilt l p~l~r l ( +iIt ++I

pil r I d w li llV - (it IM 11 Ill~ldH A dCi

ittmr o)lt(lt tf lowt )A I F it I llit 1 li~i itwi hllr 1i Vl l llL ~t lt in)(ui iz 11 M - tli I ri St1() UllI[ ofl~ill t 111 11il t1l lttit 1 1tltA

dAl I Q l l h w~ d d 1 I w R it ml id l l tt h wVIf k- rtl I i Mi u 11- Wtil l I )~ Il lt i t II) I l l i I ( 1( l l t

lit-misk ( ntmradc imiintliiiatIln w l~i hl ~I- k hilitltt i I It rltltii

11 i i11I liir1tlt illu 11iUSC IL- i lt ())11 11 I I M lamt( ) P wnm i l [lt

lt l ltt lll illiltl lii t Ill ll 1~t I (1) I 11 I( th1 tlwgt 1 1tlTit t t t( - -to iI [I wn li lli n c I mit r i latpit] Tllc i l d y ( r i t p a o l - a a ( i

14 Q11 Pricf

The Nattional Wo rksho)ps p~oxnk toIT QLUalit- ofA IlCAthIfor

I JP Cre in lPacst ine

- I I(thIcIK F N atI VAnionalF tliti6

i hA nAhwilh win ill hi and

LaCtInI Americp as i

~ ilI I ~ t trnnitl Cii WjF~~~ ~ ~ I I ~ ~ u~ ~ 1(11il ~ ~ ~~~~ d I IiINIit )I2I

I(rN antItp 1iiillit (JAI nonsi ihll A atlr tx Ir iL (QI in Ili

(2lii lt1W SrvItts inI P t NIu ra Ir Or dI East QLiit Lu-

Ilicir AVitinii~i A Qality Manageent ain tiiiinerikttciii

i N I ii ll Vai c I111 ru11t)iI I iil i(mmii 1111155 u l iItw m t il gt Il(uls of i crnI- n~ioili uiii iilC o l 5111 I

I~t Ik t 11i lt F a IMA )I(iitti il iiprvn u l I lgIMI 1iII NNlW Ill I dc (([INii tt IFt lii ( Ii it

11111N I lIit iilst III j 11111 miNNII- I ill litt andF IO ii I iANll lto liii14 0i itCA rild

I~~~rti It It ItlilitNiii N t (11 -FI()i~ ( IC ILI it Ni tI iiil t 1 Ii-i(I I(rI

u~~~~~~~~~ itt i F it pttui inW-I iNICTI rst in Ji (n (tMtiLS li

Via i t jiit iCtitlCQ UiiitN iUMi ana emt I I Ii I C NiIi I-iiCIitiillI 11(ItiCIAt~t iI

Br1-CTriilll~ CM 11(l- althli i Qandk inA 15

II cd

11 il Si-

IroiolIc in

r at tilt

I M 1 1 i 11 Pdh 1 111[~a~

I( has piiic( ti-t oppolItLl t y o hiH

ti-It( tl- It S- whatil I t ]-iIrL-ill tilW( it i-cl-ald it [rovitics ti district

pcpli- a cilaitIc- to iIltti t

hLrT1 s ill ith sc VisicS 1o

Itll it l

itIl l HfotI

Ilt t LItTr litt

cr st ron iSt -tci (LTcthatlist- t rIS tilt

t ilt0( ii ti-ti( vt-s to tiW dist ricts to

ticv sitottitS h 101c Mid tohl i at

ilo otut iilld irt inltmi tl o ack( to

il tit t t t cs vitws rc S ttittIl ttt

i lW kISiR toi tS t tlil it ttllttr exists HI trtdCr to

Sui t(Ii tiht diStritls is L Iltl) 1 t akc holi S bic

The trainingand ihe awarenessand

the use ofQA management methods

must be continuedfor quite a while

a lumber ofyears

(ill lhciollc ifJ(LirIuL]snstiveto tisWho M-ii t ltpitli vitO ac pitit -ltsictivr to his((Q

lilt J itril i 5 - It I sult iftt ills rci llv L-li Mi fr iai l tti it I t It Supphioritnit mi

nl

II-IS nt-d t otit tit-crS It

o al I( tltM S 1111 i I

i-I ll Vttlt

h-ci-ht ii t Ill [hlct fCill r-

llilla~tnlll

IMt 111cH(Inll ic

T(NM ThTc

(- titti- ill 1look

i i itTot()I1tm h

rtqtirc iu[t I ilfC lr t h l o OWnll

I orliltr11

G B Ich p)hcral IIcl ll1 (L-11I lS ill Idt(tl o I c r ilIc tt b y IMn Ici t ki)

of(o(ln i it ill if mnid

16 1 3I-h-1

LnI)ii tI-I -r~ t n t I

il il i llhat tiIi

uldt kbt tid s fil- ro-tt

Didt l l i Stiis S itn s til livisil-s

IInI ISHr llIVL b(iun rT(lucst in l k cshlls(i IcA l lhvc luwha

SC iht tiS r til A flowhitlc ~o Ith)u-h illliomcIll In(lilt( whekr idea of(rcLhlcnl1

MV 1Hiti Iiir1l l Spin ll s i Illat wa

M ( TCll 11C iliolilt tilt ttiIIIS illdt tilt kindsoilpiob-

len) solvitig lite t ilst I() Ilook iii lD hl ihc piooccss

LI lt aiIinS

)Iisl a i rT11(1AHC ICcI L- T h e lilack

icliab~lc trimporl mlakc ilitshy

workin anti inltClhgi-III rtIlInicntiallv (ifCicult IIn

Ististricts with 50 to It)) IIIitS hulnIircIs ofipctplpc irlCinlvt t- lltist ics ofttt1i1thlcni illshyso(thi g

volvi in tmaking dtecisiolS (ot itrir own arc illilld

bIog li npound

FVcrv hcalth llit has csaiblislctd a iLcaitit tllit llllshy

rntCtlt c mlllllllttcc liLCv icw tcainwork its one of

hlit t riii C s itttIdC 0A lillltallctCiclt W IIVli

ir ii(tgliltll sta-tcd ill IJ a lt t I

totcstahlisi h oitRT kittds ttfitcthS w

tlr cxist lt

playc-d

distriL [tiil i nIla ni

dilr hcialt I llMn itlil t-m

Tt I iatl t INitg

workcid with

t-olnCIltCalm and

Itall Ilroll

tiit hospital 1 I) iLtila oIn th i-jrtilllshy

wttrk ttttitipts Stt its iSt it(ItIStlt1 (d how It till cvcrvthii at it Stitc t ilC

Yit I tititk (Ittof tltr StI-rtis 0it ti-shytralizaiin is lhalt ill cias I lso toitliishy

districts tit iiistri ttr llhail lit nI (CiM lliL -t( tIlVCh h)ccn W01-ikin g Wih1

ditr G()yrtttps Itistjuit- vittiabli fIoni district to (list ric tIlhc- Ipollic now Is

tlIarl y t() irtct Iit ll i-micnin ill all

thci- r ac ii litS i pIrinial1 IlCalt ii ti-

lL itipttIlltt r(ii-it ill nttil thin s goshy

ng even tIiLu h thai wasnt l rhaps tilt- ilitial ScIt

M ithWil i-v t itt itgn iiitv

titikt ht ti

rt- (v)it It l-i li-ts hatsi

ti fi titC It- iot lln st tt

tot tutu tti

t l stleict o r is lys It

t hi

t-tS Ilo

tt I rllolc of

1I11 QA So ill lI V -IIcl( I moIIIIts A ry widCSpirc-at ipilumc was thati pcolplc fackicd

ln sl a trtlllllt m p tx lll it)

yard bu ilIt( hli 0i Hillasl tSoHnclCTrc cISc

that tliclt) tl have oiV I-IS]Iip orl t( ntlro] (olI

think thMl ()Il tli(-lt -Ct oullUc iMIt lcsIrcd thiitS

Somethcin t hati L- probal

l lc nHgIt11 I ( ll ibS11111 I-1S iJR) I II

Sh ip o fp ro b le ml s

bly (1iltli C-lnll aslzcl

nt11At S IIIC S I til0(1 ) shytI -1C l IIICo n r

GI3 ( )nt of rhi () nIs tIilat itms wVrk-t I very

iS t tl scatttlIi allS vhRtC ruSC of tC disiiCt Iti-t

tcaill phlt t tilmht-r of itcintS SC IIilgaitlSl itttiS

rcccivtd Thtv saw aitbl sica)i anid startid asl~kilg

wiy is this OVcT hcrc aid so forth AnthtIicr oMt

f o1)1( Iiha I at Id St in t1 i t SIts bI) I I Cic St r1ca tit- l focati ittnof nicwmlllt i vt-it ilt-s Viicn witIII( J10CM 011OIl(AVVC11ots V ICIIWCthi

star1cd HOwchart itit (Ils it bltt atc al~lar-nt ]ltt inoftcsistio tti-rtinari tntI hd ]iis

