5 Core Components. 1. Aim 2. Content Theory 3. Execution Theory 4. Measurement Plan 5. Dissemination Plan 11/24/2016 #IHIFORUM #IHIFORUM

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1 M3 This presenter has nothing to disclose Execution Theory: Health Care Quality Initiative Hema Magge, MD, MS IHI Country Director, Ethiopia Brigham Women s Hospital Division of Global Health Equity Boston Children s Hospital, Division of General Pediatrics Monday, December 5, Core Components P2 1. Aim 2. Content Theory 3. Execution Theory 4. Measurement Plan 5. Dissemination Plan 1

2 Execution Theory P3 What will the initiative do that will lead to adopt process changes? Execution theory is defined as the rationale for how the experience provided the initiative (KP 1), the teaching other activities delivered (KP 2), the learning accomplished leads to in the process (KP 3) or outcome (KP 4) measures. Project Background P4 Steady in overall child health in Ethiopia over the last ten years However, for mothers newborns remain unacceptably high Ethiopia Health Care Quality Initiative is joint initiative FMOH with IHI support Goal to achieve 30% reduction in facility-level mortality within 30 months using a multi-armed approach 2

3 Program Components Creation of National Health Care Quality Strategy with the FMOH o o Aligned with the Health Sector Transformation Plan (HSTP) Builds on the existing initiatives in the country which focus on quality equity Activate a culture of continuous at all levels of the healthcare system o Through multi-level QI capability building training activities Launch test large-scale results-focused collaboratives in health o Demonstrate impact of QI methods to accelerate change in key priority area Content Theory: MNH Collaborative Driver Diagram Increased Health Seeking Behavior Optimize the ability of the HEW to educate the community Community Engagement for awareness creation positive influence Use culturally acceptable strategies to improve dissemination uptake of key health messages Create positive experiences through every health encounter Utilize the Health Development Army structure to reach the house hold Use schools as a dissemination mechanism Use multimedia for Health education activities Use each facility visit to educate/counsel mothers towards raising their health seeking behavior Improved experience at care facility-based sites 30% period of 30 months Improved mechanisms to reach appropriate level of facility Improved quality of care at health institutions (safe, effective, patientcentered, timely, efficient, equitable) Improved referral network Improving transportation mechanisms (ambulance others) for immediate response Maximizing the potential of near health facilities to avoid unnecessary referral Create a culture of QI leadership Availability of skilled respectful health personnel Improve the reliability of the supply chain management system to deliver essential commodities all the time Availability of national guidelines, clinical protocols job aids Create structure (QI, committees, plan) to facilitate execute work Improve data quality through DQA s Create a learning platform for collaboration routine use of data for Increase the skills of health professionals health managers to use QI methods Organize learning collaborative among health facilities serving the same geographic areas (full Woreda Coverage) Training in key MNH national protocols Onsite mentorship to maintain skills address skills gaps Maximize efficiency of existing facility staff Professionals get regular updates on the management prevention of key causes of mortality Address gaps in essential commodities as defined in baseline assessment Dissemination of existing protocols support for local development when necessary Timely identification, prevention management of life threatening conditions to mothers newborns Fast tracking/triaging/follow-up mechanism Reliable of labor delivery bundle Reliable of the "MNH" checklists/relevant guidelines Support for a care delivery system that ensures for patients Incorporation of compassionate (CRC) change ideas training in learning sessions Clean, safe, comfortable spaces for patients staff 3

