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HIVQUAL Vietnam: National and local leadership support for improvement in HIV care & treatment
06.04.2013
Quality improvement and treatment & care at Medical Center of Thanh Hoa City Out Patient Clinic (OPC)
As of September 2012, there were 6005 people living with HIV in Thanh Hoa City and 1799 patients on ARV therapy supported through the quality care and treatment program, including 81 children.
The outpatient clinic (OPC) of the Thanh Hoa City Medical Center was opened in 2005, treating patients from Thanh Hoa and 17 surrounding districts and towns. The OPC is staffed by three doctors, three counselors, one nurse and one pharmacist with support from the Global Fund.
With strong leadership support from the Department of HIV/AIDS Prevention, Thanh Hoa Province established a technical working group focused on improving the quality of care and treatment at the provincial level. The Medical Center subsequently established a formal QI group in the OPC tasked with defining staff responsibilities for institutional improvement activities and drafting an annual improvement plan.
After an initial performance review, OPC selected two national indicators to prioritize for improvement: a) to increase the proportion of patients eligible for ARV, who start ARV treatment within 30 days, from 61% to 90% in Thanh Hoa OPC between January and September 2012 and b) to increase the proportion of patients tested for CD4 at least one time in the last six months, from 43% to 80% during the same period.
The team developed a workplan to guide action and implementation of each proposed solution with a specific timeline and staff person/people responsible for monitoring and completion.
A formal leadership structure to pursue program goals was critical. The program management team chaired briefings with a provincial technical group and OPC, meeting monthly.
Management worked with the departments to coordinate implementation between OPC, the lab for CD4 and other relevant departments to optimize realization of stated goals.
Reporting and follow-up
The program coordinator was tasked with monthly reporting to the management team, with quarterly briefings to the Center of AIDS Prevention and to the Department of HIV/AIDS Prevention.
The OPC QI staff held weekly briefings on improvement implementation plans, assigning staff to work according to the plan and timeframe established.
The Provincial QI group provided technical support to OPC monthly or as needed.
Monthly briefings were held between the provincial Center of AIDS Prevention and the OPC for review of data and strategies selected for the improvement focus. Ideas and obstacles were discussed to identify next steps and approaches to resolve and overcome challenges.
Concurrently, the team began planning for the next improvement priority, set out to integrate QI into regular briefing activities of the province and continued close coordination with the central technical support team as needed.
Lessons learned
- Value of strong and consistent leadership from the central QI management team
- Importance of regular technical support in planning, data collection and analysis at the local and provincial levels
- Establishment of a formal QI management and technical team at the provincial level
- Dedication among OPC staff for program implementation with a focus on team work
Challenges
- Heavy work load and competing priorities remain
- There is a continued need to spread improvement knowledge and build skills for data management among staff, including use of the HIVQUAL-Vietnam software
- High patient case load is complicated by their geographic spread for follow-up
- Resource allocation across OPCs is low when compared with the great demand for services and attention to issues associated with the quality of patient care
Way Forward
Ongoing QI technical support from the Central team for OPC staff will be critical for spread and scale-up of national implementation, which includes additional QI training for staff in Thanh Hoa City, at OPC and other OPCs in the Province
Download a PDF version of this Brief here.
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