MOlSt ]IACcS thtIt+L IS HOill iJAdlt nHtLth1d This Is

ipiOrtait wIltI tllii- at itunlt rtof rIIramns

hIttOt1I_-StppOrtitd (iti ittiwiSt that aR ii Oil at

it- Siinc t11 CitiTc arc ttCVcT CnOtuif vtfu ICs to0 2) arl iitt ia I CO lct cd Ceitits ittO siI(it tit ioL

Wiat tIIc diStri t Litd wamps f1lwcf tart tit ipr1OCCss of

1itistt-iiii at( is iiitii atsi cat tllt pa

11tid t-iIfc rt-pMairCIn tiWt t i istrts tIi[at I

wokcd wit h thiat tad th tcflowchaii ittit was a Tcaf

i-Vt- oputtrIL titti to s-iCwhllta 1ftapiCtt vitf

tei vt-filt Iis ft procid tOibu i hitg prIii-tm I dont

kmttIw iltItcrc is a ictatttt softHitin to tills bit I

fitmik ii pc 10Ct ioiliitIli cIUtldpit titink 1n atI

albilt aIh tt iiil i ch-iics

niitittr lol bitt CtIt-c d Il distrticts ttllit was

fiat I)c iipt- (ct Ht-tw lI I Ml I t Wip lesi thIM (tat fiti fiii wcrt- t t t tupail cvcrv 3 )1 ir Iftc th il SOtltM C tgt WC idC t W atlgI i nd l tilt

tnottt hs b+itt sonict pcot-~t wi-rtint itt ti paidi at aflf

iT0 HOha r which clill)N-g-sletd lilt pr~cess by

illt ht Ing t l ilt 1 UItind + thltt++Mird (Ihcrt WCI~TSepllat-iit uiid sCa Ill 0fit-fIRftc wcthil t ftrc L stiparatct i iltitssis fti iring~ ( )t tiF tilt nit-it dti up

fiat vYitol lia to was itik t itt iit ilt tc pari r ll atif you -

WCtrt-i ttt in I a salai alti tiilt it ci tvit Sulrt 0if itsapshy

plartid ip itt t ill0 stILtipL cc h-Ci iSC tfltN 1icit

siTitnl to ftHhw Sattttt ta Stalidaid Sio il titC basis thalt thitn a standard Itatcin i)t(

ttli tfis i- atiii talfy USCAit--fowii t

RM At tiL firlst (i-tt-rafl C(itIrtiic Of I)istrict

I t~alth TCams fiitfl iiI iKaInpala ini lD)icctnbCr 1991

distirict aftcr district relatted thu pro ems tiley had

idtifiIhCd tid tf lltt dCScsTibL lbricily lmw ti fthlcy

-g(nc about s ing thi-i lhi-riwccrc about aIox

match 20l districts rpllrcscntI d about 3(0

lplc tniCtio t c mccl iTHIand it was r-cimatiritbic

TicTy0 rcaflv fclt that thLV had mlldc mtcasuraflclt

i)r91SS in solviiig Soilcof ticir mjirIi pitrItlltus

MC It tIicv ta II CitI w ith pro lIcis or soltit oi s

V()it ItIt WtIVlt [wh till L lik t10 SULdill t lt ol fc t ovh ik-ciIiwcrc h it

vtt ttV Ui tidi-tfichm towvard a1bcttir p~robfcni itishy

did VOtl ICt it dllO

hctificationt 0iot1 tttr so tuiti 01r01 iicnil ilo

RIM No tic) WUi tortllltn abouti( wit tiiCy 1tad

til(t I thllnk []iat tiIc otit- goit af tiii iincv was

that it wouldIhIItavChti hicLptil to Ihavc LttttcriCLt ushy

mnciltttatioil of catt what fiat bCtt ttc Tiltc

ii C-ntil Ii robictIts aniId WO(rkitil with [caims Using

QA tools tilc dtcvchipcd cnriliiV sctnsibcoSoLtshy

t]l)ts Tc iatd itpricssiotis bill(tit what tic r+cStlftS

wiri but to rcfaitc Oti to t i(tfitt was atbit Iprobshy

icmltic Actual ill btis uftili QA Unit atc folshy

lfowing ILIu ipl Sonut of t0ittllltiatnat ittiiangtts

that iaVC otctutrCl IaritictLarL it ficaftit catc [or cxanpfc tltcy art IoOkitIg at inatcrtraf comnlipitatitin

c craf pat ttirns and tit shitft in appltOacth if trallsshy

oIi n t ficlwo llitin ia v in l p ro btl cm s to titll h spita ftrti g

MC( I hcrc ifocs thc ro ralt11ini itn1 illrc1 T i S i O II I III M C I C t ~I I ~

(ilB [his is ai tiUittt ryIh at has bit-n dctstrabifizcdt b~y

i -j() Itttiprogress5_20 Cars of wa Its biein making good

but wC still tay a cr foltg way t U o SCvcrItl big cit cnits iii aficati ( )nct is itiw tit kccpl tl cii u+cashy

i I in ti is 111 IoCS guafpri bcMIcat fcI(IIICcpr I llncils

CO)lIMntr Shiwm that Civet vcis Ort So( IS rglCiIOhbLt 10)1

c tttililg St inttlll tiltu Illa f p(iSpital As stillio t

whtt it t ti bft1it it di-vi-Iltpint cttuttr1ts I Wthisi StalIISlItdftt) say pt-tilabtfv ycars is tit- bitttol Cttd of thupfvi

tt kTi iptpOit uit it fiow toxiic-abIt

cv ip titi

gtoing for fic yctls o wttii pcihttii oftimli- it

kccp i-nctlil1tttl tip fiOw to IrtciCss

talkcs Thats tin chiall ng

Ihad 1- I gahi I nWh

QA Brief 17

Th IlCut Ihltu h iw haT ishow m)mvi Wie

CIICItpts (f() and c)Q IIIa ttMilt liow thI diStriut hu~alth (califuut thu OAKlto~u cun-

crs lttlvts l ans CtVt h kCti t ittilWiIi

isst o (QA maitiCHI CIItt as r ll ut l dsk d nuLn-

atCtuIttiii IllIiiltnLniit IllIl I lokctIC Vi ha nnt

altif is If c tstihs 0I stauitiartisi TIis hCklisis tid toIli(h CTrvhl()dv has to)atJlhiI 5O vU Ln

Cr i ti (If ill ilt Il latia CHtnlttt pI~)I tCt I-So ivI I

M0U c t t il th is th h0Ii l1Jh T h Ciss ult is l h vIIltiU Cict

h t lo iU(titi wthtan 5t1tt tIim ltC llli shy

+iiv ortwhat thLv Jltthitnsiivts rtt hit trn

ViSir IOth diistitI atth ttiv nin itiltatIth tilIUt

ito is li to iS( i i t) lr~is t b t Ill tfk ho c L( It~ (dlthC (itlllit i Ill+r0VtInItl tttarn tlCS al-C tIf( kciplater

RMTlIhrA NuCT(I to bC(HiltifILIC( tr-illillig AS tinC

USt With fcomtinuiny workshopsMI (ha(t thL hht (VurISiNIll((I~l vil[ 1 ofl4 H Vl i MlI( ItLR I ioll a thClIL