4 Execution Considerations Planning from the start for: Scale-up MOH ownership sustainability Integration of QI clinical skill building Adapting model to different regional contexts have not moved since In ship with the FMOH, we plan to use QI to accelerate assets system Space: -Central office in Addis USbased staff -FMOH, RHBs, s: CPC, QI How to IHI Aurum QI -Conduct assessment of current health system with regard to: data systems: leadership functionality; existing QI initiatives -Co-facilitate stakeholder sessions for syndication to gain buyin guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing strategies; baseline data collection; identify early adopters Prototype Phase: Test promising changes with representative slice of health system via collaborative woredas in 3 regions (Oromia, Tigray, Amhara); test measurement system, leadership engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, Tigray, Amhara, SNNPR, Afar); continued mentoring of prototyping sites; test further develop data systems other infrastructure needs required for scale-up; engage testof-scale implementing (TBD); test model of leveraging existing health structures for QI approach; begin integration with NQS Go to Full Scale: Fully leverage existing structures meetings, add more scalable units within each of the existing 5 regions; exp to 3 new regions in first year; exping to the remaining 4 regions in the second year; fully integrate with NQS - 5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facilitylevel staff data. -Work with public education company to develop educational radio Internal external evaluation with development of operational Set-Up: Initial bundles ready for testing core indicators selected; clear roles for stakeholders; Prototype Phase: Locally developed/tested change package; 150 health staff across three regions engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials Go to Full Scale: How-to guide for implementing change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-ofcare staff with working knowledge of QI capable of infusing it into stard review meetings -Radio or TV program to spread messages related to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials Baseline data, regular opportunities to reflect on toward aims skills in QI, testing change ideas, collecting real time data for using data for knowledge skills other change meetings team -Increase careseeking preventative /newborn delivery, PNC) -Integration of quality structures quality -Improved data quality Medium term Improve reliability of care processes for health: - Screen, prevent treat pregnancy-related conditions complications e.g. APH, hypertension, HIV, Anemia, Malaria etc. -provide compassionate -Screen, prevent treat L&D -Routine subsequent postnatal care Improve reliability of care processes -Screen manage complications i.e. Pre-term care, Sepsis care, -postnatal follow ups of mother/ba -compassionate respectful care at all levels of facility-based care -Strengthen referral participatin g sites 30% period of 30 Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities External factors - What factors outside of the project may be a barrier or facilitator to deliveries, shifting baseline due to pastoral communities, political stability in regions of 4

5 Component 1: National Healthcare Quality Strategy 2. Capability Building Activities FMOH Leadership across Directorates FMOH Technical Staff for Quality Unit in MSD RHB Head Deputy Heads Regional Health Bureau Technical Staff KEY = IA Course = QILM = Leading & Facilitating = Learning Sessions Zonal Health Bureau Head Zonal Health Bureau Staff Woreda Health Head Woreda Health MNCH r & Additional r (HEW Supporter/M&E Planning) Health center heads hospital QI leads Facility QI Team Leaders & Data managers Facility QI Team Staff 5

6 3. MNH Collaborative Aims Short-term Aim End of Prototype Phase Improve quality of antenatal care, delivery management, postnatal care Improve management of complications related to leading causes of death Improve dem for care services through reduced delays in seeking reaching quality care Medium-term Aim End of Test-of-Scale Phase facility-based sites 30% period of 30 months Long-term Aim End of 5 Years facility-based mortality across Ethiopia 30% period of 5 years Habits of Continuous Improvement Culture of Continuous Improvement 30 months 5 years 3. PHCU + Hospital Unit ( scalable unit ) 1 Collaborative includes 7-11 QI (depending on # of hospitals) X1 Primary Hospital Woreda Health X2 Referral Hospital This includes Primary Hospital supported L10K (for Agrarian regions) WHO sends 1-2 officials to participate in LS Referral Hospitals send 2 : -Neonatal (5 ppl) -Maternal (5 ppl) Primary Hospitals (when present) send 1 team Health Center Health Center Health Center Health Center Health Center HC linked HP send 1 team: -3 ppl from HC -1 from each HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP HP = Health Post 6

7 3. Learning Collaborative Design Address gaps in clinical QI skills supplies (training procurement of essential supplies) Learning Session 1 Action Period 1 Learning Session 2 Action Period 2 Learning Session 3 Action Period 3 Learning Session 4 Finalize change package, publicize & spread Intensive coaching to support to improve system skills gaps (visits, phone calls, engagement of program supervisory managers, data collation & interpretation) months Framework for scale up Set-up Phase Learnings incorporated into Design Learnings incorporated into Design Learnings incorporated into Design Size of gap population at scale Time (years) Receptivity/Will Infrastructure/Capability 7

8 Program Scale-Up Total Population: Number of deliveries: 2,520,000 7,077 12,600,000 35,385 Aug 2015 Preparation Operational Start April 2016 Prototype Launch* Five regions Mar 2018 Test Scale Up Five regions ~Mar 2019 National Scale Up Eleven regions No Woredas/PHCUs: No QI : Primary Hospitals: Referral Hospitals: Health Centers: Health Posts: *Courses to build QI capability conducted in Oromia region in April National capability going throughout initiative. 8

