ASSESSING THE QUALITY OF SERVICE
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- ASSESSING THE QUALITY OF SERVICE
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Primary Health Care Management Advancement Programme
ASSESSING
THE QUALITY
OF SERVICE
MODULE 6
FACILITATOR’S GUIDE
THE AGA KHAN UNIVERSITY
AGA KHAN FOUNDATION
Primary Health Care Management Advancement Programme
ASSESSING
THE QUALITY
OF SERVICE
Martine Hilton
University Research Corporation
MODULE 6
FACILITATORS GUIDE
Aga Khan Health Services
University Research Corporation
Center for Human Services
Dedicated to
Dr. Duane L. Smith (1939-1992),
Dr. William B. Steeler (1948-1992)
and all other health leaders, managers and workers
who follow their example in the effort to bring quality health
care to all in need.
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The Primary Health Care Management Advancement
Programme has been funded by the Aga Khan Foundation
Canada, the Commission of the European Communities,
the Aga Khan Foundation U.S.A., the Aga Khan
Foundation’s head office in Geneva, the Rockefeller Foun
dation, the Canadian International Development Agency,
Alberta Aid, and the United States Agency for Interna
tional Development under two matching grants to AKF
USA. The first of these grants was, "Strengthening the
Management, Monitoring and Evaluation of PHC Pro
grams in Selected Countries of Asia and Africa" (cooper
ative agreement no. OTR-0158-A-00-8161-00, 19881991); and the second was "Strengthening the Effective
ness, Management and Sustainability of PHC/Mother and
Child Survival Programs in Asia and Africa" (cooperative
agreement no. PCD-0158-A-00-1102-00, 1991-1994).
The development of Modules 6 and 7 was partially funded
through in-kind contributions from the Primary Health
Care Operations Research project (PRICOR) of the Center
for Human Services under its cooperative agreement with
USAID (DSPE-6920-A-00-1048-00).
This support is gratefully acknowledged. The views
and opinions expressed in the PHC MAP materials are
those of the authors and do not necessarily reflect those
of the donors.
All PHC MAP material (written and computer files) is
in the public domain and may be freely copied and
distributed to others.
Contents
FOREWORD .............................................................................................................
1
SESSION 1: INTRODUCTION AND OVERVIEW ............................... 7
Transparencies
6-1: Workshop objectives........................................................ . ................. 13
6-2: Purposes of Module 6......................................................................... 14
6-3: Service quality checklist functions ................................................ 15
6-4: Steps in service quality assessment .............................................. 16
SESSION 2: SPECIFY SCOPE AND OBJECTIVES OF THE
QUALITY ASSESSMENT (STEP 1)............................................................. 17
Transparencies
6-5; Session 2: Objective ........................................................................... 20
6-6: Question to be answered...................................................................21
SESSION 3: DESIGN AND CARRY OUT ASSESSMENT
(STEPS 2, 3, 4 AND 5)......................................................................................... 23
Transparencies
6-7; Session 3: Objectives........................................................................... 29
6-8: Unit of observation............................................................................. 30
6-9: Data collection techniques .............................................................. 31
6-10: Sampling procedures ......................................................................... 32
6-11: Ground rules......................................................................................... 35
SESSION 4: TABULATE AND ANALYSE THE DATA
(STEP 6) ...................................................................................................................... 37
Transparencies
6-12: Session 4: Objectives ......................................................................... 39
Module 6: FG; contents
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6-13: Rapid data analysis
40
Transparencies
6-14: Session 5: Objectives........................................................................... 44
6-15: Providing feedback and taking corrective action....................... 45
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SESSION 5: REPORT THE FINDINGS, PROVIDE FEEDBACK,
AND TAKE CORRECTIVE ACTION (STEP 7) ..................................... 41
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Module 6: FG; contents
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Foreword
What is the purpose of the Facilitator’s guide?
The Facilitator’s guide contains a suggested workshop design for use by
individuals who will help PHC managers and staff learn how to use the
Primary Health Care Management Advancement Programme (PHC MAP)
series. There is a Facilitator’s guide for each module in the PHC MAP series.
What information does it contain?
Each Facilitator’s guide contains instructions for conducting a workshop
on one of the modules in the PHC MAP series using the information
contained in the User’s guide.
The instructions are arranged in one to two hour sessions. The number
of sessions depends on the amount of information and/or the number of
steps contained in the User’s guide. The first page of each session lists
session objectives, major topic headings, time required, and materials and
equipment. The following pages describe the instructional activities in
outline form.
The outline is divided into two columns. The right-hand column
indicates what the facilitator says or does to conduct the session. The
left-hand column lists the handouts, overhead transparencies, or other
materials needed to support the activity. Copies of these materials, suitable
for duplication, appear at the end of the session in which they are first used.