+illcatI is brlt (lall10inbC S Cluarlyth r t I I 1

It+CN~u edisiiltts liclthIlIR cantm I]IiV T]hIC NtIlliill ItIIrIIis IthCucl

JiV_ SutiIiL skillsthaut th ISHnU tto+

oIill i aland nage Jiiidthiat W ill blcAll Oll oilig if(i it

Icv~d pim-1 ( o m ial sanda dsl

lhtCrT lltlttl41 I SStht h( fll b~Ltd -iI i Cr ILnTd tol a

(IltCAdu W Si0)l1C that htCIn S1tiutd [)ut h1iISnt gOlttCI1

t itold(ATu St- lliil tI I C l t(T ilu h l) a II a St+SIUt UIltiR

ttthdis+ti i t o aSSCS (itldtlli( tht1-ir1Cklt ill dliS-

ii(t fill ltlltol+l]i tis-tIiit litt il l bI V(t I (]~n

ltli~irit isto) ina

iliCIIn s~u ilit l W IIIamp l hVChI

Inri t bltit loir aiIlvnuhinurk Arr

111 tlls[H Ul (IC luC lbuit

-i Hoct VCl i_dV to b I )H I)LIiC~tt itlilo Tlhat is SoIIIC

liinll luhhi(- bucti ab~out how to)thalt ic (hmi l

stUSS vlllr (AVli 0 tl TVIltCfIlUdlit S -v lhClillsilLIl-1

ia 11 +hIMgtls ailtdh th( 11i)11(l Itiltdli~ttri(itll4lat1Cilti

aIP1ngt +V11t do III Sh ( IiSilldi~torlior (ltlility

i)tlhir d IStiI( IST hlu ith asiun ni ld c Sonict lltggt5-

AItthtisgtgtto iiltl(t( IIt iitnball(]~~~ ~~ ~ aloilLthloIISITIllAO

Al~ih iI I-II

HoHn~

worerstmsTCIs oli~~lli (fil popu al d

C lilsiSttClUtNto)SCthIMw thlir SLT~lVittS dit

18 QA lPrief

GB Ahot hcr thing that has st arcJ isa small grants

ptruram WIIth t do ol)praltiills ishydiStritS Wall Scarc mQA how euro1) illillprovc (plalityv thicir (lisshy

tiit antd tIv ti n tl tlCllrt)ilrtI t talut iV

t 01111c 1ta ap o(ly t L r n l i nt lnri4ta I It Hot

Try much inty [it itsn cuih tU hlip thim witi

traitnsttitt Itll so Ut Tatld Is Or M At-ritlS

WatsStlrtcd jLUst a to )t[)IltsI itck R M Two ui UItI inalttop i (s )n Uis thI inl+rshy

tUittIt t SititIit ssttI h tkIs t iUt ri hmtitti lci a SUk ()hr nc is that l Ni IS shonlid CrtIWtom

+llt mr itli t il nr thm will hct uh and ratio-Imit ruquirus atli tiitg ttt lult(lii l irtis atrhll)Uc 1+uuI l lt [tIS vW h m-1St bUt ltrC At vr o

WVi I Iroll) havit+ i il i H lll ll Lt l11 I Ilill

1rnl+ rtallt t()li 111d ShOHIIul~ bCSCtl+tUd Itltm tht

I)d rIthIi IlltIk thI m thII SoII s I IlII(I ) ilfI i- )p]Iis[tishy

t tU~ldis flotl l++ti v a1 lU0lriatULIlilrl

ThC SC t tol IScmitIlIiuInI rId tl+HlOp] CIuCai( H LCIi)IIil h La I iIlIr(VC IC t ldf gC

lc oIsiIt lg ifg ([il fIfg p o r m 1

vcls il l ediA yl~lt~Ir lIIig lIIIin tfigtIll gtd r

anti unIiVTritv Irifinilg It is b~titlg il[ro~duut illnIh

nICAVI dUVUhollCd Sduilt l IuJhlu 1tIIfori aidshyltxVantt~dlicau lth trailillli ihll1awdgt Ioln dhialt

+WILVCth+ariI td i t O t(o M illiStr Co(ill i11ll iLnl f (th1 llishy

tFnu Ln lic h l (I Ciitr 1 Crx wit( 11 ist CHllin

The lD irc( ill

the hWginling IVCn AtnltCnlb~r 0111t QhA t flit Alld

tiiltcr D)r Vint cmn ()joom cuhias fromlll

a1tabh ilit () ~ lln iti (L(tio lli ns( lol

fiht I0 illtrodlti Q lilt() All Corllshy

lI~ll~ itttkl[ilit in

IttluirtS IhC TQ NI I MIA tbull 1~ shythait (dhl 01iCl( h lild

trining otfm r1Clit41 ll centLdrcs

(A llG B1()liI 1 luUltotm + W UV +liiM()lnlhuun illshy

o vdilIl W a l vtc a u l~iio op tl bolt al llClt tC II~IId thI N 4thimial Ihosp itatlo th hISl1it~i

()lit IIICSh tLlatltt l~l tiltinilrt )HCgtofllttliit IC ihttl[(IhC MO CO IIh li(sntr Vut tstlltIhu Inumlt um tlt v aIhrclt

Md hill till iLSMor diti(i lhU (QA( igthitlltnhu

siastic ani tiil flcx itpcpit litit whctn vOnl move

Lip ite 1it11ItiletItbs sIt iII aIl t +trVlhtdV has tIhIisltctd ill ( )a tIaIdV a -VttLt thIICr hcst s Ot

coutise till Is whtlrt a 111un1llttlt ( idth lud Ct Ialgtn It)tit aI lltl(i n ii ltt V q)tl tt) tlite scrviccs

of tlc nist Isalmi it rtlldit)s htt( lllitIrt-atr Ilt

01 p1itat I() [()(I at tlii l (IRStet reSotII-CL-Srte~ iuC~inplemern

tstd

ilt- bittS IItiIt elcitctl t rtt ipounditt ull

)nLect tI udIts ct liititl aS thlat icolehbull

tat i t t t()iliat tluiiItvvI

-0t tW haveillit rCtStllt i ltSCitllt ttiIt 1hrspt

havc VhL tIIill iIl pr tltityIY WClti ti M1bt Vi ttu it i +

lll klIRIt 111MVtll I CS+ wVihtt 11T V()Li )lt tW t(k)tilt

~ M iII VMCR ~ MJ tLISSW ( tl~ ~~ JIM dll~ -IlIlbct~~ ~ ~ il~ ~ ItsS I 111 tlt l t t ltiI tS l tt lfMU )()tl

1l ti MlI hIl) t (d I(Il dI tIIltlr)11 11tu~t (IltI1(T lal So)

isthu ti pl+Iltint tic itbit Itinitk tithllt itlfthIi t1111llML-1t

ci It 1)c111iIl o kat M COf tIIC1111111 s (d+h tilI-r+ t n (WtAt ]Cilstw hit W tC

hivetlt l tt- d thIt tillit Iic t iltiloIlt Vtq tIII VWit1 hc 1111 ITS01II CtS[CshytL1111ty (hJ(til I

ta t tilt t ht t tS iftt t tcl il itlt in tlt x1a1

I IlctlIRt Cs iSJIM1lV ret ( )itt liasis Ilas hltiI

ttViii th tt htQA

AII(ATIi (tti t [it111 ( hli ilitll lit It Wit lt

areais +Vhltt t +t I fit k~iltl ii Itlitllrte tletl itt lit1Ititssttl OIllt i)t [etta rtbeltte tirittttithas

ki tiiI rwrm illI lit

M(C Vtiti Vlitl lilt aYisLtt t~llsitltr pIr at

GB ( )vtdrlI tilt has lccIl at itlt+ ItI0irtml Stltetss

thcrt IaVc lt-tin ill1V lileltnis I Jt-uttss it tlpcnids

III tClMlS (dt( hI u 1 tilSit(tI lIt dilW 111 ( LeW OHt L ad

lhmvi lz[Ihtli w ith ali0 rt tl lh it 111d111ilk ingiad jt~ t e t

Ictl a rItlI~ Isfro

tiltl I V ttV itit bSt lt5 t

ISIILL cIIl111 1 I -(a I IstIht mIIItC

l irWc pl+fn ~ tCv v I IctMttSS

TtMCS IM StI~g ht wiysill VcrythIIIIg is toing tilt WC wVlt(h likt it I think many ptcIll It inth ccnttr

lo t Ila tas tttC t ititplt it(Q as wt WOltld like and hipiti Iv Ithetrtttlt riitttinlgS wtVVt had will

