JHPIEGO TrainerNews™ |
Preliminary Study on High-Performing
Healthcare Sites Yields Postive Early Results
(February 2001)
Have you ever wondered why some clinics do better than others? What special programs, people, or traits make one site more successful than another? Have you thought about what various stakeholders define as a "high performing" clinical site? Have you been thinking about what that special leader does to motivate staff and involve the community?
Many studies focus on identifying problems and barriers that prevent sites from providing quality services. This phased study was conducted within the framework of examining assets rather than deficits.
In November 2000, a team from JHPIEGO (Baltimore and Kenya offices) conducted the first phase of a study to address some of these questions. The overall study objectives are:
Identify high-performing health service delivery sites that are working in low-resource settings.
Document differing stakeholder perspectives on the definition of "high performance."
Identify performance factors (job expectations, motivation, etc.) that have an important influence on the effective delivery of reproductive health services in low-resource settings.
Identify strategies that sites use to overcome performance barriers and build on existing capacities and strengths.
Describe strategies that contribute to the maintenance of high performance over time.
Describe key elements for the design of interventions to achieve and sustain desired performance.
The first two objectives were accomplished through a series of meetings with various stakeholders ranging from central-level stakeholders to local on-site providers and clients. At the central level, participating agencies and organizations included the Ministry of Health, Marie Stopes International/Kenya, Christian Health Association of Kenya (CHAK), Family Planning Association of Kenya (FPAK), and Cooperating Agencies (AVSC, FHI, FPLM, Pathfinder, Regional Center for Quality Health Care/Uganda). The team visited 9 high-performing sites and 1 low-performing site. These sites were identified through preparatory work with input from central-level stakeholders and based on available resources. Three government sites, 6 private sites and 1 mission site were visited. Discussing the elements and strategies that work to create high performance has generated tremendous excitement and enthusiasm.
Many ideas and strategies emerged from the interviews. The following are overriding themes.
COMMUNITY INVOLVEMENT: Community involvement was identified as one of the keys to any successful clinic. Examples of community involvement included:
Community members on the health management teams
Community involved in the maintenance of the clinic
A mechanism for feedback from the community
Clinic staff members travel within the community (e.g. health education opportunities)
FINANCIAL MANAGEMENT: Financial management was repeatedly discussed as a reason for having a successful clinic. Examples of financial management included:
A cost-recovery system
Autonomy for managing finances
Ability to use money for incentives (e.g. buying tea for staff)
Ability to use money to buy supplies
MOTIVATED AND WELL-TRAINED STAFF: These two are listed together because it was recognized that a well-trained staff member still must be motivated to use the skill. The importance of "immediate changes" or "quick successes" was key to motivation. Things as simple as painting walls or cleaning up the grounds sent a message to staff that people cared. Other motivational activities in the clinics included:
Training (e.g., those that were performing well were able to attend seminars, conferences etc)
Tea breaks with tea provided
Departmental awards
Time off
LEADERSHIP: Leadership is often credited as a key element in any successful organization. The interviews clearly confirmed the importance of leadership; however, it must also be acknowledged that not every "high performing site" had a dynamic leader. Descriptions of leadership included:
Leads by example
Maintains open communication (Staff are always informed of both the positive and the negative things that happen in the clinic.)
Is able to delegate work/duties
Is honest (both with communication and money)
In describing mechanisms for tracking their own success, many providers mentioned client feedback as well as achieving expectations of who they wanted to come to their clinic. For many, the "who" was defined as clients (both repeat clients and new clients) outside the clinic's catchment area.
The reasons that clients chose one clinic over another varied. Many clients, however, stated that they chose a facility because it provided what they needed at one place, it was clean, staff members were friendly and it was affordable.
The next phase of the study is being designed based on these and other results. The complete study will present a clearer picture of strategies that help clinics improve and maintain performance, and what it would take to replicate those strategies.
For more information about this study, contact Performance Improvement Advisor, Kama Garrison