9 have not moved since In ship with the FMOH, we plan to use QI to accelerate assets system Space: US-based staff s: CPC, QI How to IHI Aurum QI systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials toward aims skills in QI, testing data for using data for knowledge skills other change meetings team preventative /newborn delivery, PNC) structures quality Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care -Strengthen referral sites 30% Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities External factors - What factors outside of the project may be a barrier or facilitator to deliveries, shifting baseline due to pastoral communities, political stability in regions of In ship assets system Space: US-based staff s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials toward aims skills in QI, testing data for using data for knowledge skills other change sites 30% months meetings team preventative /newborn delivery, PNC) structures quality Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care -Strengthen referral sites 30% Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities 9

10 In ship assets system Space: s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational for health: - Promote -Staff early at registration of -Increase subsequent ANC visits - Screen, prevent US-based treat pregnancy-related conditions complications e.g. APH, staff hypertension, -Increase % of skilled deliveries -provide compassionate -Screen, prevent treat L&D obstructed labor, ruptured uterus, Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings -Screen manage complications to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care toward aims skills in QI, testing data for using data for knowledge skills other change meetings team preventative /newborn delivery, PNC) structures quality Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care -Strengthen referral sites 30% Assumptions Referral What systems is necessary in order for this project to proceed see results as -Strengthen referral FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities In ship assets system Space: s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational skills in QI, testing collecting -Staff real at time data for using data for decision making. -Increase clinical US-based knowledge skills staff other change meetings team of ideas, data preventative /newborn care services (pre-conception, delivery, PNC) - to structures quality Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials toward aims skills in QI, testing data for using data for knowledge skills other change meetings team preventative /newborn delivery, PNC) structures quality Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care -Strengthen referral sites 30% Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities 10

11 In ship assets system Space: US-based staff s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO system in structures phase, engaged woreda-level coach in TOS phase, will for at health facilities Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings skills in QI, testing data for using data for knowledge skills other change meetings team preventative /newborn delivery, PNC) structures quality Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care Improvement -Work Collaboratives with public education company to develop educational radio Set-Up: Initial -Engage bundles HEWs to register ready pregnancies, for promote testing ANC skilled core early adopters engaged to Maternal Newborn health /or respectful Internal external evaluation with development of operational care. package; 150 health staff across three -Strengthen regions referral engaged in QI -Client satisfaction feedback stard materials in toward aims Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into health sites 30% In ship assets system Space: How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Capacity Building -20 FMoH central Addis RHB QI coaches trained to support US-based IAs staff to lead monitor quality activities -150 senior leaders with enhanced Ethiopia understing -Up to 180 -FMOH, skilled RHBs, coaches to lead QI -Up to 150 regional, zonal, district staff s: CPC, with bolstered QI leadership skills -Up to 1,500 regional, district, point-ofcare staff with working knowledge of QI capable of infusing it into stard review meetings Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational -Radio or TV program to spread messages related to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials toward aims skills in QI, testing data for using data for knowledge skills other change meetings team preventative /newborn delivery, PNC) structures quality Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care -Strengthen referral sites 30% Baseline data, regular opportunities to reflect on toward aims Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities 11

12 In ship assets system Space: US-based staff s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational Medium term for health: skills in QI, testing Set-Up: Initial bundles ready for testing core indicators selected; systems: clear roles leadership for stakeholders; data functionality; for existing - Screen, prevent QI initiatives treat using data for pregnancy-related conditions Prototype Phase: -Co-facilitate Locally developed/tested stakeholder change decision sessions making. for syndication complications e.g. to APH, gain hypertension, buy-in engaged in QI -Co-develop in strategy with knowledge FMOH, skills inclusive Labour of & delivery sites 30% collaboratives; guidelines learning shared across groups; evaluation -Learn metrics promising development of a Patient identified; full FMoH Rights ownership Charter other change -provide compassionate Test of Scale Phase: Stardized process for -Screen, prevent treat L&D stardized materials, including manual for locally adapted Set-Up: QI training Define reference clinical materials bundles select pre-eclampsia/eclampsia, core indicators PPH, with MOH meetings team Go to Full Scale: approval; How-to guide for create implementing all QI coaching/clinical mentorship, create change package ; QI fully integrated into program monitoring collection etc. -Immediate ; breastfeeding analysis of existing strategies; baseline data collection; identify -Early postnatal early care adopters -20 FMoH Prototype RHB QI coaches trained Phase: to support Test promising changes with representative slice of IAs to lead health monitor system quality activities via collaborative preventative woredas for in newborn 3 regions health: (Oromia, Tigray, Amhara); test measurement system, leadership engagement, data -150 senior leaders with enhanced understing /newborn system; test integrated clinical care services (preconception, QI mentoring -Screen manage complications -Up to 180 skilled coaches to lead QI Test of Scale Phase: Exp delivery, to 21 PNC) woredas Asphyxia in care 5 regions etc. (Oromia, -Up to 150 regional, zonal, district staff with bolstered QI leadership Tigray, skills Amhara, SNNPR, tracking Afar); of data continued mentoring of prototyping -Up to 1,500 regional, sites; district, test point-of-care further develop data systems other infrastructure staff with working knowledge of QI capable of infusing it into needs stard review required meetings for scale-up; -National engage Quality test-of-scale -postnatal follow implementing ups of mother/ba (TBD); test model of leveraging -compassionate existing health respectful structures care for at all levels of facility-based care QI approach; begin integration with NQS to Maternal Newborn Go to health Full /or Scale: respectful Fully leverage structures existing quality Referral structures systems meetings, add care. -Strengthen referral -Client satisfaction more feedback scalable stard materials units within -Improved each data of quality the existing transportation 5 system regions; exp to 3 Measurement new And Evaluation regions in first year; exping to the remaining 4 regions in the Baseline data, regular second opportunities year; to fully reflect integrate on with NQS toward aims Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities In ship assets system Space: US-based staff s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. Internal external evaluation with development of operational Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for region stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI radio -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials toward aims skills in QI, testing data for using data for knowledge skills other change preventative /newborn delivery, PNC) Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications sites 30% - 5 QILM courses for FMoH, RHB, WoHO staff for each meetings team - 5 Data Quality Trainings at each LS2 for facilitylevel staff data. -Work with public education company to develop educational -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care structures quality Internal external evaluation with development of -Strengthen referral operational Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities 12