QA Forum

Each issue of the QA Brief features the QA Forum This column provides our readers

the opl0rtUt1ity to share their experiences in ting tluali ty improvement ntea-

Sores in LDC primary health care systems We wish to hear aboUt methods results or even unresolved issues related to LDC qualshy

ity assurance inittatives Otir goal is to foster an exchange of Ideas a[Oblt SuCCeSSfUl quality improvement measures such as

innovative methods for monitoring the~~Lllt Of Ciltrt+eVltItt

quality o care team approaches to successful problem-shysolving

supervision techniques which ensure CItlity ofcare

t tools used for quality assessment

I you have an experience to share please

send a summary ( I000-word maximum) to

Forum

Center for H uIman Services 7200 Wisconsin Ave Suite 500

Bethesda MD 20814

Ifappropriateptasec oa aerf may obtainiialc

fulter inforwaiw Wtnvilfiiaturt submisions in fitrt isucs of the Q11 ritf

hl pSt ltlt Clt u LMt ill t gl h lh t B t I t h in k itS l g lg

Miiitctfincidolilt otthlct In ttilaspttttiarjiljo rIl cssilg tsolQA IllUItan la hlasll

n c(O or(I IIn g thIi ethIrI thIiIn a t Ji t p uit ngsto g e Ink

Illt ha t w ia t l~ arji0yItIhIS M C 1)lt aSI CctactlIL

QA Brief 19

Documentation and Dissemination

ver tile past year QA I hlts boostedL ctforts Ministry ol I lealth officials hLot tiuirsi ties

to gather c(ocrete C-vIlceltedIntl S rat- the 111iiita Ilcalth service aitl 1111111i11111

ngtthe assolciltionll ()QA a)lpir0chcs with tranliit insIilulcs In tiddit loll scvcral JORLdian

improvCd STvice uILIlity i)octliLr tit iloll fom1 te jOitilll ncSle)apcr iltld llialallite i ie Its hiiv

Iietl has bct iprviIldIw tltlalitv leainls as part of called altlCjli to I e stll-til of iht pI)IoeI tiIy

ltdlr Il)ItOLIc -SYIviI a( IiVitWs ill bLeen iprotlit Cd variOulS trat iii it i(ors s held i oglto11h0ti1 ti t

It l-Mu1t i spcialefort tl Ileptrt of ()AP Stailf to Tal aid related tleVCeII)lptens inI (uality aSStitshy

tA IlR 11Mi itlISIL II -MI tlli( L( [III Ita tid eedn i p

1tli 1(ll 1 an IoW i ll JlI tileo t tto illf Itt rlil alt act Vt tiissct iuI at o

loat~ll dli~sctinti its have bccome att a0th ol ettiliitatllltoll s-tt ite- stIiiltIV whtitIdesintlils

il patof tlativ ()AB liititQt rv Inlsand target grotiltS dltint lIIbtc M t1oPr itt- iVCatlS ittli(15

LIi li tIl cvcloCotit be tistti aiti coisidCis tlit estttesof Rel ilal ICwsIettcTs l CSniccdcd 10

par( pat Mol ill tnt oti l tltlfetttctlCS atid liblica- otimize the efolt

tpMit11t1s( ILSI~II alo t tI iUSs111enOIittatet SltrotIgl Iii iulotia Niger lie tceat i(n iind quarterly

of I lciltI it I- lSttihitI uult tii tegciill ica 1i C t newsletter p)rst itilit 1 1 ieI n io N itist is

fhas glltil Iv sCrvcTd QA s iItl lt ll Talitiailli lt Cl as part ltlt in diiO(M rainin workshyshopl s tiitltittd fo itihil hialtI staff lS ilutuIt l)epatmttn tisscniialt ion ojecttives The

ID) I 1S l W itl erlcry iicwsIctcit AtLt Sillt is I Ibli sited I)InIl ctI) rlill nlW01 inlI ( )I( llvl ily CXltritnCCS111d p IUoltalitt wrkIt IlC CI Wt1~i I Deilprlet ( )fficll Mi 1in(lyhICSYMd I S ICepart nitt t Itt al)tI t

and~~HIIMfro tiltIC ltlli iI wart WSl C Hc Q artt ivit its pirt itulatiylieest efilts afexvareincliutcs iclilltilii QrAlatit Itsolt lettic ltews

higli iltutd blw tile work OfI pt itss ini ivlcit ItamllS )epairt-

Ill JOttlii lisscLinatiintt is pirccRivCe to be an mcittal stafilf have CIItd cUilT tl I]Itlt it0

a tivc method ion DIftommnuiicat thc itilorrtai lIt inmtreotver itDissemiiatiot11lwtparint l It

does not requirc merely priduoting a wreittn has filhe a cl mtunti at ion oid cxist ini amo tit9

LuiIClitct otiither piitl tict lid disttribut ing it the dis iitl beccw tl Ito 1itts ot lit IeIi tie

all co terititl )it at ively t )tlll tclll al iin tltc Dtiea ttii t l I lealt It ( )fftc atd I t(l ist icis wocrk it fict I-01t1)l C In tolicrti h)Lgl (is l H11s cets The bul lIt ill has Ais) scrvcd to keCp ct nltal

trininll worikshopls iIico- Ct prscal ctats M()I I staffatt d lit tcCraITtblic iitirf ctd of

TellJortlai project his l atill At iaCt tlisselinta- lieltll sttlo0 prVObltms I toI ill Tilh(ta Ill IiLIttt tion atlnpai tt frorI t it stat Everyt IctLrc mobilizc al tll Le ItRt Vt I11S UI IteIUtIlC1lingi-S

worksl II) aii IMeeti i119 cotItltttI I tas istcred tis out break I)) SIIpuI)Il i tt IItt 11oinlnlIulliZat 11

the objective ofl iiviIt4 art itipants duplicat tile tanpal1iIs t ftc ttwslcic1r hlIpcdIt( itlrm

QA effor aidc pass it it iii (t rs ItIttles and people ibooIt til LIatuOt of t I 11i1break iailtI

workshoips have bteCn Citloctitl not 11nly h ir remindcd iealIth workers to chc k measles

20 QA Brief

-

- _I

__-_ _-_- - -- - -- i __ lin I

II-_ _ - - -- iii i l )iiul h

-l lwI tP W k InIJ

r

i I li ill iml irt inl i cSSinmtifli ILLS hbT III ItiCi I t()i tiLttl II Ii Lii tr rshy

i I iijt It

I its Mid rt l li it iLL

_ (IOlil i litiL c trill IIIIlliliv 1) 0 IS iI ]l( CoISSII) S Ihr t u I

I U IIIIN ) I L I -

Ii rI CI il I

M cxhili~t iht Liist]Mliati

nlIiln Z l (( iLL S L In L I Ttac t n cs ILnTL e Istllltlll I rlt l) ltSn l isLL it~l~ ~ ~ iii~icILt~iUllSL l i tiit tist uit LLLUis i i is iLtt t5 tlUvshyhit jpL)iiTILiin a IS l h inLI l mctc11 HOW Oilla hl-S A S - id C LCId d ll1S i ldiILSnathniilitciharts taiiut-aLui-ttttt I Jiai~liis n i iniaitts

prtstIlt I lit IS (U itt I LhL ALt ixit it Cshystilt ti (iii

hla IIItJIL iLttiirk art vtlr tliSCttll ILLCallinglil - Scrihc tilt Si Liii RitS wh i sl UVMILILdiSjlilI Llits

tIL Illn t tilitta iivit sitt Q2A (tli11s l(ir tXilnlllt llIIliCl (S ill ~trtiirlliiit ttIL