Some transparencies are used in more than one session.
How are the workshops organised?
The first session of each workshop contains activities designed to
introduce the PHC MAP series and explain its importance to PHC
programmes, present an overview of the workshop, explain the purpose of
the module, review specific terms or concepts used in the module, and
Module 6: FG; foreword
2
acquaint the participants with the organisation and content of the User’s
guide.
The final session of each workshop contains activities designed to review
key points of the User’s guide, if appropriate, help participants prepare an
action plan, and brings the workshop to a formal conclusion. The sessions
in between present the steps required to accomplish the purpose of the
module and provide an opportunity for participants to apply those steps
to their own programmes.
Each workshop is designed to be given on consecutive days, uninter
rupted except for breaks, meals, and rest, if the workshop is longer than
one day. It is recognised, however, that situations vary and the PHC MAP
modules will be used singly or in combination by individuals and or
ganisations in the field and on university campuses. Therefore, it is
expected that the workshops described in the Facilitator’s guides will be
adapted to fit a range of circumstances. Indeed, those who facilitate PHC
MAP workshops are encouraged to make adaptations to meet the needs
of participants and/or specific PHC programmes.
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Who can be a facilitator?
Ideally, the person who serves as facilitator has training and experience
in the fields of public health, management, planning, and evaluation, as well
as sampling and survey design. It is recommended that this person also be
skilful in working with small groups.
The facilitator should be someone from outside the PHC programme,
perhaps from another agency or a university. As a person with no direct
interest in the programme, the facilitator can be neutral in disagreements
that may arise and help the group members resolve an issue objectively.
Having an outside person as facilitator also allows the programme director,
who usually has a leadership role, to contribute his or her knowledge and
experience as a full participant in the work of the group.
It is also recommended that a facilitator have a full set of PHC MAP
User’s guides and Facilitator’s guides. It is sometimes necessary, in the
course of completing one module, to refer to information in another module.
Who should participate in the workshop?
The primary audience for the PHC MAP series is the team that manages
PHC programmes or other population-based health programmes in either
the public or private sector. An example of a PHC management team in
the public sector is the core staff of a district ranging from 100,000 to
300,000 in size of population served.
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Module 6: FG; foreword
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An example of a PHC management team in the private sector is the
core staff of an NGO that provides PHC services to a specific population
in a given geographic area. The average size of the service population may
range from 40,000 to 60,000, but may be as small as 10,000 or more than
100,000. In either case, the management team should have:
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• the knowledge and skills needed to complete the steps in the module,
• the time and resources required to collect and analyse the required data
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• the authority to plan and implement improvements in management
systems and procedures based on this analysis.
If feasible, teams from several districts or from several PHC programmes
within a given NGO, may work simultaneously with one facilitator to
complete a module. It is recommended that one facilitator work with no
more than four teams or 20 people at one time.
What does the facilitator do?
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Understands the needs of participants. If the facilitator is working
with one PHC programme, the most efficient way to gather information
about participants and the programme in which they work is to meet with
the PHC director to determine:
• the nature of the PHC programme (services provided, size and description
of area served, number and type of facilities, number and qualifications
of staff, community involvement, computer capability, strengths, major
problems, etc.);
• if information needs have been clearly identified;
• previous staff training in management information systems or related
topics;
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• resources available for training (time, space, equipment);
• possibility for subsequent technical assistance to workshop participants.
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Understands the content of Module 1. Read the User’s guide and
Facilitators guide for Module 1 and consider options for workshop delivery.
• The purpose of Module 1 is to help participants select priority information
needs and to review some basic concepts underlying management
information systems. Depending on participant background, the amount
of time available, and the need to establish priorities among management
information needs, Module 1 can be presented in its entirety, limited to
Level 1; Quick start, limited to the PHC MAP systems framework, or in
Module 6: FG; foreword
• Other options are possible depending upon the circumstances of each
situation.
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Determines what programme information, if any, is needed for
completion of the module. For example, census data and lists of households
are required to complete some of the steps in Module 3.
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• Participants could plan steps in the workshop, complete them on the job,
and bring the results to the next workshop session. This approach is
particularly applicable to Module 2 which requires development of a
questionnaire, selection of a survey sample, training of data collectors,
and data collection. These steps cannot actually be carried out within the
time limits of the workshop as contained in the Module 2 Facilitator’s
guide.
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• If follow-on technical assistance is available, the content of the module
could be presented in the workshop and the application of the procedure
to the PHC programme could be conducted on the job.
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• Depending upon the length of the module and the availability of staff for
training, the workshop sessions may be presented as described in the
Facilitator’s guide, or workshop sessions may be delivered at intervals (for
example, every morning for a certain number of days, one session per
week, or one day per week for three or four weeks).
