United Republic of Tanzania
Ministry of Health, Community Development, Gender, Elderly and ChildrenPresident’s Office- Regional Administration and Local Governments
Basic Hospital Management Trainingfor Regional Referral Hospitals
Facilitators’ guide
October 2018
ISBN: 978-9987-737-97-0
United Republic of Tanzania
Ministry of Health, Community Development, Gender, Elderly and ChildrenPresident’s Office- Regional Administration and Local Governments
Basic Hospital Management Trainingfor Regional Referral Hospitals
Facilitators’ guide
Supported by Japan International Cooperation Agency (JICA)
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i
Table of contents
Foreword iii
Acknowledgement v
Acronyms vi
CHAPTER 1: GENERIC GUIDANCE AND GOOD PRACTICE IN PREPARING
TRAINING 1
1.1. IntroductIon 1
1.2. Background 1
1.3. oBjectIves of the guIde 2
1.4. organIzatIon of the guIde 2
1.5. gettIng prepared 2
1.5.1. Knowing the targeted audience 2
1.5.2. Training Preparation 2
CHAPTER 2: IMPORTANT CONSIDERATION FOR FACILITATORS 4
2.1. Important consIderatIon 4
2.1.1. Familiarity of training content 4
2.1.2. Adapting and preparing sessions 4
2.1.3. Resources need for session 4
2.1.4. Promoting effective Learning 4
2.1.5. Using right methodology 5
2.2. other Important attrIButes for effectIve facIlItatIon 5
2.2.1. Ensure that the entire course content is covered 5
2.2.2. Effective coverage of the content: 5
2.2.3. Strong Opening 5
2.2.4. Session Delivery 6
2.3 communIcatIon 6
2.3.1. Communicate effectively 6
2.3.2. Modeling positive attitude 6
2.3.3. Presenting effectively 6
2.3.4 Avoid presentation killers 7
2.4. exercIse/group dIscussIons 7
2.4.1 Exercises (when applicable) 7
2.4.2. Engage the group effectively 7
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2.4.3. Managing group discussions 8
2.4.4. Control in group discussion 9
2.5. revIew and closIng 9
2.5.1. Reviewing and closing 9
2.5.2. Reviewing a Training Event 9
CHAPTER 3: GUIDE ON PARTICIPANTS’ MANUAL 11
3.1. IntroductIon of the partIcIpants’ manual 11
3.2. composItIon of the traInIng package 11
3.3. flow of teachIng 12
3.4. modules 12
3.4.1. Module 1: Understanding the RRHs setting 12
3.4.2. Module 2: Basic Management 15
3.4.3. Module 3: Human Resource Management 21
3.4.4. Module 4: Basic Financial, logistics and Information Management 26
3.4.5. Module 5 Quality and Safety of Hospital Services 29
CHAPTER 4: MEASUREMENT OF THE TRAINING COURSE/PROGRAM 34
4.1. pre- test and post-test assessment 34
4.2. course evaluatIon 35
4.3. analysIs of the results and actIon to Be taken 35
CHAPTER 5: BASIC MANAGEMENT TRAINING; INSTITUTIONAL FRAMEWORK 36
5.1. roles and responsIBIlItIes of mohcdgec 36
5.2. roles and responsIBIlItIes of traInIng InstItutIons 36
5.3. roles and responsIBIlItIes of rrhmt 36
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Foreword
In November 2017 The President of the United Republic officially instructed all RRHs to be administratively and technically manned by the MoHCDGEC. In this change, Honourable President clearly stated that his decisions are meant to improve and ensure smooth management of the RRHs as their day to day undertakings will be overseen by the responsible ministry. As a matter of fact, this announcement by the President came at an opportune time when MoHCDGEC through Regional Referral Hospital Management Project (RRHMP) has already completed first round of capacitating Regional Referral Hospital Management Teams in Basic Hospital Management skills; the objective being the same as that of the President - of improving and strengthening management of the RRHs to deliver quality services.
