5. Form CQI teams
Having an improvement team at the health unit is vital to lead VMMC improvement work. Experience has shown that facilities which have functional CQI teams showed faster improvement compared to facilities that did not have teams to spearhead improvement.
The CQI team is made up of staff from the site who implement the action plan and assume responsibility for ongoing improvements to VMMC services, including collecting and analyzing data on the site’s performance. Team members of the CQI team should include all cadres of staff involved in the delivery of VMMC services, including clinicians, counselors, cleaners, assistants, and data managers. The site manager usually designates team members. In large facilities, CQI teams may include 5-10 members; more members than that can inhibit the team’s ability to perform its functions.
A team leader is helpful to ensure that the team functions effectively and that all members contribute. The CQI team leader should have good interpersonal skills and leadership qualities, such as organization, planning, and effective communication. The CQI team leader does not necessarily have to be the VMMC in-charge at the site. Often, the site manager appoints a staff member with the necessary organizational and communication skills to act as CQI team leader.
The main responsibilities of the CQI team are to identify and prioritize gaps in the quality of VMMC services, implement changes to address the gaps, review performance data to determine if changes are resolving the gaps, and decide what to improve next. CQI teams need to meet regularly (such as every week) to plan changes, review results, and decide on next steps. Uganda’s National Quality Improvement Framework outlines roles and responsibilities for facility-based quality improvement teams.
If a site already has an active quality improvement team, it may make sense to involve that team in VMMC CQI, as long as the team can be expanded to include VMMC staff. If a new VMMC CQI team needs to be formed, the site’s existing quality team should provide internal CQI coaching support to the VMMC improvement team.
Why CQI team composition is important: Having representation on the CQI team of staff from all the processes that form part of VMMC service delivery is important to ensure that the people who are most familiar with each process participate in analyzing process problems and possible solutions. For example, staff who handle cleaning or waste management are best positioned to help figure out how the waste management process can be streamlined or made more reliable.
While the site manager does not necessarily have to be a member of the CQI team, the team should meet regularly with the site manager and/or district focal point to keep them informed of the team’s progress and to enlist their help in addressing issues that require decisions above the site level to resolve.