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Understands the content of the selected module. Read the User’s
guide and Facilitators guide for the selected module and consider options
for workshop delivery.
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• If information needs have been clearly identified and participants have a
background in systems, then the overview of PHC MAP in the selected
module will be sufficient.
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summary form as contained in the first session of the Facilitator’s guides
for Modules 2 through 9.
• If information needs have not been clearly identified and participants
have no background in systems, then Module 1 should be presented in
full. The selection of the next module will depend upon priorities set by
the participants as they complete the steps in Module 1.
• If information needs have been clearly identified and participants have
no background in systems, then that portion of Module 1 can be added
to the first session of the selected module.
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Module 6: FG; foreword
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Determines the most appropriate people to attend the workshop. For
example, Module 7 is best completed by those responsible for planning,
training, supervision, logistics, and other management services.
Discusses the delivery options and participants with the PHC manager
and make decisions regarding the most appropriate option and participant
selection. Also determines if the needed information is available and if it
is not, the alternatives for obtaining the information.
Notifies participants of the date, time, and purpose of the
workshop and confirms attendance. Initial notice of the meeting may come
from the PHC manager, with follow-up by the facilitator.
Prepares the agenda, using as a model the sample in Session 1 of the
Facilitator’s guide for the selected module.
Inspects the room where the workshop will be held and answers these
questions:
• Is the room large enough to seat all the participants?
• Can chairs and tables be arranged in a variety of ways; all participants
around one table; participants in groups of three or four at smaller tables?
• Is the lighting adequate?
• Can temperature and humidity be controlled?
• Is there an electrical outlet for an overhead projector?
• Is a microphone necessary for everyone to hear and to be heard?
• Are toilets conveniently located?
• Is the site convenient to parking, restaurants and public transportation?
• Are supporting facilities available and convenient: duplication, word
processing, computers?
Prepares notes to conduct the workshop using the session outlines in
the Facilitator’s guide for the selected module, and makes the necessary
adaptations. Refer to the appropriate User’s guide for content.
Duplicates the worksheets and other handouts as indicated in
the Facilitator’s guide and obtains the necessary equipment.
Conducts the workshop as planned.
Provides follow-on assistance, if appropriate.
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Module 6: FG; foreword
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Session 1: Introduction and overview
Objectives:
Participants will be able to:
• Explain at least one purpose of Module 6.
• Explain the purpose of service quality assess
ment.
• Provide examples of when to use the four
types of quality assessment tools.
• Discuss some limitations of service quality
assessment.
Session outline:
I. Introduction (30 minutes)
II. Overview of workshop (10 minutes)
III. Purpose of Module 6 (10 minutes)
IV. Module 6 User’s guide (5 minutes)
V. Introduction to Module 6 (20 minutes)
Materials:
Module 6 User’s guide
Handout 6-1:
Agenda
Transparency 6-1: Workshop objectives
Transparency 6-2: Purpose of Module 6
Transparency 6-3: Service quality checklist
functions
Transparency 6-4: Steps in service quality
assessment
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 6: FG; session 1
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Session 1: Introduction and overview
I. Introduction (30 minutes)
Note: Skip Section I if you have presented a
module immediately prior to the presentation of
Module 6.
A. OPENING REMARKS
• Introduce self and other staff, as necessary.
• Explain your role in the workshop.
Name tags or
place cards
• If you do not know the participants, ask each
one to state his or her name, position title, and
job location.
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Note: If the group is larger than 6 or 8, you may
wish to have them wear name tags or place cards
with their names at the places where they are sitting.
Flip chart
o Ask each participant to complete this sen
tence: 'As a result of attending this workshop,
I expect..." and write their responses on the
flip chart.
• When all responses have been recorded, say
that you will return to this list after giving an
overview of the workshop.
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B. OVERVIEW OF PHC MAP
See the Module 1 User’s
guide for this information.
• Explain why information is important for
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PHC programmes.
• Summarise PHC MAP programme, includ
ing;
Purpose of PHC MAP
Title and purpose of each module and other
materials
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• Make the following points about PHC MAP:
Has been field-tested and revised to ensure
usefulness to PHC programme staff.
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Module 6: FG; session 1
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Session 1: Introduction and overview
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Modules can be used in any sequence.
Checklists and other materials can be
adapted to fit a particular situation.
The procedures outlined in the modules can
be adopted as routine monitoring activities in
a PHC programme.
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• Explain why MAP is being introduced in this
PHC programme.
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Note: The remarks here should be tailored to the
specific programme and should provide answers
to these questions:
Why are we doing this workshop?
What do we expect to achieve?
It may be appropriate for the PHC manager to
make these remarks.
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II. Overview of workshop (10 minutes)
Transparency 6-1;
Workshop objectives
Handout 6-1: Agenda
• Review the workshop objectives.