The need for the Basic Hospital Management Training (BHMT) to RRHMTs is a result of the Baseline survey that was conducted in 2015 before the commencement of RRHMP to set out Benchmarks for the project outputs. According to the findings of the survey, managerial capacity of the Hospital Management Teams which is composed of clinical and non-clinical support service staff is limited. Majority of them are assigned to manage very crucial positions in the hospital but with little opportunity to acquire basic knowledge and skills on management. With this situation, MoHCDGEC through RRHMP in support of JICA, organized and conducted first round of BHM trainings that covered six (6) RRHMT members from all 28 RRHs in the country by May 2017. Second round of the same involved five (5) RRHMT members who were not trained before from the same 28 RRHs; making a total of 11 Hospital Management Team members trained on Basic Hospital Management in every RRH by April 2018. Both rounds of trainings were conducted using Basic Hospital Management Training Manual and training slides that were continuously improved every after each batch of training using inputs and comments from participants and facilitators.
With a total of eleven (11) members trained in every Hospital and keeping in mind that there will always be un-trained members and new recruits to RRH as well as transfer of staff to and from the RRH, the necessity to sustain the BHMT became inevitable. This Facilitators guide not only reflects the efforts made by the MoHCDGEC through its JICA supported RRHMP in strengthening HMTs of the RRH in Managerial endeavors but also sustainability of the capacity building investments injected by the government through the RRHMP to RRHs. This guide is a road map for the institutions to carry on and sustain the BHM training to the RRHMT. It is intended to guide institution for Human Resource for Health development and other high learning institutions on Basic Hospital Management training specifically to Hospital Management Teams.
The guide is tailor-made to ensure that the guidance and materials reflect the real situation of the RRHs in Tanzania. The provided guidelines will enable facilitators to maintain the quality and consistence of the subjects needed for training of hospital management. By doing so, the learning and acquisition of skills necessary for proper management of the RRHs will be controlled regardless of when the training is conducted, who deliver the training and where the training is offered. Participants will understand RRH system, structures and management processes. Furthermore, participants are expected to acquire the intended adequate skills to innovate and produce competences required to improve and maintain the quality of healthcare services delivered at the RRHs.
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The ministry expects the Health Institutions selected and instructed to organize and conduct the BHMT and other universities to fully understand the contents of the facilitators guide and adhere to the guidelines provided herein. It is my wish this document be indeed instrumental in running and sustaining the BHMTs towards improving management and quality of services rendered by our RRHs.
___________________________________________Prof. Mohamed Bakari KambiChief Medical OfficerMinistry of Health, Community Development, Gender, Elderly and Children
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Acknowledgement
The Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) wishes to thank all those who participated in one way or another in the development of both Basic Hospital Management Training Participants Manual and Facilitators Guide. It is indeed through their individual and collective efforts that the accomplishment of the task was made possible.
The ministry would also like to acknowledge the contributions made by Dr. Mollel from Mzumbe University and his team and Dr. Hadija Kweka from Ifakara Health Institute; all for the initial development and pre-testing of the Participant Manual and the Facilitators Guide. The same is stretched to Primary Health Care Institute- Iringa, CEDHA-Arusha, PORALG, members of RHMTs and RRHMT for their participation and fruitful contributions in many stages of development.
It is for the first time in the history of the Health Sector in this country that Manuals for Basic Hospital Management Training (BHMT) have been developed specifically for the RRHMTs. The exercise was spearheaded by the directorates of Policy and Planning and Curative Services through Regional Health services unit and RRHMP –JICA. In this regard, the Ministry would like to acknowledge specifically: Dr. Mutagwaba R.D, Coordinator Regional Health Service; Dr. Angelina Sijaona – department of Curative Service; and RRHMP Chief Advisor Dr. Hisahiro Ishijima for their splendid work, inputs and comments.
