Applying Quality Improvement Methods to HR Performance Management

Maina A. Boucar

Quality Improvement Advisor, USAID ASSIST Project/URC

This post originally appeared on the K4Health Blog.

Dr. Karimou Sani, former USAID-HCI Advisor Tahoua, Niger; Dr Ekoye Saidou, Director General MOH Niger; Mr. Sabou Djibrina, UASID – HCI Niger; and Lauren Crigler, USAID HCI Bethesda, USA contributed to this blog post.

Faced by a severe shortage of health care professionals throughout Niger, the country’s Ministry of Public Health requested assistance from USAID’s Health Care Improvement Project (HCI) in 2009 to implement a program to address the health workforce crisis within the country.  In response, my team and I recognized this has an exceptional opportunity to implement a program to improve the management of human resources in selected facilities and management offices within the Tahoua Region.

As a part of the collaborative approach we adopted, quality improvement (QI) teams tested and implemented changes within their own facilities, while simultaneously monitoring performance with QI advisors and coaches from both HCI and the Ministry of Public Health. 

Applying improvement methods to HR performance management

Applying quality improvement methods to HR performance management

As Quality Improvement Advisors, we recognized the importance of supporting the facility teams in strengthening their ability to recognize where they needed to improve their performance and helping them to have confidence in managing the quality of that service within their team. In order to address areas that were in need of improvement, we determined the variables that were adversely impacting health worker performance, engagement, and productivity.  The steps we undertook to address these areas are displayed in the diagram to the right. We began by aligning and clarifying tasks, and we measured progress in performance by tracking clinical indicators. 

We realized exceptional results from this innovative approach – specifically understanding that focusing upon human performance factors positively impacted health worker performance and resulted in improved health outcomes. 

Specific outcomes that impressed us evolved in only two years - between 2009 and 2011:

  • Deliveries by qualified health workers rose from 27% to 45%
  • Contraceptive prevalence increased from 9.6% to 36%
  • Post-partum hemorrhage fell from 2% to 0.06%
  • Mortality from severe malaria in children under five dropped from 15% to 4% at the pediatrics hospital

We recognized the need for making major changes to existing supervisory practices and the self-management of health workers.  With increased understanding on part of the health workers of their own work processes at the service level, they were instrumental in helping to guide the assessment of each human performance factor and design changes to address weaknesses and improve care.  As the health care providers became more comfortable with this approach, there were better able to assess their own performance and make associated improvements.

As Quality Improvement Advisors in Niger, our team also recognized the need to closely involve facility managers and supervisors as part of the improvement process.  As a result, we also focused efforts upon strengthened supervisory and feedback mechanisms, which served to further increase the engagement of health care workers and led to improved clinical outcomes. 

As a result of this innovative collaborative approach, we are offering countries a new way to address the many challenges they face in the health and human resource sectors.  Additionally, the feedback we received from both health workers and managers was extremely encouraging, in that they felt as though the human resources improvement work led to enhanced working conditions and performance:

“Before the HR Collaborative, we worked in unclear and cloudy conditions, but when we started aligning goals and objectives with those of the Ministry, we saw a clear direction”.

– Moustapha Boukary, Health of Tsernaoua Health Post





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