• Distribute and review the workshop agenda,
describing the activities that will take place to
accomplish the workshop objectives.
• Review the expectations contributed by par
ticipants at the beginning of the session.
Indicate which ones will be met and which
ones will not and why.
Suggest, if possible, alternatives for meet
ing the expectations that will not be met in
this workshop.
• Ask for questions or comments.
III. Purpose of Module 6 (10 minutes)
Transparency 6-2:
Purposes of Module 6
Module 6: FG; session 1
° Explain that the purposes of Module 6 are to
help PHC management staff to:
10
Session 1: Introduction and overview
Assess the quality of PHC services provided
in the programme.
Assess whether clients’ needs and expecta
tions are being met.
Identify opportunities to improve the quality
of care.
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• Ask for questions and comments.
IV. Module 6 User’s guide (5 minutes)
Module 6 User’s guide
• Distribute a User’s guide to each participant.
• Highlight key sections of the User’s guide.
Overview of the Primary Health Care Man
agement Advancement Programme has more
details on the purpose of PHC MAP and the
materials included—information that has al
ready been presented in summary form.
Seven-step process for carrying out a service
quality assessment.
Appendices.
V. Introduction to Module 6 (20 minutes)
Transparency 6-3:
Service quality checklist
functions
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Paraphrase the purpose of the module.
Service quality assessment tools
Discuss how and when to use the check
lists.
Explain the purpose and content of the
discussion guidelines.
Describe the relationship between check
lists and discussion guidelines as service
quality assessment tools.
Explain the purpose and content of the
multiple observation checklists.
Discuss limitations of service quality
assessment.
Module 6: FG; session 1
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Session 1: Introduction and overview
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Transparency 6-4:
Steps in service quality
assessment
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Module 6: FG; session 1
Review briefly the steps in service quality
assessment and explain that Session 2 will be
devoted to Step 1.
• Ask for questions and comments.
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SAMPLE AGENDA
MODULE 6*
Session 1
(1 hr, 5 mins)
Introduction and
overview
Session 2
(1 hr)
Specify quality
assessment
objectives
(Step 1)
Session 3
(1 hr, 50 mins)
Design and carry
out assessment
(steps 2, 3, 4 and 5)
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Session 4
(50 mins)
Compile and
analyse the data
(Step 6)
Session 5
(1 hr, 5 mins)
Report the findings,
provide feedback, and
take corrective action
(Step 7)
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£* For an actual presentation, substitute the appropriate times in the first column
Module 6: FG; session 1; handout 6-1
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s WORKSHOP OBJECTIVES:
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2. Prepare a list of action steps to assess
other service functions after the
workshop using the same steps and
materials
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1. Conduct a service quality assessment
for at least one PHC service function
using the steps and materials contained
in Module 6
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Module 6: FG; session 1; transparency 6-1
PURPOSES OF MODULE 6
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To help PHC programme managers to:
3. Identify opportunities to improve the
quality of care
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2. Assess whether clients’ needs and
expectations are being met
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1. Assess the quality of PHC services
provided in the programme
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Module 6: FG; session 1; transparency 6-2
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SERVICE QUALITY
CHECKLIST FUNCTIONS
A framework for supervision
A self-assessment tool
• A job aid for service providers
• An instrument for area-wide assess
ment of service quality
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• As guidelines for training
• Tools for pre-test and post-test assess
ments of service enhancing efforts
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• A combination of the above methods
Module 6: FG; session 1; transparency 6-3
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STEPS IN SERVICE
QUALITY ASSESSMENT
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1. Specify the scope and objectives of the
quality assessment
2. Determine the unit of observation and ''
select data sources
3. Select and adapt the appropriate 5-;
service quality checklist(s)
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4. Determine the sampling procedures n
and select sample (optional)
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5. Carry out the assessment
6. Compile and analyse the data
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7. Report the findings, provide feedback, p
and take corrective action
Module 6: FG; session 1; transparency 6-4
17
Session 2: Specify scope and objectives
of the quality assessment (Step 1)
Objectives:
Participants will be able to follow the directions
in the Module 6 User’s guide to specify the
objectives of a service quality assessment for
their PHC programme.
Session outline:
I. Introduction (5 minutes)
II. Questions to be answered (15 minutes)
III. Application, quality assessment of PHC
services (40 minutes)
Materials:
Module 6 User’s guide
Transparency 6-5: Session 2: Objective
Transparency 6-6: Questions to be answered
Handout 6-2:
Worksheet for planning
quality assessment activi
ties
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 6: FG; session 2
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Session 2: Specify scope and objectives of the quality
assessment (Step 1)
Introduction (5 minutes)
I.
Transparency 6-5:
Session 2: Objective
• Review the session objective.