Furthermore, the ministry recognizes and appreciates continued support and investments that have always been injected into the Health sector by the government of Japan through JICA. Our heartfelt thanks are therefore, extended to JICA not only, for their financial and Technical support provided from the onset to the completion of both Participant and Facilitators Guide documents but also, for their commitment and impetus to overseeing adoption of strategies for sustainability of the BHMT. Likewise, the ministry understands that development of the two documents was a complex task and would not have been possible without commitment and working in synergy of all those involved. The MoCDGEC is in this facet prompted to deeply recognize the efforts of Mr. Fares J. Masaule -RRHMP Senior Technical Advisor for his tirelessness endeavour in editing, refining and completion of the documents.
Finally, but not least, appreciation to Violet Mlay for organizing all meetings geared at development of all Basic Hospital Management Training Materials, pretesting of the same and actual round one and two Training.
___________________________________________Edward MbangaAg. Director, Policy and Planning Ministry of Health, Community Development, Gender, Elderly and Children
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Acronyms
BHMT Basic Hospital Management TrainingCHMT Council Health Management TeamCHOP Comprehensive Hospital Operation PlanCMSS Central Management Supportive SupervisionCQI Continuous Quality Improvement DMO District Medical OfficerDPG-H Development Partners Group for Health EHPA External Hospital Performance AssessmentHAB Hospital Advisory BoardHMT Hospital Management TeamHRH Human Resource for HealthHRHIS Human Resource for Health Information SystemHRM Human Resource Management HSSP Health Sector Strategic PlanISS Internal Supportive SupervisionJICA Japan International Cooperation AgencyKPIs Key Performance IndicatorsMSD Medical Store DepartmentMoHCDGEC Ministry of Health, Community Development, Gender, Elderly and ChildrenNGOs Non-Governmental OrganizationNHIF National Health Insurance FundOPRAS Open Performance Review and Appraisal SystemPORALG President Office, Regional Administration and Local GovernmentQA Quality AssuranceQC Quality ControlQI Quality ImprovementQIT Quality Improvement TeamQIU Quality Improvement UnitQM Quality ManagementRAS Regional Administrative SecretaryRHMT Regional Health Management TeamRMO Regional Medical OfficerRMSS-C Regional Management Supportive Supervision for CouncilRMSS-H Regional Management Supportive Supervision for HospitalRRHAB Regional Referral Hospital Advisory BoardRRHMP Regional Referral Hospital Management ProjectRRHMT Regional Referral Hospital Management TeamRRHs Regional Referral HospitalsTQM Total Quality ManagementWB World BankWIT Work Improvement TeamZHRCs Zonal Health Resource Centers
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CHAPTER 1: Generic guidance and good practice in preparing Training
1.1. IntroductionThere have been a number of management related trainings designed and conducted at different levels to improve various aspects of the health systems. The trainings are either institutional, or program/project based. Most of the institutions’ training programs are mainly general. They only provide the basic management knowledge and skills which is sometime difficult for the participants to align and translate to the management of the hospital. Program or project training short courses are mainly designed for specific purposes and mainly of small scale. This Guideline has been developed to guide institution for Human Resource for Health development and other high learning institutions on Basic Hospital Management training specifically to Hospital Management Teams
1.2. BackgroundFor many years, Tanzania has been implementing health sector reform in order to strengthen health services. The features of health sector reform included strengthening of district health systems to enable them plan and implement health services in a decentralized context. However, the paces into which reforms have been implemented differ between the regions. This discrepancy was realized by MOHCDGEC and development partners, Japan International Cooperation Agency (JICA) inclusive. Since 2008, the Ministry of Health, Community Development, Gender, Elderly and Children in collaboration with JICA has been working to strengthening health systems focusing on Quality improvement, Human Resource Information and the Regional Health Management Teams (RHMTs). From the experience of strengthening RHMTs, projects (Phase 1 and 2), it was further realized that despite their key role in the health system and despite the fact that majority of national health expenditure is spent on hospitals, performance of hospitals has been given less attention.