1t It( iv 15 1[ iptil in (iliiD 1ypr flews (i As 111t in lt St ( r UiriJ li itIW tcnI iiSttL ill tillt

ilit pl ti tltirt t(U iinprI Axt tL lUltr rtLi- Ruaill IL-illti I 1 1S ( R II s) Ud t i cut PrNWshy

inH IHIShthl i int 111 tttfi it I rttLt ill (Itsk intt Iill inits iIC ii lt llsU( tddistllilliatltinu

I [ilhlit i t iln ii () t( I ILc ilL)S W didtl rtilt liLt w()rk Ut irL)lcnl-s(iv ini itilnms Ill ttitinL

int~irninL iii IniuL iilits in (ilii( S I rtSu t (lit St lVIL rkd ilt( tiillIS rtxit tdti (lit1)l()ttSS

si tm lli irrd in L Inlllt ipic So-I Ilict i I )I Vt I 1n- 1 LI iI I I Vt rt ll l id I i c ItrtIh-r L I t~IllnIix~ li 1 hL I t ILC t R 10t IlI il y t10 iILdi(cSSIv~tIlttIIh W IR- II Ottilrll C It the 11ILth M

fi ll 11Ist at 11 l iLn L li) T itLL Tr 1ilLi1tnI s irI 1iL xd LtIntil (Clll intliint llitCst ItIrtI

lilt ruI L nt( ill 11lIrCiS (d Ilt lIitili - i iSt t Lni Si ill ll iWWills t Ill t Itlin s )1111kill

tilt111iiIkth 1 R t V t tls hit ils II i citiisthIi ulxt -

iI tI LI ti tli If(t) j(i I ssii il xii it-Vt 1LL iL- il tuiL liti as 5ti liat

MtIIILrItIi ( t Ity lL T h

x k L t i- rSL tILIIIi iki L5 Ir A ttIS(IiI1 SI I l Si1i

s pii (1 it quLL i sl r ft t I (c l it nii QAMtmOlint IIt hIt i111 hC Ii)lpl d iil in MIl i CunIL-rtL Mt LC(tt lr 1 I()htll ]ltvalthllll h~ illhyi~n()vu tht RI It

(PAalit Iillailtrit Il Iltilh () ii ly tii oiii cl II )

QA rief 21

Some Strategies for Managing Change II W t l 1 11 Ilwll 11l Ilg QA Pl

AP rcc() niztd tirl ill tihat simpll i )- This ap] ii t ]I strv l i rI-tilifrcet torltrtt i pitshyriii II kiiiiwlctlt and skills Wvhilts lmiH iiiit t iitV lti skill b l ltiitsts no()ullit Il~ tX Uril u 1 tt(litlin tll M tiiIIIIt t ss lttit it l~ g

1J IIIdC tl[ltait il+ Iltd iwtlrv i i-s ss t n t r tslponsibi i tt h - I I l skills h tct ll tl C

ItltiI tI C l-i L

stilt r l h ucI alls Iml alla 0 itM

aii I I t iil ohi ( II II i)ini lCltI a tlll st an

A T ) ti r I I I I C11 Q A )I I) IIIIi lit IlC()l 1tl iiI t ll( N iMa li IQiih11Ilttt ( (d (I t 11111 Wall) bsiliitl I IiaW tlttld r1 -c ialldl r it~l +IcM ) MIIL 11 (dl ifS tltch- I iil t1 A

1 1 i rls l i I ti id~i i i t i i I iMI t I aii li i tui I Sc Iy Itith11(aASU ( dA M1 JtI 11-t( 1I t 0 H11 tli~tt11ll

htc i li iWiit i(it k II litd CiI ItIt NI I t LIc(lt IIII V Mh (itffI i I

A Y Il[-IIlt R ((t I JIh lr ~ Itl(ItLII hMIIdI ITccIlit s ilt( tc llt 0 I(t [I I c Itlclil 1-(((-1 ( t ( I- i t I~i ( IIllll

irI d]t i i i I t it m ( d iict i I iiliwtc Ik illI tiltI kn( )I- I lIII lln tllcili I Trill (Q )l 1t r ) 11(~l( lit L( I 1i [-i l1 R 1 Iw ori w k cttIiii i1]l CU itl l l 1- I itic

lt+llllIli t)lc lltts ill( p ilit (lIqi(~l woillc 1ii()tt((ilt4 d p ii da tIlc rm ( (I-cll idldti-lrt l c W )IT H 1tilitic iOcW rd~Illiti~ c ()f Q A hillt M )1(I IVl~t Ihlt C W H)11 ll gts ) Nl~ sid viin illitIiaited ii ll ci ir1)(1i tol l nd tLcchniishyl l i i ahlI IVl IJtl~ IM 1 t( Ja LllXt--l ll stx (f I ) ( h i - 1 C I l 0 1 C I) -A l tIIn h mil vill tl l l ~ lth l ll h rl~cn

A ( riillill-pliu l ill Q I glypt il t~umcd is t d1) 1) Mh IsII CIIIII (ItIta 1sa~-~lilIIa[da Ms()I) ~~~ ICll~ai11Iy~~l~lallv~I~clcrha 1ihc_[(( lt

cu it llltllfII ll h uitI J1( Ji iId ai11N Wl il- i i t11II Ci i i ( C Itani u t ilfi If ililitiht i nriit-iurtl ircuitl ti~ itlir S i l 1 d I V I I ) - N ~vi c ili i tl l ilili ti c )u lt ilmp icnewitoill it lit Ili MV1U_L i d~skillsI lg p m ss h yf l1111f R o (Iililll) tvc (l t pr( 1tti

IILtIILp l IIlll cr t l ir 1((l in is (d helplcss-M (~lt

Atcr 1 iiiimi ii - t ( )p Clat ing Rollin nCY WIll I lhc kI IC( l()lil[ MiPi tt-C i th

Illl in rtlt litt gttlp~-- sx i llr( im -c th ir ((M It-ltd degIlhcv il hl c to aap thl (Q A

tc( hini( t] mil gt iiiltinl killsO A() 1I~ C dlv~ ll 1i ill( Tclilim aLI~t ll ( C ThlC Itall

all t p r dt It I--illm itw ( isti a llil ( 1 11l i l n III CIIII)Tll t~ t- If (Ilit I Cl I l1111itIt It lti(dQ A w crc w o)rk w ith tlI li i tlli t i i h ir lioniclt h slit~al 6it i ii pmltailt lidt (t(-i pr )Wilhnl-s( ll t was hyi~ail 1)(-i() L() 0llu(I ltis tlitliii ~- h c bt ( 111119C Ill b Id i oit ( Muh il y ll ILt WithI roic iu towr (ht [sm~iltrs litiliii s (u~pl pu n ind atl ad~t(ILiJIit Mdi h ii ~ AiLt tliR-ir Hiliingl

tl I s k iIIs I nI( k nIi (Ig t hI Ic y if nII cIc cn w I wIc

a2 d 2 C ( lll iiuMu (M-1 hc-job ( iainiii WhciI n~ccd

22 Q 8 ricf

cain-buiilding

TLrkiildlh t pruntnhtir i(

IMi I itti i LI Ill

tl l l r- I rtI ir 1 i t t ll I ii

Iit t Iirt iit II ia lI m mI i ti

r t1111t1lit Allil 11Ii

+t AS t I I 1 iI r Nht 11Il it i II It t i lS

)(t) im) lit lilt Il l lt ill iti) iii QA if 23 trIIr

It(tlttl I III ~l-lunl 1(utdtt 11

1l1MA I cdtt (h 1n J(i i t

t~ Ipp~lly I-ll (u kill list- ct1(+ 0 A)tillt ill j()rft In n)(mdt h_()t liigtu + tilt I thi

bullL-11 ) IT)t()(lr tt ( tC I (1CS d I IIitCHnk-n1 ()ks

I(l I( tkIilt tttI c 11 ( itm p artiIpllI M l lW)l i S

It 141111111111l(tllItll)II I LtI11t1 Ltt 1) ctt _rtI11 I t I tI) w(t

)llI-ii t I ((+)rtlli(_t I( AIY IIlt l)[- tatill(

wi h +lJIMttst v rll ttM AUll tt(+S+I+l ( C Sha rd s a ndR e w_v lRe co g nitiO 111 bull ()~Of-MMtit 1lt-0t1 dirt Ltrtilishyf It t(+ qtlltl) ()t

