4. Conduct the assessment, give feedback, and develop an action plan

The CQI assessment tool is usually applied by a team of 3-4 individuals, including clinicians knowledgeable about surgical circumcision, and may take 2-3 hours to complete.  The assessment team must include a staff member from the VMMC unit being assessed and ideally includes a representative of the implementing partner, a representative from the Ministry of Health, and the CQI partner. 

In Uganda, ASSIST-led CQI assessments often use pairs of assessors working in parallel with paper copies of the MOH CQI assessment tool. After completing their observations, the pairs would copy the other team’s observations into their assessment tool in order to create two identical copies of the completed assessment, allowing for one copy to be left with the site.  They also leave the site with an SMC MOH Standards Assessment Scorecard, which is a one page summary of the overall score for each of the seven VMMC standards used in Uganda, with comments written in about the main actions needed in each standards area. An action plan to address the weaknesses and issues identified in the assessment is usually developed during the CQI assessment visit.

In South Africa, CQI assessors input data into an electronic version of the CQI assessment tool and use a portable printer to print out the summary results for the assessed site.

An important part of the assessment is to provide immediate feedback to the site staff about the main strengths and weaknesses of the site with respect to compliance with national VMMC standards.  Sometimes this feedback is given immediately after the procedure if it will benefit the next client. This feedback and the specific findings of the assessment are then discussed by the site team and implementing partner. Together they develop an action plan which identifies all actions to be taken, who is responsible, and by when.

In Uganda, the action plan is usually developed during the CQI assessment visit.  In South Africa, a separate meeting is often scheduled a few days after the CQI assessment. In some instances, after providing feedback, all parties involved list identified gaps on the action plan matrix and then classify gaps as those needing internal resolution by the site team or external support by mentors/coaches to allow site to test changes within their control while awaiting CQI support.

Why the CQI baseline and action plan are important: The CQI baseline is the first assessment conducted at a site and serves as the starting point for improvement efforts.  The same tool is used for baseline and subsequent re-assessments, providing an objective and consistent measure of improvement. The CQI baseline assessment is ideally conducted at a time when clients are being circumcised to allow the assessment to include client counseling and surgical procedure.  Performing the CQI assessment when clients are not present limits the scope and value of the assessment.

It is helpful if the assessor team meets first with the entire VMMC unit staff to explain how the assessment will work and to reinforce that the findings of the CQI assessment will help the site understand where its quality gaps lie and will not be used in a punitive way. After the assessment, the assessor team needs to assemble the entire VMMC staff again for feedback on the findings.

The action plan developed after the assessment should summarize the key gaps, actions to be taken, and responsibilities of all involved parties to help bridge the gaps and lay out actions in a feasible time frame. Care should be taken to avoid very tight deadlines that are not realistic, but at the same time ensuring that each gap is addressed with the urgency it deserves, especially any gaps related to patient safety and emergency preparedness.