Three Pivots for Improving Health Care Provider Performance

Abstract

We share recommendations on 3 important pivots away from longstanding approaches to continued professional development and in-service training programs that have demonstrated a measurable benefit across a diversity of health-related applications and projects.nThe first pivot involves shifting from focusing on using data primarily for reporting purposes. Encouraging team members within facilities to regularly use their own data to track, review, and measure priority quality indicators promotes the quality improvement process and can improve service delivery outcomes.nThe second pivot involves shifting from focusing on repeated, external, quality assurance assessments, often from the district or subnational level, to using facility team-based internal service delivery indicator data reviews to implement quality improvement efforts based on these data. n These pivots toward health care provider and facility manager ownership of the quality improvement process also lead to the third pivot, which involves shifting from one-time, groupbased training toward workplace-based educational interventions. Team involvement in interpreting their facility data can lead to identifying targeted team-based learning needs and the potential need for individual mentoring.

A low resource simulation-based training package leads to increased knowledge and skill retention post Basic Emergency Obstetric and Neonatal Care in rural Tanzania: A Quasi-experimental research design

“…20,21,22 According to the theory of skill acquisition complexity of a skill and frequency of clinical exposure and opportunity to apply, play a key role in identifying practice thresholds; the more technical or complex a skill (bag valve mask), or rare in terms of clinical exposure (Asphyxia, PPH and Sepsis) or application (oxytocin), the more practice is required to achieve and maintain competency over time. 31,33 Skill decay suggests compromised maternal and newborn care and this is alarming, but again it resonates with the reported high rates of MMR and NMR. Skill decay was not observed in the Cluster accessing our simulation package.…”

“…Lastly the dose of BEmONC we used was 5-days, compared to 8 days described by Ugwa and colleagues. 33 Findings of skill and knowledge retention, and the improved OSCE scores at 6 months and 12 months were associated with access to our simulation package. Cluster A who was given access to both facility-based peer-to-peer learning practice and mentorship visits after the initial BEmONC training workshop retained the scores at 12 months.…”

Use of Supervision Data to Improve Quality of Care for Malaria in Pregnancy: Experience in Six African Countries

“…Although offsite training can be resource intensive, on-the-job training and mentorship can be an effective, targeted way to support health worker competency. 22 Onsite training also has the potential to reach more providers. During country validation meetings, several countries noted that large-scale malaria and/or MiP training was carried out after these rounds of supervision, likely contributing to increased provider competency moving forward.…”

A low resource simulation-based training package leads to increased knowledge and skill retention post Basic Emergency Obstetric and Neonatal Care in rural Tanzania; A stepped- wedge research design Short Title: BEmONC simulation-based training package leads to skill retention in Tanzania

“…22,24,25 According to the theory of skill acquisition complexity of a skill and frequency of clinical exposure and use play key roles in identifying practice thresholds; the more technical or complex a skill (bag valve mask), or rare in terms of clinical exposure or application (oxytocin), the more practice is required to achieve and maintain competency. 20,39 Skill decay suggests compromised maternal and newborn care and this is alarming. Importantly, skill decay was not observed in the Cluster accessing peer to peer facility-based simulation practice after initial training.…”