1111l1-(i IM-t)uLu ++ i l+Lshylt ()I vh( MTt

IWit SIl11~t Mid M1t)hIrShill))-trI[IISlt()nl)llt tWC rut t)1txlt()tlIli h I(4-illf(tM 1 s h+titi 1 P()tSO intht h(Wl llv Sttt(

kimtw thatt Ilcd )t(Ulmm Iuti)tli(d) m-rit (uld

titau 1W tI(lctrl ()r- Il+u )t-ilit ) t t l i )ld l~r

I(IrT ()L1 l A A-A 111) ISt[ I() Coll 1 31P1

Il1 1 a ll i oll+ and1( htiII wtxICIt h t ((111it1()111 C A- 1 I) P III N

TV st 111 h -t)rI l u 11Q l lw tn11 N PPNI t( I) ()lh W2 11(A lL a A1

buh ++vc l III hc rmcIu11Iil a H hlld lwd + p s

t )bC In(+lk buttllI(tlrIl~ I( l ilk~tt

QA Brief 23

Institutionalization Issues for Quality Assurance Prograns

Lori I)) hf ) h OA )n I PI I)i

11order to achieveu mtI InaI iii allt potco- hL elII itan It IlCiTdS IL dI aO ti rrLl IIb JUti ve tIal itir amp itI V IItLIJSStIrllh SI N- O( Ih sSV l all rlhrillrt tailh mem elr 1f) t Illt ]()111ilW ittVit w it] ll C IW th I lll l(III ll lillIis

0rILIi liI LL(IT I S 1 tL IT INL)V[i LinS

it hi1 1 ll1 et III ( [ tl l l I m rI-IHHIS LtLr rL it 1 JSlMIITS Slx )ililit Finiil I belief in tl i l t

tl t 51 ltLL (l(I te l LLStI LlL btIl0L IlIVtl11 tb iliItet tl 11( olttril lh I0I ict ILLk

N NliI1 IltilhL11i tlLStN le sLIlls ltvrrntil tlur-iI(IL~I fHY t11I I)(5 tI IC li I( I ]IL10 La I l ~ls1 lMIhI I (it II I (hi LtliL II IIlIIII II (It LL iii n I) V IL L I Tl i N ii I(n1Il(IL It IlliLu AV isliuitlIt ( I(l (VtI will rtMii1drCI(U

IL I rCtL ( h ihIit li lI I li ( 1 (IllS tLIi0stiSI

I nlstutltolila~iisha tionl tllliltI5l 1 ltI (xL a1( lpeel~rtni v t(i(Lrt i i L~~l~ l)lI L(i ItIli L t iv i)Hsioi iILal iia ()t Il)12riLn V z~iIiVilui Lli I IlgW i Ihi LII t I grilil A )ILI TliitL

I (iLIlC tll-U d Nio (ILL (SSLLhII MILThtaIHSCL peLIIILiIl t (Is l lt Lllie L i l)5I aLLICli rltf(Islu i fI 1 It ( I) I0lIlt l ftlmhl i L il 5 VIS II h to

hL i lt4 Il ()tL I 1(L liLsI l LV l AelILll)AsV tll IiNLL~rIh11SlL I IIIL~ IL ILI) LLLI~ (~t5EIt5i1141 IVIuu ittIresein(Ii1 [11 lii 5 tlltl1 O la nd lilt t1eiItfleIIQAt I1lVl A IItde iIiIitrr I

I~~NI IaIL oLILL siLL 1WA[pI LAL Ii -QA11 ICILLbe furm d brhI e l etI0I) i II IIit i (( i tUI 0Ivilli)ItIICt S IIuVI1 II IC IlICinII CCzIII w hinM R Cti11i)L i~tll ttxI1 tl I[ tAmillil() nl

IQAiI Ill oi tllil l l Q t1ilie t L Q A izI l i S t l ( ki shy+

S MWAi i Ltlu r llc i ( hI (I I l s ll o0t rtLLSLta s i t ltrLi-

IilttL liIMl I Lr tll(lil t ihL ( tl ii(I il o all

Ihvuhlpcl QA p~ro1j1a111 ICtiitCS

i llLf ~tI (L Ih Iirii Inm vtli itt~ if lljrex si v 1112rl(t nItiaks iil nl(J Ivtns tOA Irmlul i Vi ic lolrcllt ItIlItll tLT 10(JiILIVUih QA L TIr l Illir ) i llT]I d( miIt ~IReshVUi Ill IiI CIII IitS11 tel CtpCltLoII I lL4L a IllI Lr2AILNI I 1 Ill5II LILISIISCI 11(15 Iis So lh t CliLIIll ttLS nlIrworkil tLII isIL~tl~If tlIL I~LI1 4ib1 I~t jts 111CCIIlig~it aLI i hiklt L il tiM I t 11 1(1UC1 11 it llt Ill14rt ijIL~lIglLtItS lu it Ill sr ol Iatl l and shycentt~t o ll aIx (ill t lli ll i lLL o t(01 7IiL I l lVIII 12liretc bulltQ I Q A SIr 11)IlllCI I (IIttaisks IONr Sivilli l lIs h l~t o d r II li Iolrinill I( iltLLltltl Vi~it I NI l 111t 11l l

tAttilNtr 0I lit ileSH llN(i nt an illt ilit Lidl L tIti L LL If llt h Ill1(RI(II 11t1rilV I c i - O rT (ttI it tlul 51ity Ill (I l ms S I)(iI M lt i ttC 1 QLALpsroili (1r il-il rea

StiATiI (lllilllo~llwllU vary CI~24o h lthi tlltlIlvr a( h ntllCTIl~lrc rttI tor A A inlvp ritismpo nii lldolohy rVn(d r i i Ill (10n1l11gItsuitoI mii ll(~ilq TI0o (Ittl lo d bC HSUClm1IlSStI lU111( li-dI bIti k~t CIl)CML ittl t ( ilm -1r i i io ll )ttrl Oflil~ t t0 rlt10t

sv il)H CIL II ( ctswvithint m isIlhcLhdtkI 1 (hi 1V4( hiluh- OfILIAth(Is iNII~( 1I iCtartnwvlshoul1d19ib1 to)IllStllt1LN ~MlidIM I]ltxi toIAallw for local(ItLIltt llit11- lC1II(RO()

it Ill dICCloIrvCAl 111i1iV C(MIl irV SCitIiLgS Iinstill- ldaptlatiOll

il tlyIhis (ll i i llv ( )lHi4tt hrt sll)li~LL

24 (JIA )111

(lose alliance with the existing I inmistr of I lelth (M)0 ) structure is essential

l alm(1 n~ Allt i iii ti

Qi t-lilrt 1 ill il slIl([Iml S AillICti t()ICtSS-(ist (33 t-

itili cit i l 1A ii n ( )AtI in tAv iIt ilt-ss ditti-

I~s~ Ill hitilt 11 UCI I A1lItIll Niirt tlli M-vIMII AtISidi skill ilt L[-t 11 tot

i11r r ii lo

liii3td Iit(itl (lsil l ( CIht-s

fill[ Q lu c 6c (itll ililiciti

QAci MI hih Lnt ili

I~ Ill +k lld I thStitI)O S Wttts

33alNli~iro ut h srl1i3flIii ((~ iiii imii-1 it ii t 111d CO(cis aIt)tl Irii lt i( r

Tl a l l i)t ) l i n h ntp torAr [- )i I l l i1s

IlIll t(t t sjl rstl r s 111( 1l icclt-lItiili r i tini

Vsi i s Ltc h(( tilt (StihliShIl niiti tOTHIilr stitsi is

uIi s bcu iiMllit liiuin i li ilitIt ridir

Iioll ( A Im-siiil -idati ml1ni ( r lil l Illliilini s I

k -vl i m

(tll isi isuista inIi itictl su itiur oils aitcuwls in the health sectolr

Srep redtA t h Q dewi it entA iitllS W

wk ) IllIhicptli(i schw(I-i-i n III I ( (ltI I LI tiilttw il l b I lw cdll l i l S( llltI im t )r

i( iils l -M( ) I11 ( ) ll ti s Il tiltllll g mlt-l1lllt ml1tl sctt

HO nlll((i(tltlts itlils Ilttlld ( linliclA tfiltt tinlivtrsittl

(lii3s l3ciIlltimi m tilt tr hr1n in ( l i i

(0 im iiin11 (( I tth tia Il s mii)iTrs 0wli hla-b Ir mI I c stip p stm-1icli(ts

TS (it mici lntiit-s ihip

lI I(A So(-IsI( ll ( CSittIN IIIt(m)k tCthJ tIM nIVC ltiI

N 1111Ad IC)1-()fI tf I( t Is ( R N 1i tll(li s im lt k 1((tup(q lnIhiln til 1t-c l1vt