. Explain that you will introduce and discuss
the questions to be answered in specifying
assessment objectives, after which participants
will answer those questions to plan their own
service quality assessment.
• Explain that assessment objectives are
specified by answering a series of questions.
Transparency 6-6:
Questions to be answered
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Questions to be answered (15 minutes)
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• Show one question at a time and discuss the
purpose of each, and possible responses, using
the points contained on pages 16 - 17 of the
User’s guide.
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• Encourage participants to ask questions and
give examples from their programmes as you
present each question.
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• Ask participants how satisfied they are with
their answers to these questions.
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III.
Application (40 minutes)
Handout 6-2: Worksheet
for planning quality
assessment activities
• Distribute the worksheet and direct partic-
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ipants to complete Step 1 for their PHC pro
gramme.
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• When participants have completed the work
sheet for Step 1, ask one participant to present the responses developed by the group and
explain the rationale for each response.
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Module 6: FG; session 2
19
Session 2: Specify scope and objectives of the quality
assessment (Step 1)
Note: As you listen to the presentation, consider
whether the responses are consistent with the pur
pose of each question and consistent with each
other and the needs of the programme. For ex
ample:
Are the services to be observed consistent with
the purpose(s) of the assessment?
Does the scope of the assessment exceed the
resources available?
• Ask for questions and comments about the
worksheet and the process of specifying the
assessment objectives.
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Module 6; FG; session 2
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SESSION 2: OBJECTIVE
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Specify the scope and objectives of
service assessment for your PHC S£
programme.
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Module 6: FG-. session 2; transparency 6-5
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*- QUESTIONS TO BE
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• What is the purpose of the assessment?
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What services will be included?
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Who will use the information gathered?
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• How will the information be used?
What geographic area will be covered?
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• Over what period of time will the
assessment take place?
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© What additional resources, if any, are
available?
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Module 6: FG; session 2; transparency 6-6
22
WORKSHEET FOR PLANNING
QUALITY ASSESSMENT ACTIVITIES
Step 1:
Specify the scope and objectives
of the assessment
A. What is the purpose of the assessment?
B. What services will be included?
C. Who will use the information gathered?
D. How will the information be used?
E. What geographic area will be covered?
F. Over what period of time will the
assessment take place?
G. What additional resources, if any, are
available?
Module 6. FG; session 2; handout 6-2
23
Session 3: Design and carry out assess
ment (Steps 2, 3, 4 and 5)
Objectives:
Participants will be able to follow the directions
in the Module 6 User’s guide to:
• Determine the unit of observation and data
collection techniques.
• Select and adapt the appropriate service
quality checklist(s).
• Determine the sampling procedures and select
sample, (optional)
• Carry out the assessment.
Session outline:
I. Introduction (5 minutes)
11. Determine a unit of observation and data
collection techniques (45 minutes)
III. Select and adapt checklists (30 minutes)
IV. Determine the sampling procedures and
select sample (optional) (45 minutes)
V. Carry out the assessment (45 minutes)
Materials:
Module 6 User’s guide
Transparency 6-7: Session 3: Objectives
Transparency 6-8: Units of observation
Transparency 6-9: Data collection tech
niques
Transparency 6-10: Sampling procedures
Transparency 6-11: Ground rules
Module 6: FG; session 3
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Handout 6-3:
Handout 6-4:
Handout 6-5:
Equipment:
Worksheet for Step 2
Worksheet for Step 4
Worksheet for Step 5
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Flip chart, stand, markers, masking tape, overhead projector and screen
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Session 3: Design and carry out assessment
(Steps 2, 3, 4 and 5)
I.
Introduction (5 minutes)
Transparency 6-7.
Session 3: Objectives
° Review the session objectives.
• Explain that details regarding each of the
four steps will be discussed and that the major
portion of the time will be spent in a group
discussion focused on the service function
chosen in Step 1.
II.
Determine the unit of observation and data collection techniques
(45 minutes)
Transparency 6-8:
Units of observation;
Transparency 6-9:
Data collection
Handout 6-3: Worksheet
for Step 2
• Approaches to service assessment.
Remind participants that this module pre
sents quantitative and qualitative approaches
to service assessment.
Say that the quantitative approach empha
sises the use of the checklists contained in
Appendices A, B, and D; the qualitative ap
proach emphasises use of the discussion
guidelines contained in Appendix C.
Make these additional points regarding ap
proaches to service assessment:
Both checklists and guidelines can be used
by the management team.
Both also can be adapted for use in the field.
Briefly review factors to consider in selecting
assessment methods.
Distribute the worksheet and direct par
ticipants to complete Step 2 for their PHC
programme.
° Refer participants to their responses to ques
tions in Step 1 of the Worksheet for planning
quality assessment activities for the service
activities they selected for assessment.
