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Training

Instructor with three trainees in Benin (outdoors)

Photo by Peggy Koniz-Booher

The QAP Training Division was involved in a number of training activities designed to facilitate the introduction and adoption of quality assurance concepts and tools. Training methods included traditional "stand-up" training, as well as newer, innovative training approaches, e.g., just-in-time training and computer-based learning.

Our training approach focused on defining the performance problem for which training is prescribed; providing specific practice during training of skills needed to address the performance problem; measuring performance at the completion of training, and when feasible, conducting long-term measures of performance changes.

The following is a list of courses developed for a variety of clients and settings, ranging in length from two days to two weeks. Courses are available for download below.

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Collaboratives for Quality Improvement in Health Care

The Improvement Collaborative is a major approach for rapidly improving the quality and efficiency of healthcare. A collaborative focuses on a single technical area (for example, prevention of mother-to-child transmission of HIV) and seeks to rapidly spread existing knowledge or best practices related to that technical topic to multiple settings, through systematic improvement efforts of a large number of teams. A collaborative is a time-limited improvement strategy, usually lasting from 12 to 24 months. This training is designed to be used in workshop format to orient, sensitize, and otherwise guide a management team in the planning, development, and implementation of their own collaborative. Because the basis of an Improvement Collaborative is the Quality Improvement (QI) process, one must have skills in conducting QI in order to implement a collaborative.

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Download accompanying PowerPoint slides by session title below:

Quality Improvement in Health Care

This four-day course was designed for service providers or managers who are new to quality assurance. If possible, an entire facility team attended together. Participants learned how to identify opportunities for improvement and plan a quality improvement project at the facility level. Instructional methods included small group work employing a variety of exercises and case examples. Topics included:

  • Principles of management conducive to improving quality
  • Systems view of organization
  • Quality improvement tools
  • Working in teams; team-building
  • Measurement using quantitative and qualitative data, common cause and special cause variation
  • Planning for quality improvement

 Learning Objectives

 At the conclusion of this course, participants were able to:

  • Define the principals of quality improvement
  • Identify a quality improvement opportunity at their facility
  • Develop a plan for beginning a quality improvement initiative that:
  • Incorporates the principles of quality assurance
  • Applies a flexible approach to quality improvement methodology
  • Uses various quality improvement tools and techniques

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Download Instructor's Manual

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Monitoring the Quality of Primary Care

This course was designed to help mid-level health managers develop skills in monitoring quality of care in an ambulatory healthcare setting. Building on standards already in use, the course guided participants through the steps of developing and using indicators in a systematic method to routinely monitor health worker performance. Participants defined and developed indicators, design data collection tools, collect data in a facility, and analyze and interpret that data. This course was part of a larger technical plan in which participants already had general knowledge of QA, and were planning to use quality improvement techniques to address the gaps between standards (desired performance) and actual performance detected through this monitoring.

Learning Objectives

At the conclusion of this course, the participant will:

  • Select a priority health service to be monitored
  • Identify the standard of care for the priority health service
  • Identify the process of care for the health service to be monitored
  • Identify the healthcare provider's performance standards that will be monitored
  • Develop performance indicators for each standard selected
  • Design monitoring tools to collect information
  • Collect the necessary information successfully
  • Tabulate and display the collected information
  • Analyze and interpret the information
  • Design a strategy to feed back the results of the data gathering to the staff of the facility in a way that will support change and improve quality of services

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Download Instructor's Manual

Download Participant's Manual

Download in French

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Coaching and Team Building

Training in Nicaragua

This course was designed for quality assurance coach candidates who have a working knowledge of QA concepts. It was paired with technical content training in a specific QA method, such as indicator development, quality improvement, problem solving, or process redesign. It used hands-on methods to develop coaches' ability to facilitate teamwork and provide competency-based, just-in-time training. Ideally, this course would be conducted with existing teams and their coaches. When that was not possible, participants formed teams that acted as real teams working through real-life QA activities. This course was accompanied by a practicum in a field site with a coach's real team.

Learning Objectives

At the conclusion of this course, participants were able to:

  • Discuss the benefits and challenges of working in teams
  • Distinguish responsibilities and behaviors appropriate for each role within a team: team leader, team member, timekeeper, recorder, and coach
  • Choose facilitation and training techniques that enhance a team's ability to:
  • Create a positive team climate
    • Clarify roles and responsibilities
    • Conduct effective meetings
    • Make decisions
    • Manage conflict
    • Manage change
    • Enhance creativity
    • Communicate with the organization
  • Demonstrate key communication skills:
    • Active listening
    • Giving and receiving feedback
    • Effective questioning
    • Assertiveness
  • Design and deliver competency-based, just-in-time training
  • Develop action steps to apply the knowledge and skills learned during the training program

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Download Instructor's Manual

Download Participant's Manual

 

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Training of QA Trainers

This course in training skills was designed to help health workers (e.g., physicians, nurses, midwives, administrators, information officers, clinical assistants) become more effective QA trainers. Training emphasizes doing, not just knowing, and uses competency-based evaluation of performance through both peer and self-assessment of actual training. Participants were required to have general QA knowledge, and specific skills in the technical area they were going to teach.

Objectives 

At the conclusion of this course, participants were able to: 

  • Apply a competency-based, participatory approach to QA training
  • Plan, establish, and maintain a positive training environment 
  • Prepare and use audiovisual aids
  • Present information effectively using interactive training techniques
  • Facilitate small group activities
  • Evaluate acquisition of new knowledge and skills using competency-based assessment instruments
  • Maintain a positive learning environment when using participant teams to accomplish learning objectives
  • Conduct and document a QA training course

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Download Instructor's Manual

Download Participant's Manual

Download Reference Manual

Download Training of QA Trainers, French

Improving Interpersonal Communication Between Healthcare Providers and Clients

This course was designed for care providers responsible for counseling, educating, or otherwise communicating with clients. Topics included characteristics of effective interpersonal communication, including caring and socioemotional communication, diagnostic communication and problem solving, counseling, and education. Course activities included role plays, case studies, and the use of job aids to enhance use of new skills.