1)1(t1t(0 )t Itl~ tc- i III ( [t Ici I)C ~ISii[~HcA I ((m t r is

tol tli mII)i tcs illuIIs Illi- IIItss~ lll

Bte d e l W t h f-C ( LIC l t h a n e s

illperistonnetl atltall levels s~m llu - l I I (- cilTH1 1MV ( pu11-m il i I r 1 ( IIs luiiiuittrrltull um-st~ hilts

H) hL(IM Hff il)(Iliil~sif-L I IIinlitiilIM IWA tt1iltAs 1ilT IIl l n tH)(tIC t101in g it HTtitl (inlt(IIt (till

w rin r is o iimim mmi

ilui (miutrics I( tiviiits I()hc stmtcsstul itis

This Itt t-i ctI dicvchly-

FIr (w)

widrlthii ts (d iutthis tist-)( stlt icitll ilt Cil

SttIl icS Fll U iitlC W I itAn i lli lntuiiIiIm

AIci titS (i St M-1c 1) tiirit- Iil lI tSit

ltwilltiinlcInltsni iiili itliiiSLiit-si titil lalCi tff l t ito (Si tilt) t tshy

m litrt i S ( itQ A l ialtlt-sd t IIiiili il ilshy

mwidcSb rcd lclt icI i hiiui n lll l c - luC tilt hiks ri

IcAclS Il (Ilt s ti iiIrtIaiiitd o ntiCiAS (Mnii sshyli iici triitr aairiii ii clii~lsilMaking hcldn i 0tA) IClit - SUit Of) calul

u1 t cat dismiss tilt i itiiishypim mpl ilshanity n

titsi i t ila Illi stt hat i s imilscsIn iiii(tCiti

tinlt - a i Of c(stllio cskil u lIIshyi sct s i (L(iiiiI -l

mI Ctnr mn-

nllcSlt h ILci (tlt ill ir Q A islr il

oran t 0 lttIril I t t hill c tMr ahnic skills

ti ri ks ii ilt il s r

to s lrivwill(Jllol(sSk u i i l politilill lt Itr( t limiau shy

tiim Making extrai ILltldS availableC toi QA

r fiinactl u

i lllllc ittci may K- it ( i

prgra msl hls i mpl ica io s foi ialnl

-n ntic

AStIItd t C~ rIin til t )tlrt(ampt+cg icistittlli isS LIu t S A

MU S ltlt - t l ) 1 liln LC(c iilly ill StttinS w h c rc-

Stilt I tchtir izattitcciii ivctlsr iss li lit Its thic( it n

tcrca111inrllii agcib si ldu -L oitli n ink- tri inse (li shy

iii hn aI is mt-m 1i-Yiitir W SlC iilirtiIii i itI I ( Wl W~ll1 iC iiItts l s Itii( Mil t S cld It-ii i lg

uch ultiii4 (lt inj- 1s ICctst ilt-

Ah i 2 hats buctln irtitl sttotushul hlil pr-tldussitlnilis w ill lwIIIcI gntI I( ) ti txtt rnIC in-QA W ith IA ilti~l]C iiII

TSCItIlIl

()It tilW li ind i()A 1))lrll l bniM ITr ]tCItSSSisshy

lt itit is I)I d i iitt(IIU M ddi ltttld iillni tC l iohlil IL i n

l ivllbcb d1c l yb ls fiiIlt m iii

u lppm t It is ipss i hlctrlt)ilIh c lutstctw ~ n](gt iitt by~s)iltlmrllig clc illl (dhi

I tl in ltit] its tt-lll+(w-il-y ilillurc

Q11 IPie 25

(f it1I i illIt i

beiii-I t tlti(i ic0 i dptwiincntivces ild IMc

tIti(lliIII tIci i titis1itO i l]iliticis in ril prev iil-

IIII li1ItI SSCtll IVIt I if t Iltisui of sti ini ilit

t1All[iti tiliitI l ilttLit5l5 finhtin t iL tittltitol

Th 111101tlnt Clitl lIStc irttn t sh u ld

ii a

it C liltit VtiiaIini ( t i c iiiI i I ttttrfis iiI

N (virsn]tilofoi ll-iiLililliCitnit

i vusioI t siit t lT It nL-t 11li ii tSl I iLtli-

tIhe iit 2 v latcd ( d tlhliI ca+1iLtA ISO dLIns tilL +

lil~ivi+t()A I iu ct +il i r lli tii

SlIlI)()Irt lIMrt iltNI ( )I1I 11 t ilu lItt( )Tr tIn11c

It1MVCVtr (iht ( ()StS i iiktll I) tIhe 1 linls-v 01lt

ampli tI ~ h it l tnS IlluIItr l l It II I I l e I 1 St II

ctriaill il sill-snstiHinn ater

2 VirS ACft irciiMi tht cr iet

tit Pr a i ti n i

ot viar if iI C LI i () Lv +u80le (d the t nsIdA lltl~~ WI ( s li t il

part teila vI Ute OftiltCOn lltr)sdiftt(ti eiiisc

extreme cconomic deILenceLlC il dnor asSSisshy

tlliCe fo i)st of Its licaltlicare

f i n nIISItII tiaIllililt liLtt ir dltiVT (d

itLlblIi l in( olml

rte I aIICocal i tLrl A i

thstiitl lpp I It Il U llitll

St - I i itin 111 nllI hIu huLidlSLili)I)()ilti tSSLlil t 1r1- Oft Iit

IIIrmnaninl Stion)l i nuiMemplnt t Adt(liia ilt

cn cItilrr itASStliit t ll ni tIt iI iiits 4 cfir

bult4ct it]IMt Itsvsttttl01iani lil tC Oi ()StS i S 1Iitn 1glliiltOf It ll t C~ o( l it[ W I1 ll Ii 4

il i tli (nIit IInlpr()vcshy]nt It~slitill [rw ctsst I

iIClit iltiVitICS IllCwO rtoW I he (tltllr

The idLe1 O)f UalltlitV iS poVCwerfull

The dCfiniition iltialll tinall its tlitnItlSitlnS lig4ht be i ticill -I(Smieiit t rti isBut intfi tit

lllhais ]+tivitn tic he atviirv cvefuti toii r cteat iniai

ifirt iii l(vpiItilt ctntihiiticcri ticvis S illptiain

lctroxin Iii SI) I c the ccM L i( aLiuls o fiti it S vA itst litistsI f iilfitQ Aipttit Iia v )tir ( Iticitliav l a

ai Iitiiii NRtcii I h c ctiitist sTiccl i) crt it tis tuiituirt whitni

act its lI( I( )II S[ IIti tI l)itc Ilrattsb t t it uishyh t1I it PWlie +iii ItytIs ait ii thIfIIie ti

nhitiviniii la+l ilo ctistiiiiit i4xiin y isfr itisssat tcnitettliwai en

c4cctriiri ()int astii tu it itl iztI

Illtii ( A P Irc 1 il ill Iiiiti S tr i ilticts ait o i IrtIlsfI otll t oill iin ensions of

() sscrk in it tr ttus i )itiltllta ai11ttrnii it Ip[icshy

lountI ilt

appricit ili hasft iitait tit cutiity iris tIiiictutk4i liit 1 wicidshylltsi(4n1 tilt inmph- iticint a Which i