Module 6: FG, session 3
26
Session 3: Design and carry out assessment
(Steps 2, 3, 4 and 5)
III.
Select and adapt the appropriate service quality checklist(s)
(30 minutes)
User’s guide
• Refer participants to Appendix C to find the
guidelines appropriate to the service activity
they chose to assess.
• Direct participants to review the questions
under the section headed "Discussion Guide
lines" and "Key Questions".
• Point out that the "Key Questions” have been
extracted from the corresponding checklist for
this activity and are phrased to be answered
yes or no.
• Direct participants to find the corresponding
checklist in Appendix A and, if they wish,
select other key questions they would like to
address in the group discussion.
Flip chart
• Next, ask participants to rephrase the key
questions so that they cannot be answered yes
or no. Record the rephrased questions on a
flip chart.
Note: The questions under "Discussion Guide
lines can serve as a model for rephrasing the key
questions.
Questions that begin with "how" or "how well",
when , why" and "what" are called open-ended
questions and require more than a "yes" or "no"
response.
Open-ended questions stimulate discussion and
promote exploring questions rather than making
judgements.
Module 6: FG. session 3
27
<1
"st
3
3
Session 3: Design and carry out assessment
(Steps 2, 3, 4 and 5)
IV. Determine the sampling procedures and select sample (optional)
(45 minutes)
3
y
Note: This step is only necessary if the objective
is to conduct a study or evaluation of quality in an
administrative area, such as a district or province.
3
• Refer participants to the Appendices of Mod
• Discuss the purpose of sampling.
ule 2 for detailed instructions for drawing
samples.
=3
Transparency 6-10:
Sampling procedures
• Discuss sampling procedures appropriate for
Handout 6-4: Worksheet
for Step 4
• Distribute the worksheet and direct partic
=3
quality assessment.
ipants to complete Step 4 for their PHC pro
gramme.
• When participants have completed the work
sheet for Step 4, ask one participant to pre
sent the responses developed by the group and
explain the rationale for each response.
• Ask for questions and comments about the
worksheet and the process of determining the
minimum number of observations to be made
for each unit.
3
3
y
y
y
V. Carry out the assessment (45 minutes)
a
-a
Transparency 6-11:
Ground rules
• Review the ground rules for a group discussion and explain their value in making the
discussion as productive as possible.
a
• Explain the procedure for the group discus
sion:
You will take the role of facilitator, reminding
the group of the ground rules when they are
broken, pointing out when the discussion is off
a
s
-3
Module 6: FG; session 3
28
Session 3: Design and carry out assessment
(Steps 2, 3, 4 and 5)
the subject, and announcing the time at
various points so participants can adjust the
process as needed.
The group will select a leader and a recorder.
The leader will chair the discussion using the
guidelines as provided or modified in Step 3. The
recorder will write down the group conclusions
to each question including minority opinions
where applicable.
• Refer participants to questions they re
phrased in Step 3.
Handout 6-5: Worksheet
for step 5
• Discuss the tasks involved in preparing for
an assessment visit.
• At the end of the discussion, direct the re
corder to read aloud the conclusions of the
group to each question and make agreed upon
modifications.
• Summarise the group performance on the
ground rules, including things they did well
and areas where they need to improve.
• Ask for final questions and comments on
Steps 2 through 5.
Module 6: FG; session 3
29
£3
230 SESSION 3: OBJECTIVES
SI
• Determine the unit of observation and
3
data collection techniques
al
• Select and adapt the appropriate
service quality checklist(s)
3 • Determine the sampling procedures
and select sample (optional)
al
• Carry out the assessment
3
3
a
•a
Module 6: FG; session 3; transparency 6-7
30
UNITS OF OBSERVATION
• Client/patient
• Health worker
Service elements
g...
Clinic sessions
• Health centre
Module 6: FG; session 3; transparency 6-8
DATA COLLECTION
TECHNIQUES
Direct observation
• By supervisor
• By peer
• Self-assessment
Interviews
® Structured interviews
® Open-ended interviews and discussion
Record review
© Routine records
• Records kept
assessment
r
Module 6: FG; session 3; transparency 6-9
32
SAMPLING PROCEDURES
• Develop the sampling frame
• Determine sample size
• Sampling procedures
• Simple random sample
• Stratified random sample
• Systematic sample
• Lot quality assurance sampling
• Convenience sampling
Module 6: FG; session 3; transparency 6-10
33
WORKSHEET FOR PLANNING
QUALITY ASSESSMENT ACTIVITIES
Step 2: Select unit of observation and data
sources
Unit of observation:
Client/patient
Service elements
Health worker
Clinic session
Health centre
Data sources:
Direct observation
by supervisor
by peer
self-assessment
_ Interviews
structured questions
open-ended questions
discussion
Record review
routine records
records kept specifically for the assessment
Module 6: FG; session 3; handout 6-3
34
Step 4: Determine sampling procedures and
select sample (optional)
$
WORKSHEET FOR PLANNING
QUALITY ASSESSMENT ACTIVITIES
Number of units in sampling frame
Sample size
(%) =
(N)
Sampling method:
0)
Census (100% sample)
W
Random sample
rp
Systematic sample
LQA sample
Convenience sample
Purposive sample
f t to
What is the minimum number of observations that should be made
for each unit?
