Support for Improvement (Coaching/Supportive Supervision)

While improvement activities take place at the local level (community or facility), they must be supported at all levels of the system from the national level down. National, regional district and local leaders can create the enabling environment for improvement through policies, resources, and training in addition to openness for local teams to test ways to best improve care and sometimes fail. 

Practical support to teams in the form of coaching or supportive supervision is critical to help teams:

  • Form representative teams
  • Set aims and targets specific to their local needs, usually within larger national improvement aims
  • Develop measurement systems, including proper recording, data collection, aggregation and analysis
  • Facilitate discussions of the problems and possible solutions to test
  • Provide ongoing training and support for improvement cycle (plan-do-study-act)
  • Advocate for resolution to larger system issues such as supply chain, financial, or policy problems
  • Integrate improvement into their ongoing work
  • Synthesize learning

Our experience has shown that the most effective coaching for improvement is built into existing government systems and structures, rather than creating outside or parallel systems. This can take the form of coaches external to the facility or community, such as a district representative, or from within the local site, such as an enthusiastic nurse or employee.  Whoever the coach is, they should always approach the improvement team with an attitude of supportive problem solving rather than critical evaluation. 

Coaches need competency in both basic improvement skills and in facilitation of improvement teams, which is best built in a combination of classroom training, mentoring and on the job training.   A system of evaluating coaching skills to identify and close competency gaps helps to maintain consistent support to teams.  In addition to the resources for training on basic improvement skills, there are competency building resources available for coaches. Training modules for tasks of coaches and approaches to supporting teams below include instructor’s manuals, PowerPoint slides, and a reference manual for participants:

Coaches may need initial training in their roles and responsibility, teambuilding and facilitation skills with later additions of conflict management, change management or enhancing creativity.

Competency building activities must go beyond classroom training for coaches.  The tools and documents below were designed to build coaches’ ability to support teams including job aids, reference materials, and guides for coaching visits:

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