Itit tIv tl iltt) It ithiIII intIltiti licl t(I ctt itlwl p tci55i which have erst Cill stt ill diiat

cinnci Misicc sliitd Iiii4tlWit wid Whch ic rtIct 5 aid tilt maly ((cSt I I(CtV il il

impriveshysit ailti maki ngtl4itIl iltciTSMiRCt -ccc Iilii Iliiilia 1ti (Iistiss tletir k arnd SStunllurtmlltlrt(vti-Sllrchitilth ILontlitunltllillsVstil iclit at r sit its ittini rt ticlit in ut fiuini- rtills

ill stmilcctt It is Iiktl tic stiv this v~i f cy _____ __l_

1111Lt totMil11 ( 111JhDltm+ Al d31-l0AIPI AIS

CJAwl c IhIvcvi 1 ) I ic A bikDc1r Al I)i tiltt pri trl (I is Stlppi)it I4 act u t tih

atsctiUttriv intl4s inti l7 mI i hhill SY I aI( Phc ) IIIri n)staffl nltii stiptisisiccii visitshctn11t ii1P P Ntir Gad Almui 11 P IINR)I I ISuLIi~ihh (0 1gt iheIllot )11tilltclvIiht-

c ts f ttH iit itI tiI sI int txIn)arIII( I

Whtr( A fli nt 1Snot likely In iger IinSIt ii n ilildtilli i iil StSiiiIth lIt iucL ++ i

26 OA lPrief

Organizational Conditions That Favor Institutionalization of a QA Program

n - ) c A VItJv l toanc QASo nea szltt 11tmspI) 1 ( t that makIc it o a sucaess progra W the absence ofthcie 1A st not ian it Mhe act lStuc1 o I hL imposi t0 start apog1ran0 Program cclopmco and c nuisoi e slouer when ths condilions are not met In mine cases the u11a) estahiSinhicnt of ydccopcdi 02A pro am nn i not be pssibi nutil these charat isti s are present

There is top-level support for QA There is an existing system or activity Top-level leaders must provide Ongoing support that provides a foundation for the QA for the QA effort While they need not be in- program volved in day-to-dJay activities it is important It is much easier to build on existing systems that they send a consistent message about the 1ra- rather than developing systems from scratch If portance and seriolisness of QA QA activities are already ongoing in the organishy

zation through supervision monitoring day-to-There is a quality assurance champion day managenent or special committees QA In addition to top level support it is also helpful progranis can be developed aOulnM]d these activishyto have a clampion within the system who will ties so that they have niore impact and increased lead the QA effort and be personally Identified prominence in the organization In the case of with the effhrt The champion should have lead- nationarl programs QA programs may be built ership (]ua1lities enjoy the respect of colleagues around existing expert bodies (ie accreditation and have the ability to motivate others bodies or governmental groups) or professional

Organizational systems are relatively organizations developed and stable Adequate time and resources are Mature management and administrative systems available within the organization or system will greatly en- Staff must have the flexibility to shift sonic of hlimce the likelihood of success of the QA effort their regular activities to spend time on the QA Systems that are stable at their base are more able effort QA activities may also incur sonic finanshyto develop and sustain new prograns and activi- cial costs related to data collection documentashyties tion and transportation Without the

QA supports the organizational or commitment of staff tinie and modest fiancial health system mission resources it will be hard for the tearm to get

Establishing atdirect and visible link between the started Eurtherniore niembers of the organiza-

Q Aprogram arid an organizations ratison amptre tion may doubt the commitment of top-level leadshyis a prerequisite for instittitional ization This link ers if allocations of time or ioney areiinot miade

needs to be clearly established so that all iieshybers ofan organization understaid that QA serves their overall mission

QA flricf 27

ISS t h_( (tl Asm tIII( L I IN l lu Ii~ tIIJ llI tI WA fltILi4 frA lt)t1r ()u1111INy t I M VLTS I IN SC IMO d Icnt 11h P tlh

MHN+ l tt I li~t ]rqpt I1( tt tl(ld~t i A(+ii(L-+1I MF d lt it HIM I I l)LAvck )I lllt lh jt I IS

s 1 tl sort I) tilt 1 llit SIll 2tll +IM Iotitl l1111 t

(Q talit A s Lrance )issem in ation

7200 V Iscoisin A tNCl Suite 500) IFor5t)t) t --f - )(U (l-I lti itl t rili lt II

ll)sd LolttBethestda MardIland 208 Ili

I SL)Ar William Jackman I )ir cr

The Qu~ity ANStlllnct PIt)jCt

( Cltr fiwir I1tlnlIn SciC_S PrincipalVri atiltfittr 7200 Wisconisin AVllUl Sn I(t 501)

Maria FralllCisco Bethesda Marsland 2081i

VIrolli0tjtt ALltph lllU DIr JMesI IbbIyI ictl anILgC1r SampgTllualth

I 11 US Agency IOr Intem Prjction ational ltveIn11111t lKurt N1ulh1(d1and Vashington DC(201523-I1817

bull B1 ief (Cnier I IlutLman Scr IcCS 721)) Wisconsin Avenue tBcthcshtI NIl) 218 14-482) bull (31)1) 654-2551

Quality Assurance Project ( tUTC tfr I11m1n SLTrIrits 702(1) Visconnsi 0 Avc- tnu Sn it 5()()

lrhws la Nil) 2081 i- is2() 1I JSA

LEiZE1i3

tI e I LIIntricS ii1d sit t ins WIiIT LiCiIizCd TIiS

iSSIC (it Il OA Ilis1 thiS llh Ihrlos-I(L lhi II SMIlS ltlntd i lLill Snr (tifiCC01tlntrv illt(rATlltiO)nS

in QA p l a lnii iii t ccts IiUJm -(cIvt tI l i n1Ii ia Iiss iflht il id int it[it loll NIhr wiilll ii willi

t(0lW In li tis W t V Iltof lIi iM tc 11hi ti i (amp

~

This isite (fthe QA IBri(etttCVni tif e u tdi o h contributions 1hfalmost all sttifoln the Q u l t

Qality Assurance Proect ticle t5 an(itli)t I) uoklalt theirIniIlIV

ViewpoiltS aiid eli)ui nd r the )1(1ior headinor isues which eniiited

Yet this was bY In ans intended to he

the (1efinitive piece on Lessons Learned

fir the prectl nor aid weLo wish to prsellt

(iii over idealistic vie ofollr work illQA

Rathet i e wished tofetatinr somie ldhe

many experiences and ifjlections our

stafand colleagtues over the )sastfew ycars

as they have worked to appv Q1 intheir

progranm

The Editors

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Q11 IPie 25

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26 OA lPrief










QA flricf 27
















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QA rief 21




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22 Q 8 ricf

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IMi I itti i LI Ill























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24 (JIA )111






i11r r ii lo



QAci MI hih Lnt ili








k -vl i m



















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Q11 IPie 25

(f it1I i illIt i






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26 OA lPrief










QA flricf 27
















LEiZE1i3




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22 Q 8 ricf

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IMi I itti i LI Ill























QA Brief 23























24 (JIA )111






i11r r ii lo



QAci MI hih Lnt ili








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Q11 IPie 25

(f it1I i illIt i






ii a











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itLlblIi l in( olml




















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26 OA lPrief










QA flricf 27
















LEiZE1i3

cain-buiilding


IMi I itti i LI Ill























QA Brief 23























24 (JIA )111






i11r r ii lo



QAci MI hih Lnt ili








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FIr (w)











mI Ctnr mn-






r fiinactl u



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TSCItIlIl






Q11 IPie 25

(f it1I i illIt i






ii a











tit Pr a i ti n i






itLlblIi l in( olml




















lountI ilt











26 OA lPrief










QA flricf 27
















LEiZE1i3























24 (JIA )111






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QAci MI hih Lnt ili








k -vl i m



















FIr (w)











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Q11 IPie 25

(f it1I i illIt i






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tit Pr a i ti n i






itLlblIi l in( olml




















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26 OA lPrief










QA flricf 27
















LEiZE1i3






i11r r ii lo



QAci MI hih Lnt ili








k -vl i m



















FIr (w)











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Q11 IPie 25

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26 OA lPrief










QA flricf 27
















LEiZE1i3

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itLlblIi l in( olml




















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26 OA lPrief










QA flricf 27
















LEiZE1i3










QA flricf 27
















LEiZE1i3
















LEiZE1i3

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