Objectives

At the conclusion of this course, participants were able to:

  • Describe the framework for effective provider-patient communication
  • Identify the three critical elements of effective provider-patient communication
  • Describe the importance of emphasizing the relationship with patients through caring and socioemotional communication by using the acronym CARE
  • Demonstrate the ability to show caring and respect for patients
  • Describe the importance of appropriate communication techniques in gathering critical information for diagnosis and problem identification and solving using the acronym SOLVE
  • Demonstrate the ability to use these techniques to encourage patients to talk about all aspects of their problem/illness
  • Explain the importance of using appropriate communication techniques in counseling and educating patients, using the acronym EDUCATE
  • Demonstrate the ability to use these techniques
  • Demonstrate the ability to use appropriately the skills outlined in the acronyms CARE, SOLVE, and EDUCATE in provider-patient communication situations
  • Apply the information, skills, and techniques learned in the workshop to their individual situations

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Licensure, Accreditation, and Certification: Approaches to Health Services Quality

This course was designed for health care leaders including representatives from the ministry of health, regional health directors, hospital directors and others involved in decision-making regarding the implementation of licensure, accreditation, and/or certification. The Accreditation Course was based on the content of the Quality Assurance Project monograph entitled “Licensure, Accreditation, and Certification: Approaches to Health Services Quality”. The intent of the course was to clarify the three approaches to external evaluation: licensure, accreditation, and certification and, provided the participants an opportunity to consider the application of these approaches in their respective countries. 

General Objectives

At the conclusion of this course, participants were able to

  • Identify the need for an external quality evaluation of healthcare in a country
  • Describe and give examples of three types of standards (structure, process and outcome)
  • Describe the difference between implicit and explicit standards
  • List examples of standards within a country/institution
  • Discuss the application of standards within an organization
  • Differentiate between the three external approaches of quality evaluation: accreditation, licensure, and certification
  • Use the guide “Issues For Consideration In Evaluation: Licensure Mechanisms For Healthcare Professionals” to describe the current situation in a country
  • Discuss the applicability of the three approaches to their organizations/country
  • Define the term “stakeholder” 
  • Identify major stakeholders in the healthcare delivery system
  • Use a case study and select a quality approach that could respond to the need identified
  • Determine what it would take to implement the selected approach

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Cost and Quality in Healthcare

This course was designed to introduce health professionals, program managers, and other decision-makers within the health system to the concepts of cost and quality. It provided guidance on measuring the effect of interventions aimed at improving quality relative to their cost and quantifying the cost of poor quality. It also provided a basic overview of quality definitions, quality assurance framework, and cost analysis approaches. It does not intend to provide an in-depth review of cost analysis approaches. The course material provided additional reading and references to continue exploration of the topics covered. 

General Objectives

 

 At the conclusion of this course, participants were able to:

  • Define quality
  • List the different dimensions of quality
  • List the perspectives on quality
  • Define quality assurance
  • Define cost in monetary, economic, and accounting terms
  • Define the three major cost categories: people, machines (equipment?), and material
  • Describe the dimensions of cost: direct, indirect, unit, and average
  • Describe quality in cost terms
  • Identify the four components of the cost of quality: prevention, appraisal, internal failure, and external failure
  • Discuss common assumptions and beliefs about cost and quality
  • Describe the relationship between cost and quality
  • List the major levels of cost analysis: cost categories (general ledger items); activities; processes; programs/interventions; services; departments; organizations; health systems and subsystems 
  • Describe the methodologies used to analyze cost and quality related problems; list general guidelines for selecting methodologies when trying to address a cost-quality problem
  • Analyze cost and quality related problems using the appropriate methodologies.

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Download Instructor's Manual

Download Participant's Manual

Reference Manual

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PVO Quality Improvement Workshop:  Practical Applications

This training workshop was specifically designed for private voluntary organization (PVO) headquarters staff who were exploring ways to incorporate quality improvement techniques in their usual work. It was designed to create an awareness of the advantages of using Quality Improvement (QI) approaches to improve the quality of child survival interventions and to equip the participants with skills to use selected QI tools and techniques. Session plans, presentation slides, case examples, and other materials used in the workshop may be downloaded in PDF format from this website.

View summary report and agenda of PVO Quality Improvement Workshop.

Objectives 

At the conclusion of this course, participants were able to: 

  • Discuss the basic principles of a QI approach (data, teams, system/process focus, client focus, leadership commitment) 
  • Discuss how to apply QI approaches to child survival program improvements 
  • Using exercises, suggest appropriate QI interventions from a range of possible activities (including getting client input, facility and health worker assessment, standards setting and /or communication, monitoring with feedback, decision making, root-cause analysis [problem solving], process improvement, PDSA [Plan, Do, Study, Act] or PDM [Plan, Do, Monitor])
  • In exercises, use brainstorming, force-field analysis, and priority-setting techniques
  • In exercises, construct, interpret, and evaluate high-level and process-level flow charts, cause-effect diagrams, pie, bar, and run charts, and Pareto diagrams 
  • Develop a list of QI activities pertinent to their service delivery
  • Develop next steps to take in implementing QI in current child survival activities
  • Apply principles of change management techniques to next-steps planning

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The Quality Assurance Project (QAP) is funded by the U.S. Agency for International Development (USAID)
under Contract Number GPH-C-00-02-00004-00.