$
01
01
p
Quota sample
Module 6: FG; session 3; handout 6-4
35
GROUND RULES
© Everyone’s ideas are important
® No "right" or "wrong" answers
@ Positive and negative comments
• Disagreement is expected/encouraged
® Don’t wait to be called on
® Only one person speaks at a time
Module 6: FG; session 3; transparency 6-11
36
WORKSHEET FOR PLANNING
QUALITY ASSESSMENT ACTIVITIES
Step 5: Carry out the assessment
Preparation for the visit
___ Select and train observers
___ Produce data collection forms
Conduct a pre-test of the checklists
Select dates for the assessment
Inform health centres and service
providers (optional)
Arrange for transportation for data
collection
Module 6: FG; session 3; handout 6-5
Session 4: Tabulate and analyse the
data (Step 6)
Objectives:
Participants will be able to follow the directions
in the Module 6 User’s guide to:
• Compile, analyse, and interpret results of
quality assessment.
• Use at least one rapid data analysis calculation
to arrive at service quality information.
Session outline:
I. Introduction (5 minutes)
II. Rapid data analysis (45 minutes)
Materials:
Module 6 User’s guide
Transparency 6-12: Session 4: Objectives
Transparency 6-13: Rapid data analysis
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
Module 6: FG; session 4
38
Session 4: Tabulate and analyse the data (step 6)
0**
I. Introduction (5 minutes)
Transparency 6-12:
Session 4. Objectives
• Review the session objectives.
. Explain that in this session, participants will
review the basic elements of the rapid data
analysis plan.
II. Rapid data analysis (45 minutes)
&
E=
&-
• State the value of rapid data analysis.
Calculations can be quickly and easily hand
tabulated.
Problem areas can be easily identified.
Transparency 6-13:
Rapid data analysis
£
• Explain the types of analysis and answer
participants’ questions.
• Direct participants to calculate as many of
the indicators from the data analysis plan as
time allows, using data from Exhibit 7 in the
users’ guide.
• Ask for questions and comments about rapid
data analysis calculations, particularly the
ones they used.
£?-
L?
EE&
e-
if
Module 6: FG; session 4
39
93
93
SESSION 4: OBJECTIVES
Compile, analyse, and interpret results
of quality assessment.
39
93
Use at least one rapid data analysis
calculation to determine service quality
information.
93
93
93
*3
13
93
1*3
Module 6: FG; session 4; transparency 6-12
40
RAPID DATA ANALYSIS
1. Total
2. Frequency distributions or counts
3. Percentage distributions
4. Threshold analysis
5. Scoring
6. Breakdown by site
7. Graphs
5s
is
Module 6: FG; session 4; transparency 6-13
41
-51
'J
43
-33
43
43
rai
'
43
43
43
43
>3
43
--y
i3
'J
•a
Session 5: Report the findings, provide
feedback, and take corrective action
(Step 7)
Objectives:
Participants will be able to follow the directions
in the Module 6 User’s guide to:
• present and review preliminary results with
the assessment team.
• describe how to take action necessary to imple
ment an appropriate, effective, and acceptable
solution.
• check the results of that action.
Session outline:
I. Introduction (5 minutes)
II. Taking action and checking results (15
minutes)
III. Next steps (30 minutes)
IV. Conclusion (15 minutes)
Materials:
Module 6 User’s guide
Transparency 6-14: Session 5: Objectives
Transparency 6-15: Providing feedback and
taking corrective action
Equipment:
Flip chart, stand, markers, masking tape, over
head projector and screen
43
43
Module 6: FG; session 5
42
Session 5: Report the findings, provide feedback, and
take corrective action (Step 7)
g.1
I. Introduction (5 minutes)
Transparency 6-14:
Session 5: Objectives
• Review the session objectives.
• Say that the final activity of the session will
give participants an opportunity to think
about and list the actions they will need to take
after the workshop to continue the work they
have begun on assessing and improving the
service functions of their PHC programme.
e?
&
jSL
II. Taking action and checking results (15 minutes)
&
• Refer participants to the notes from their
group discussion in Session 3.
Transparency 6-15:
Providing feedback and
taking corrective action
• Explain the review questions and direct
participants to review their discussion notes
with these questions in mind.
• Ask for questions and comments on the serv
ice assessment process.
