Why PI is Important to JHPIEGO | Defining and Strengthening the MAQ/PI Relationship at JHPIEGO

JHPIEGO Strategy Paper¹ • May 2000

Prepared by: 

Nancy Caiola, MPH
Performance Improvement Advisor

Richard L. Sullivan, PhD
Director, Learning and Performance Support Office

• Introduction
• What is Performance Improvement?
• Considerations for Developing a Performance Improvement Strategy
• JHPIEGO's Performance Improvement Process
• Conclusion
• References

Introduction

The primary goal of JHPIEGO and similar organizations working in low-resource settings is to improve the performance of reproductive healthcare providers and other healthcare professionals in order to improve the quality of services they provide. One of JHPIEGO’s contributions to this effort has been the strategic development of training systems capable of producing qualified preservice education faculty and inservice trainers. Using well-designed learning packages consistent with national policies and service delivery guidelines, these faculty and trainers have, in turn, prepared qualified healthcare providers. JHPIEGO’s mastery learning approach, based on the premise that all participants can learn the required knowledge, attitudes and skills if sufficient time is allowed and appropriate training methods are used, has proven to be highly effective. This approach has resulted in a global network of proficient clinical, advanced and master trainers.

Although training may be highly effective, there are many other factors that affect the transfer of training and the subsequent performance of the healthcare provider. Galagan (1994) asks trainers to shift from a focus on "training and development activities (input) to the performance of individuals and organizations (output)." Callahan (1997) suggests that the following four questions be asked about every training intervention:

• Is training the solution?
• Will training in this particular area provide the biggest return on investment?
• Is the focus performance improvement?
• Can training solve the problem on its own, or are other types of actions needed?

Training courses may be well designed and conducted, but may not always produce the expected results. Baldridge (1999) describes five reasons why this occurs:

• Lack of management or executive commitment to training
• Ineffective training that results from not allowing sufficient time for the design and delivery of quality training courses
• Training unrelated to organizational objectives
• Lack of tools to measure the effect of training on job performance after a worker has completed training and returned to work
• Lack of time and support to implement newly acquired knowledge and skills on the job following training

During the past several years there has been a global trend in business and industry to move from training to performance improvement. This paper presents a review of selected performance improvement and training literature that has been helpful to JHPIEGO in identifying issues related to this trend and in shaping our performance improvement strategy.

A healthcare provider attends a course to learn clinical skills (e.g., IUD insertion and removal, manual vacuum aspiration for the treatment of incomplete abortion) in order to provide a reproductive healthcare service. During the course the provider learns the essential need-to-know information, demonstrates mastery of course content by achieving a specific score on a knowledge assessment and demonstrates mastery of the clinical skills with anatomic models and clients. During a followup visit 3 months after the course, it is discovered that the provider is not using the newly acquired skills. Why not? It could be that the training itself was of poor quality. But there are many other questions about the transfer of learning from the classroom to the work setting to be considered, including the following: Does the clinic have the capability to provide the healthcare service? Is there a demand for this service? Are the commodities, supplies and equipment available? Is the clinic administrator and/or provider’s supervisor supportive? Are other human resources needed? Was this the appropriate person to attend the course? Is the provider motivated to provide the service?

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JHPIEGO Strategy Papers are designed to summarize JHPIEGO’s experience in reproductive health, with a focus on education and training. The papers are intended for use by program staff of JHPIEGO, USAID and its cooperating agencies and other organizations providing or receiving technical assistance in the area of reproductive health training.

JHPIEGO, an affiliate of Johns Hopkins University, is a nonprofit corporation dedicated to improving the health of women and families throughout the world. JHPIEGO works to increase the number of qualified health professionals trained in modern reproductive healthcare, especially family planning.

JHPIEGO Corporation

Brown’s Wharf • 1615 Thames Street, Suite 200 • Baltimore, Maryland 21231-3492 • USA

http://www.jhpiego.org

Copyright^© 2000 by JHPIEGO Corporation. All rights reserved.

Editors: 

Chris Davis
Kathleen Hines
Dana Lewison

Funding provided by the United States Agency for International Development (USAID) Office of Population, Center for Population, Health and Nutrition/Global Programs, Field Support and Research Bureau/CMT Division, under the terms of Award No. HRN-A-00-98-00041-00. The opinions expressed herein are those of JHPIEGO and do not necessarily reflect the views of USAID.