Improving health worker competencies: Applying consensus-based methods to develop recommendations and strategies for in-service training improvement

Tana Wuliji Senior QI Advisor,URC Diana Frymus HSS Advisor, USAID 4 December 2012

Overview
Introduction

What is it? Why?

What affects the effectiveness, efficiency and sustainability of IST?

Content

How was it developed? What is in it?

Which of these areas are most challenging to address?

Application

How has it been used?

How could this framework be used to improve IST effectiveness, efficiency, and sustainability?

Overview
Introduction

What is it? Why?

What affects the effectiveness, efficiency and sustainability of IST?

Content

How was it developed? What is in it?

Which of these areas are most challenging to address?

Application

How has it been used?

How could this framework be used to improve IST effectiveness, efficiency, and sustainability?

What is the in-service training improvement framework? A set of practice recommendations to improve in-service training effectiveness, efficiency and sustainability that were developed and agreed through international expert consensus

Global landscape of IST

Significant proportion of country HRH investments Needed for scale-up of health services (HIV, TB, MCH) Growing attention of countries in reviewing IST portfolios *Need for evidence-

based guidance for improving IST programs and systems

How can we ensure that we are achieving the greatest gains in these investments?

Effectiveness-in training outcomes at all levels Efficiency-in training processes, reducing waste, and improving cost effectiveness Sustainability-to support in-country institutional and national systems for continuing education

Overview
Introduction

What is it? Why?

What affects the effectiveness, efficiency and sustainability of IST?

Content

How was it developed? What is in it?

Which of these areas are most challenging to address?

Application

How has it been used?

How could this framework be used to improve IST effectiveness, efficiency, and sustainability?

How was the IST improvement framework developed?

4. Rate agreement on recommendations

1. Develop and revise recommendations

25 member consensus group 3. Targeted literature review on recommendations 2. Consolidate recommendations

June December 2011

How was the IST improvement framework developed?

Delphi process Development and review of recommendations through 5 rounds of peer review and ratings (Delphi process) and literature review
Round 5: Consensus on 40 recommendations

Improvement framework
Expected early 2013

Round 1: 75 recommendations generated Round 4: Open consultation November 3-29 2011, online 26 countries 86/119 complete responses Consensus on 44/48 recommendations

Improvement framework Compilation of evidence summaries, examples and links to resources and tools for each recommendation to form how to guidance

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Have your say

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Which of these are most challenging to address?

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Engage national authorities, regulatory and professional bodies Build capacity and strengthen local infrastructure and trainers Support CPD systems

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Coordinate IST Minimize duplications: Coordination mechanism Reduce disruption to health services IST tracking mechanism

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Synergies between pre-service education and IST systems Consistency in approaches and content

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Needs based: aligned with plans, understand performance barriers Compliance with policies, strategies and laws Evidence based methodologies

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Share resources and materials Support trainees post-training Life long learning skills

IST improvement framework themes

1. Strengthening training institutions and systems 4. Design and delivery of training 2. Coordination of training 5. Support for learning 3. Continuum of learning from preservice to in-service 6. Evaluation and improvement of training

Build in evaluation to inform continuous improvement Evaluate against defined criteria Engage key stakeholders and trainees

Design and delivery of training: Recommendation: 4.3 IST should be based on sound, evidence-based learning principles and methodologies that offer the best opportunity to produce sustainable performance improvement within the workplace. Explanatory note:
In order for IST programs to most effectively improve health worker competencies, they should apply state of the art learning principles and methodologies appropriate to the context that are based on the latest evidence

Examples:

For the development of clinical decision The Johns Hopkins Evidence-Based making skills, a RCT comparing an interactive Practice Center recommends workshop-based training to simulation training multiple techniques, multiple media, found that simulation training resulted in interaction and repetition. better skill performance. This is reinforced by Marinopoulos SS et al, 2007. systematic reviews that identify clinical The Learning for Performance tools simulations as an effective technique for provide guidance on designing developing psychomotor and critical thinking training for desired performance skills. Daniels et al, 2010; Nestel et al, 2011; http://www.intrahealth.org/page/lea Issenberg et al, 2005 rning-for-performance

Resources:

Overview
Introduction

What is it? Why?

What affects the effectiveness, efficiency and sustainability of IST?

Content

How was it developed? What is in it?

Which of these areas are most challenging to address?

Application

How has it been used?

How could this framework be used to improve IST effectiveness, efficiency, and sustainability?

Country Experiences: Utilization of IST Framework

Nigeria- IST Assessment of PEPFAR Nigeria Portfolio (CapacityPlus/Intrahealth) Afghanistan- Informed organization of National Training Standards for the Afghanistan General Directorate of Human Resources In-Service Department (HSSP/Jhpiego) Ethiopia- IST Rapid Assessment to inform Ethiopia Federal Ministry of Health FMOH efforts and strategies to improve, institutionalize, and standardize IST (HCI/URC)

Country Experience: Ethiopia

Rapid IST Assessment
How was the assessment developed and conducted? TWG Consultation
Identify assessment objectives Identify key themes of focus from IST Improvement framework

Tool Development
Turned framework recommendations into survey questions Developed 10 practice scenarios from recommendations for key informant interviews

Conduct Assessment
Survey sent to 62 survey IST providers 20 key informant interviews selected by FMOH

Country Experience: Ethiopia

Rapid IST Assessment

National IST Situation IST Program Provider Practices Key stakeholder opinions on IST priorities, issues, and strategic development

Country Experience: Ethiopia

Towards a National In-service Training Strategy: Consultative Workshop August 13-15th 2012
To develop and reach consensus on a draft strategic framework to inform a national IST strategy

Country Experience: Ethiopia

Development of a National IST Strategic Framework
Identified and Ranked Priority Issues Strategic Objectives Strategies and Inputs Opportunities and Barriers Stakeholders/ roles

How can this framework be used?

Inform the development of in-service training standards or quality criteria Inform the development of in-service training assessments/self-assessments (eg of training program providers, training systems) Guide the development of indicators for monitoring and evaluation Guide the development of activities to improve in-service training Guide advocacy for policy changes

What are the take home messages? A multistakeholder process is an effective way of engaging expertise to build consensus on how IST can be improved The IST improvement framework can be used to bring together country level stakeholders around a shared vision for IST

Acknowledgements
*Akuba Dolphyne, * Emily Lanford, USAID Health Care Improvement Project (HCI), University Research Co. LLC (URC); * Lois Schaefer, USAID; * Marita Murrman, International Center for AIDS Care and Treatment Programs (ICAP); * Mike Rouse, International Pharmaceutical Federation (FIP); * Shaun Noronha, * Kate Tulenko, IntraHealth; *Rebecca Bailey, IntraHealth and World Health Organization (WHO); * Gabrielle OMalley, * Tom Perdue, * Frances Petracca, International Training and Education Center for Health (I-TECH); *Julia Bluestone, * Peter Johnson, * Edgar Necochea, Jhpiego; *Karen Chio, * Gail Naimoli, Management Sciences for Health (MSH); * Rosa Maria Borrell, Pan-American Health Organization (PAHO); * Cathy Solter, * Graciela Salvador-Davila, Pathfinder; * Julia Seyer, World Medical Association (WMA); * Tisna Veldhuizen Van Zanten, URC; * Habib Benzinan, * Alan Lyles, * Linda Ippolito, * Hugo Mercer, Independent experts.

Where can I find more information?

Tana Wuliji twuliji@urc-chs.com Diana Frymus dfrymus@usaid.gov Improvement Framework Publication: early 2013 www.hciproject.org/healthworkforce