According to the findings of the survey conducted by JICA’s Project for Capacity Development in Regional Health Management Phase II (2011–2014) in RRHs, managerial capacity of the Hospital Management Teams (hereinafter referred to as “HMTs”) is limited. HMT is composed of clinical and non-clinical support service staff. Majority of who are assigned to manage the hospital with little opportunity to acquire basic knowledge and skills on management. Although there have been initiatives for strengthening management capacities of RRHs, the delivery has been less comprehensive and the results have been evident in only a few RRHs. Hence, in endeavor to address the gap, the Ministry of Health, Community Development, Gender Elderly and Children in collaboration with JICA decided to further strengthen the management of Regional Referral Hospitals.
Under this collaboration, the MoHCDGEC has conducted Basic Hospital Management Training (BHMT) to 28 RRHs in 2017 and 2018 for capacity development of RRHMT members. However, number of trained personnel on hospital management is still insufficient, and thus it is crucial for the Ministry to establish a sustainable mechanism to continue training hospital managers in management through the existing training institutions and/or universities.
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The realization of the importance of providing hospital management training to RHHMT and the long-term sustainability has necessitated the MoHCDGEC to offer this short course through its existing health training institutions. This facilitators’ guide is a road map for the institutions to carry on and sustain the BHM training to the RRHMT.
1.3. Objectives of the guideThe objectives of this facilitator guide are:• To enhance perception of facilitators towards training of Basic Hospital Management that
reflect the real work environment of RRHs,• To ensure the management training that is focused and aligned to improving the quality of
health services delivered at RRH, • To maintain the quality of management training delivered to RRHMTs by addressing real
issues faced on day to day basis and in long terms
This facilitator’s guide is developed to standardize the facilitation that is provided by several trainers on the same content. It emphasizes on the objectives of the training, the envisaged learning outcomes, as well as guiding the facilitator on how to deliver the training including areas requiring special emphasis.
1.4. Organization of the guideThe guide is organized on the following: Chapter 1: Generic guidance and good practice in preparing TrainingChapter 2: Important consideration for FacilitatorsChapter 3: Guide on Participants’ manualChapter 4: Measurement of Training course/programChapter 5: Basic Management Training; Institutional Framework;
1.5. Getting prepared
1.5.1. Knowing the targeted audienceIt is important to know the background of the applicants for the course or program as the target of hospital management training is the personnel who are going to join hospital management teams, or those who wish to obtain the knowledge on hospital management for their future career.
1.5.2. Training PreparationIn preparation for the training there are a number of pre-requisites for the training institutions or universities. A number of tools may be used, not limited to the checklist presented in Table 1. Organizers of the training course/program need to make sure that the issues listed in the checklist must be well discussed and have consensus among staff, lectures and facilitators. Once preparation
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is started, it is necessary to monitor the progress of preparation time to time. Table 1-1: Progress checklist
Key areas Done In progress Remarks
Is the course residential or off campus?
How long will the course last?
Have training rooms been selected?
Have participants been enrolled?
Have facilitators and coordinator been identified and appointed?
Is Training of Trainers (ToT) for BHM4RRH available?
Have the facilitators attended the ToT?
ToT trainers identified?
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CHAPTER 2: Important consideration for Facilitators
2.1. Important ConsiderationTraining Courses require enough preparation. It is important that the organizer’s and facilitators of the training familiarize themselves with the training content which they are expected to deliver. Facilitators require enough time to adapt the training materials. The following are crucial to be taken care of before the onset of the course:
2.1.1. Familiarity of training contentAs a facilitator, you need to have a high level of engagement and commitment to the subject area that the course covers. Familiarize yourself with the basic design of the course and with the information in this guide.
2.1.2. Adapting and preparing sessions• Review the Training Material and identify any areas in the Slides or Exercises that have
possible errors, missing information, etc.• Decide what needs adapting and changing and what should not be changed. Course material is
usually prepared to act as a template and should be adapted to your training style and replaced with latest information where relevant.