13 In ship assets system Space: US-based staff s: CPC, How to IHI Aurum systems: leadership functionality; existing QI initiatives -Co-facilitate stakeholder sessions Space: for syndication to gain buy-in guidelines evaluation metrics development of a Patient Set-Up: Define clinical bundles select core indicators with MOH approval; create all QI coaching/clinical mentorship, create program monitoring ; analysis of existing engagement, data system; test integrated clinical QI mentoring Test of Scale Phase: Exp to 21 woredas in 5 regions (Oromia, sites; test further develop data systems other implementing (TBD); test model of leveraging existing health structures for QI approach; begin integration with NQS Go to Full Scale: Fully leverage existing structures meetings, exp to 3 new regions in first year; exping to the remaining 4-5 QILM courses for FMoH, RHB, WoHO staff for each region - 5 Data Quality Trainings at each LS2 for facility-level staff data. -Develop client satisfaction feedback mechanism Internal external evaluation with development of operational Set-Up: Initial bundles ready for testing core engaged in QI in Test of Scale Phase: Stardized process for stardized materials, including manual for locally adapted QI training reference materials change package ; QI fully integrated into US-based staff s: CPC, -20 FMoH RHB QI coaches trained to support IAs to lead monitor quality activities -150 senior leaders with enhanced understing -Up to 180 skilled coaches to lead QI -Up to 150 regional, zonal, district staff with -Up to 1,500 regional, district, point-of-care staff with working knowledge of QI capable of infusing it into stard review meetings to Maternal Newborn health /or respectful care. -Client satisfaction feedback stard materials skills in QI, testing data for using data for knowledge skills other change meetings team preventative /newborn delivery, PNC) structures quality How to Guides (co-developed IHI Aurum toward aims Medium term for health: - Screen, prevent treat pregnancy-related conditions -provide compassionate -Screen, prevent treat L&D -Screen manage complications -postnatal follow ups of mother/ba -compassionate at all levels of facility-based care -Strengthen referral sites 30% Assumptions What is necessary in order for this project to proceed see results as FMoH, Regional, woreda-level leadership, woreda-level change agent for joint coaching with IHI PO in phase, engaged woreda-level coach in TOS phase, will for at health facilities Execution Considerations-Know your! Intentional pauses for learning adaptation of intervention to strengthen execution impact Operational approach New IHI model Local finance regulations that affect the way work is able to be executed Continuing meaningful effective work in midst of security challenges in some regions Planning amidst changing funder priorities 13

14 Execution Successes High levels of ministry ownership engagement 150+ health system staff at all levels engaged in QI programming Successful LS1s with participation from staff at HP, HC, hospitals Early successes during site coaching Looking Ahead P28 Completion of collaboratives, regional change model refinement ualizing approach to pastoralist communities Introduction of phase 2 design in Test of Scale with increased integration into existing system 14

15 Questions? 15