Success of the project hinges on whether we can establish 
  robust performance management systems for continuous 
  improvement
                                            6 monthly 
                                            counter 
                                            verification
   Business/           Initial             Quality            Quarterly 
   Operational         investment          Improvement        quality 
   Plan                funds               activities         assessment
                                                     Performance 
  • Clear set of performance                         management 
    indicators                                          System
  • Robust data collection and            3 month 
    verification system                   Operational         Performance 
  • Rigorous review of                    Plan                bonus
    performance data and use for 
    planning 
                                                                              2 
  Building multiple levels of accountability and performance 
  management system is critical
                          Technical     • Overall oversight of performance 
                          Committee       trend and project implementation
                                        • Resolve project-level issues
                                 • Provide oversight to hospital management
                   Hospital      • Make SMT accountable for results and 
                   Board           implementation of business plan
                                 • Community involvement and grievance
            Senior       • Develop business plan with supervisors
            manage-      • Hold supervisors accountable for quality indicators
            ment Team • (At least ) monthly performance review with QI team
                         • Support QI team implement their plans
     Hospital     • Responsible for improving specific quality indicators
     QI team      • Carry out weekly/monthly self-quality assessments and 
                    track results at each ward
                  • Provide feedbacks, coach and train health workers 
                                                                               3 
 QI team will motivate health workers to improve key 
 indicators through tracking and coaching (1/2)
  Sample activities of Maternity QI team and LMDC coach
                       Areas Responsible Example of Activities
   Management           • Waste disposal        • Monthly self-assessment using 
   and structural       • Use of patograph        checklist and feedback ward/SMT
   checklist            • Delivery room         • Plan, support and monitor specific 
                          maintenance             activities of health workers (e.g., 
                        • Basic supplies          supplies tracking, waste disposal)
                        • Obstructed labor      • Weekly chart review, scores on 
   Process of           • PPH                     wall, feedback to health workers
   care checklist       • Sepsis                • Training to health workers
                        • Eclampsia             • Checklist on wall, attached to chart
                        • Complicated and  • Ensure home address of patients in 
   Quantity               assisted delivery       the register
   Checklist              Normal deliveries  • Monthly recording to invoice
                          of at risk referrals  • Put monthly numbers on a wall
                        • Training              • Plan training with faculties
                                                                                        4 
  QI team will motivate health workers to improve key 
  indicators through tracking and coaching (2/2)
   1 Self-Assessment                         2 Tracking and Feedback
                                                  e.g., Sepsis
                                                50
                                                40              40
                                                30          30
                                              % 20     20
                                                10 15
                                                 0
                                                 W1 W2 W3 W4
       • Weekly/daily chart review             • Post scores on a wall
       • Monthly management and                • Provide detailed feedback 
         structural checklist review             to staff
                  3 Support to Improvement QI Activities
                   • Support improvement activities (e.g., 
                    standardize chart, waste disposal, cleaning)
                   • Training on the treatment protocol and chart 
                    writing 
                                                                               5 
  SMT will create continuous improvement system in 
  the hospital and support QI team
                                       Indicator   • Assign all indicators and 
                                                     checklists to specific wards 
                                                     and QI teams
              SMT                      Tracking  • Provide QI team with graph, 
                                        system       etc. for tracking
                                                   • Run monthly performance 
                                                     review meetings to hold QI 
                                                     team accountable
                                                   • Establish healthy competition 
                                                     and recognition by QI team
     QI        QI         QI                       • Provide QI team financial and 
                                       Support       other support (e.g., on-time 
    Team      Team      Team     …
                                                     investment based on B-plan)
                                        Trans-     • Ensure full transparency of 
                                       parency       use of funds to the Board
                                                                                    6