2.1.3. Resources need for sessionFacilitator should make sure that all the resources required for a specific session are in place and functional as per suggested checklist.
Identify equipment required. A suggested list which is subjected to change time to time is as follows:
• Laptop computers• LCD (multimedia) projector• Flipcharts, paper and markers• Writing paper and pens for participants• Tape (masking/cellophane), pins (for hanging flip charts)• Cards or post-it notes for the exercises• Name Cards
Prepare/photocopy handouts and activity sheets if coordinators do this make sure that everything is done as per your expectations. Make a list of materials for photocopying to assemble Participant Material Package. The package should include the following: program, handouts, exercise sheets, writing papers and pen.
2.1.4. Promoting effective LearningGood facilitator encourages contributions, particularly from those who may be less self-confident. Control conflicts, devise non-aggressive, friendly ways to deal with difficult participants such as over talkative, argumentative etc.
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2.1.5. Using right methodologyParticipants usually represent a wide range of different backgrounds, specialties, job titles, and experiences. Therefore, it is essential that you prepare the course in a way that makes it useful to a diverse group of learners i.e. not too elemental or too complicated. It is also important to be able to draw the participants into the sessions by way of referring to their experiences. During the course pay close attention to group dynamics, signs of enthusiasm or disengagement, what works and what does not, and adapt accordingly and on the spot. In general, follow the principles of adult education (such as lecture discussions, role plays, group work activities, Q&A, scenarios, simulation, etc.).
Start out with a stimulus presentation or exercise, follow with an opportunity to apply/analyze the new ideas in light of the participants’ own situation and develop an application (e.g. develop a plan for what to do to implement the new ideas/approaches after the course or during the rest of the workshop, anticipating barriers and impediments).
2.2. Other important attributes for effective facilitation
2.2.1. Ensure that the entire course content is coveredIt is important to stay on schedule and help participants see how each session logically follows from the one before. • If participants deviate from the topic, offer to address their comments during a break, • Write additional topics identified by participants on flip chart paper as a reminder of topics to
cover if there is time remaining at the end of the session. Keep this list visible to participants throughout the workshop,
• Each session’s lesson plan includes key summary points. Referring to these key points, and reviewing them at the end of a session, will help you know if you have covered all of the main content of your lesson plan
2.2.2. Effective coverage of the content:The facilitator must know the priorities of the course. Look back on the learning outcomes and training needs- attempt to initiate some personal priorities by marking items: H = High Priority, M = Medium Priority, L = Low Priority. From this analysis, it will be possible to summaries the best use of your time during the training and you will be able to have effective coverage of content. Summarize your priorities below:• High Priority Training Needs, • High Priority Learning Outcomes.
2.2.3. Strong OpeningGet participant’s attention from the first moment. In your opening try to arouse curiosity, clarify the purpose of your session and connect the participants to the topic. There are many different ways to do this. Consider asking a question, sharing a personal story, displaying an eye-catching visual, making a provocative statement, or sharing a provoking statistic.
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2.2.4. Session Delivery• Cover key points of the session slowly and re-emphasize them, • Address ‘What is in it for you’. Clarifying why the information presented during the session is
important for the practitioner and how they may use it in their work,• Encourage participants to share their experiences and examples making the session interactive,• Enhance the session with your personal experience and interesting anecdotes and encourage
the participants to share examples,• Limit the time you are talking to make space for interaction and exercises.
2.3 Communication2.3.1. Communicate effectivelyGood communication skills are essential when training adults. Several resources have consolidated key issues to consider for effective communication. Facilitators dealing with adults ought to ensure that they can communicate effectively. The following are generic effective communication guidelines that run through the whole course and are not limited to one type of training method or another. There are important things a facilitator can do to help create an effective learning atmosphere for course participants.