• Discuss other ways that PHC managers
could use these steps and materials in Module
6 to improve their service functions.
Transparency 6-3:
Service quality checklist
functions
• Review Transparency 6-3 and ask partici
£
&•
gc
pants what other uses for the checklists they
think would be most useful in their pro
gramme.
S
III. Next steps (30 minutes)
Transparency 6-4:
Steps in service quality
assessment
&-
• Review the steps in service assessment,
highlighting the outcome of each step.
&' ■
gT
£Module 6: FG; session 5
43
J
33
Session 5: Report the findings, provide feedback, and
take corrective action (Step 7)
User’s guide
• Direct participants to review their completed
worksheets, and the notes from the group
discussion and indicate where they need to
take action to:
assess other service functions;
implement and check solutions that have
been identified.
39
=3
33
• Direct participants to list what they need to
do to implement those actions and then
develop an action plan which includes:
tasks in order of accomplishment;
when each task must be completed;
who is responsible for each task.
=3
33
• Ask participants to review their action plan,
3
anticipate any problems that might occur, and
suggest a way to deal with each problem.
• Ask for questions and comments about the
action plan.
3
IV. Conclusion (15 minutes)
• Review the expectations participants ex
3
pressed at the beginning of the workshop and
ask them to assess how well they think those
expectations have been met. If any were not
met, ask how the workshop could be im
proved to make that happen.
33
33
1J
*3
• Thank participants for their time and atten
tion, congratulate them on the results of
their work, and wish them good luck in im-
33
Note: Indicate what follow-on assistance will be
plementing their action plans.
available, if appropriate.
0
Module 6: FG; session 5
lb
44
As a result of this session, participants
will be able to:
ii w di (a ®
SESSION 5: OBJECTIVES
SF
1. present and review preliminary results
with the assessment team.
2. describe how to take action necessary gto implement an appropriate, effective,
and acceptable solution.
3. check the results of that action.
£•
S'
.&■
Module 6: FG; session 5; transparency 6-14
45
&
PROVIDING FEEDBACK
AND TAKING
? CORRECTIVE ACTION
What activities are going well?
^3
f
® What activities need improvement?
• Of the problem activities, which are:
• easy to correct?
• a priority?
43
• hard to correct?
43
<3
39
Module 6: FG; session 5; transparency 6-15
PHC MAP MANAGEMENT COMMITTEE
Dr. Ronald Wilson • Aga Khan Foundation, Switzerland (Co-Chair)
Dr. Jack Bryant • Aga Khan University, Pakistan (Co-Chair)
Dr. William Steeler • Secretariat of His Highness the Aga Khan, France (Co-Chair)
Dr. Jack Reynolds • Center for Human Services, USA (PHC MAP Director)
Dr. David Nicholas • Center for Human Services, USA
Dr. Duane Smith • Aga Khan Foundation, Switzerland
Dr. Pierre Claquin • Aga Khan Foundation, Switzerland
Mr. Aziz Currimbhoy • Aga Khan Health Service, Pakistan
Mr. Kabir Mitha • Aga Khan Health Service, India
Dr. Nizar Verjee • Aga Khan Health Service, Kenya
Ms. Khatidja Husein • Aga Khan University, Pakistan
Dr. Sadia Chowdhury • Aga Khan Community Health Programme, Bangladesh
Dr. Mizan Siddiqi • Aga Khan Community Health Programme, Bangladesh
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Yawarat Porapakkham • ASEAN Institute for Health Development, Thailand
Dr. Jumroon Mikhanorn • Somboon Vacharotai Foundation, Thailand
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India
PHC MAP TECHNICAL ADVISORY COMMITTEE
Dr. Nirmala Murthy • Foundation for Research in Health Systems, India (Chair)
Dr. Krasae Chanawongse • ASEAN Institute for Health Development, Thailand
Dr. Al Henn • African Medical and Research Foundation (AMREF), formerly of
the Harvard Institute for International Development
Dr. Siraj-ul Haque Mahmud • Ministry of Planning, Pakistan
Dr. Peter Tugwell • Faculty of Medicine, University of Ottawa, Canada
Dr. Dan Kaseje • Christian Medical Commission, Switzerland, formerly of the
University of Nairobi, Kenya
KEY PHC MAP STAFF AT THE CENTER FOR HUMAN SERVICES
Dr. Jack Reynolds (PHC MAP Director)
Dr. Paul Richardson
Dr. David Nicholas
Dr. Wayne Stinson
Ms. Maria Francisco
Dr Neeraj Kak
Ms. Lori DiPrete Brown
Ms. Pam Homan
Dr. Lynne Miller-Franco
Ms. Mary Millar
MODULE 6
FACILITATOR’S GUIDE
Primary Health (are Management Advancement Programme
- Media
10635.pdf
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