2.3.2. Modeling positive attitudeOne of the most important tasks of a good facilitator is to build an atmosphere of trust. An accepting and non-threatening atmosphere encourages the expression of ideas, questions, beliefs, and attitudes by all participants. Strategies for building positive attitude in training;
• Assure that confidentiality will be maintained. Establish a group rule on the first day that everyone’s confidentiality must and will be protected so that people can talk freely without fear. Provide constructive and supportive feedback. Let participants know when they’ve contributed something useful and interesting to the group. For example, you might say, “That’s a very good example of the concept we are discussing.”
• Model a positive attitude. Participants will probably get tired as the course progresses and need some encouragement. Call upon the person appointed as the energizer and maintain your own positive attitude. Address any difficult moments during the course with honesty and constructive comments. For example, “This topic brings up difficult feelings for many; by exploring our own feelings, we can better help our clients to do the same.”
2.3.3. Presenting effectivelySession Introduction • Introduce yourself and your co-facilitator• Present the session title, objectives and duration of the session and describe the overall plan• Relate the session to the overall course design and explain why it is placed where it is in the
agenda
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• Relate the session to previous sessions, when possible • Establish/emphasize learning norms that you feel are essential to the session. This may
include respect for diversity of opinion and confidentiality, active participation and revolving leadership, ask questions at any time or only at the end of the session
• the time you are talking to make space for interaction and exercises.2.3.4 Avoid presentation killers• Awkward beginning or weak close• Minimal eye contact or facial expression, • No humor, • Vague objectives and limited preparation, • Poor visual aids, • No audience involvement, • Reading handouts, • No movement, • Turning your back to the audience, • Lack of example
2.4. Exercise/Group discussions2.4.1 Exercises (when applicable)• Conduct group learning activities where possible,• Explain the purpose, objective, duration and instructions for the exercise clearly,• Ensure you have all the material for the exercises sheets, related reading, stationery etc.,• Encourage participants to document their findings on a flip chart, transparency, PowerPoint
slide etc. for presentation at the end of the exercise,• Ensure that the exercise is debriefed and any participant questions are answered during the
session, • Detailed questions may be addressed in between sessions or after workshop hours
2.4.2. Engage the group effectivelyFacilitators can monitor group progress or better let the group monitor itself. This allows for far more ownership of the course and the group taking responsibility for its own learning and development. A rotating group of participants could be selected to monitor one day of the course each. This group could meet at the end of their allocated day to discuss their observations. At the beginning of the following day they could present to the course participants as a whole their comments on the previous day, recommendations for the future days and news items. This presentation should be brief (20 minutes maximum) and may cover some of the following issues:• Key lessons from the day• Points of agreement or disagreement• Points that link with earlier material• Matters needing further clarification
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• Good examples from the field• Good (or bad) jokes from yesterday’s presentations• Any quotable quotes• Any changes the group need to make to the rest of the program• Any news items with reference to the course subject area
These reviews can achieve several important results:• They help course facilitators to grasp the ’pulse’ of the group.• Are they happy?• Are they learning?• Are the messages being received?• They encourage participant participation and ’ownership’ of the course.• They assist in consolidating vital lessons.
2.4.3. Managing group discussionsA group discussion is a method that will be used by a facilitator to create a learning situation where attitudes and opinions/arguments are sought and examined. There are three key features about the process:• The participative environment encourages the sharing of experiences and the introduction and
development of ideas.• The fact that all participants are actively involved in thinking, listening and speaking leads to
better learning and fuller understanding.• For adults, particularly experienced adults ‘social learning’ is one of the most powerful modes
of learning.
PurposesThe purposes of a group discussion may be one or more of the followings:• To help develop knowledge and understanding about a subject.• To learn how to solve problems and make decisions.• To develop interpersonal skills• To develop attitudes and beliefs.• To make learning an active process.• To develop relationships and promote group dynamics.
EnvironmentPeople should sit fairly close to one another, preferably in a circle; if not, a square• Getting started• Introductory talk or presentation.• Film or video.• Case study or written handout.• One of the best ways to ‘seed’ a discussion is to start with an open question that requires
a value judgment for an answer. For example, “What did you think have…” or “Having watched, done, observed… what did that mean to you?”
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2.4.4. Control in group discussionClose control• Trainer may lead the discussion by asking questions to which the group members reply.• Decide who will contribute by naming those who will respond.• Suppress uninvited contributions or people speaking out of turn.• Evaluate contributions and may pass judgment in terms of “That’s right” or “That’s wrong”.
Style may be used when there is a specific subject and limited time. Success depends to a large extent on the group’s willingness to accept it. The level of expertise of the leader compared to the group.
Medium control• Trainer may initiate discussion but permits and encourages the group to talk to each other
directly, rather than through the ‘chair’.• Leave it to the group to evaluate contributions.• Intervene from time to time to expand on points, which have arisen, or bring the discussion
‘back on track’.• To encourage this approach, the leader may be amongst the group to reduce his role and may
keep silent for long periods; does not interfere, if it is going well.
Low controlTrainer may withdraw from the discussion completely. May sit at the back and observe and may speak only if invited to by the group. When invited to speak may turn the question back to the group or give a number of different opinions to give the group something to work on. Group not used to this approach my find it uncomfortable to start with.
2.5. Review and closing
2.5.1. Reviewing and closing• Review the session objectives and make sure they were fully covered during the session.• Re-emphasize key points made and issues raised during the session.• Invite and answer questions regarding the session.
2.5.2. Reviewing a Training EventThe following checklist can be used after the delivery of a training event for your own self-assessment and review. If you have a trusted colleague or a close friend, ask them to sit in and complete it as well. Or, if you are very daring, ask the audience to complete it! Note: Not all the questions may be relevant on each occasion.
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Examples of questions
• Was the material appropriate to the group?• Did the main points come out?• Was there too much or too little material?• Was the attention and interest of the group secured?• Were communication aids used to the best possible effect?• Was the audience encouraged to participate?• Were any phrases/mannerisms, e.g. ‘Er’, ‘Mm’, ‘OK’ (or whatever) used excessively?• Did everyone appear to hear and understand what was being said?
ü If yes, how do you know?ü If not, why not?ü Was the time used to best effect?ü If not, why not? What were the objectives?ü Were they achieved?ü If not, why not
Adapted from Tutor-delivered training by Steve Truelove. In the Handbook of Training and Development - 2nd Edition (ed: Steve Truelove). Blackwell Business, Oxford, 1995
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CHAPTER 3: Guide on Participants’ manual
3.1. Introduction of the participants’ manualThe participant manual has the same content as the facilitators’ guide but excludes facilitator instructions and answers for exercise. Participant manual is for assisting participant to learn effectively and act as a reference document during and after the training. Some of the activities including the facilitators’ guide are in the participant manual to facilitate learning.
The Manual is composed of five modules designed and developed with a view to impart key management skills to hospital management teams.It is expected that the training of the RRHMT through the five-module, participant Manual will lead to realization of:
• Management capacity of RRHMTs being improved,• Planning and reporting capacity of RRHs is improved,• Strengthening of M&E capacity of RRHs, • Strengthening of Resource management and quality improvement activities through KAIZEN
approach
3.2. Composition of the training packageBHMT training package is composed of five modules. Each module is composed of several sessions. Each session is important for hospital managers to understand to achieve the ten functions of RRHs.
Table 3-1: List of Modules and sessions in BHMTModule Session Session title1 Understanding RRHs setting
Session 1 The composition, roles and functions of various structures at National and regional level
Session 2 Policies and Strategic FrameworksSession 3 The Context of Regional Referral Hospitals, existing operational challenges
and missed opportunities2 Basic
ManagementSession 1 Hospital SystemsSession 2 Basic concept of ManagementSession 3 Effective LeadershipSession 4 Principles of DelegationSession 5 Change managementSession 6 Team BuildingSession 7 Communication in organizationSession 8 Managing MeetingsSession 9 Conflict and Conflict Management
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3 HRH Management
Session 1 Basic Concepts of Human Resource ManagementSession 2 Human Resources PlanningSession 3 StaffingSession 4 Staff inductionSession 5 Performance AppraisalSession 6 MotivationSession 7 Supportive SupervisionSession 8 HRHIS
4 Basic financial, logistic and information management
Session 1 Hospital Information System and Records Session 2 Financial ManagementSession 3 Logistics Management
5 Quality and Safety of Hospital services
Session 1 Definition of Quality termsSession 2 QI activities in TanzaniaSession 3 5S-KAIZEN-TQM approachSession 4 Safety ImprovementSession 5 Customer care and Client satisfaction
3.3. Flow of teachingTeaching flow need to be well considered based on the weight (volume) of the session to be presented. It is recommended to start with RRH settings, followed by Quality and Safety of hospital services. This will be followed by Basic management, HRH Management and finally teach Basic financial, logistic and information management as shown on the training schedule.
3.4. Modules
3.4.1. Module 1: Understanding the RRHs settingThis module is the foundation of the RRHMT’s roles and responsibilities. Module one is designed to create an understanding of the RRH settings for better performance of RRHMT functions, especially function No. 1: Planning, No.2: Monitoring and Evaluation, No.7: Referral system, and No. 8: Supportive Supervision so as to improve efficiency, effectiveness and quality of health care services and meet clients/community needs.
Objectives of Module 1 are as follows; At the end of the module, the participants/learners are able to:
• Describe relevant structures and their linkages• Outline composition, roles and functions of relevant structures at regional levels• Outline important policies, strategic frameworks and regulations guiding their operations• Understand the framework of RRHs
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Session title The Composition, Roles and Functions of various Structures at National and Regional Level
Session # 1Time allocation TBASection objectives At the end of this session RRHMTs will be able to:
• Describe the background, settings and role of National / Regional Structures• Describe composition, roles and functions of Regional Health Management
Teams (RHMTs)Issues to be covered • Overview of the structure at national and regional level
• Background of the national and regional health structure• Structure and linkage among MoHCDGEC, PORALG and LGA• Roles and Responsibilities of MoHCDGEC• Roles and Responsibilities of PORALG• Roles and Responsibilities of Regional Secretariat• Roles and Responsibilities of Regional Health Management Team• Roles and Responsibilities of Regional Referral Hospital Management Team
Key points Understanding how the composition, roles and linkages of various structures of regional health system and parties concerned operate regional health systems. Therefore, it is recommended to allocate a facilitator, who has working experiences in regional health systems.
Remarks • Regional health system is operated under new arrangement since 2017, and there is a possibility of changing the structure. Therefore, it is important to have current information and update the session contents.
• On the exercises, facilitators should aim at enabling the participants to identify how effective they have been on the particular subject matter, what are the challenges and possible solutions to address them.
References Roles and functions of RHMT 2009
Session title Policies and Strategies FrameworkSession # 2Time allocation Approximately 90 min. (including exercise)Session objectives At the end of the session RRHMTs will be able to:
• Define the terms: Vision, Mission, Policy, Strategy, Guideline and Regulation• Identify relevant health policies, strategies, Guidelines and regulations
Issues to be covered • Definition of terms (vision, mission, policy, strategy, guideline, and regulation)
• Relation between policy and strategy• Relevant policies and strategies for Tanzanian regional health services and
systems (Vision 2025, Health policy, HSSP4 etc.)• Programs, specific strategies• Important guidelines• Relevant regulation
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Key points The management of the RRHs requires government policies, strategies and regulations to give directions on provision of standard and quality health services.The government of Tanzania has existing policies, strategic frameworks and regulations that govern the work of RRHs.Policies, Strategies and Guidelines are important in:• Aligning country’s priorities with the actual health needs of the population;• Allow integration of government and development partners hence make better
use of all available resources; • Provision of quality health care.
Remarks • There is a regular review of strategies, guidelines and regulations. Therefore, it is necessary to check the updates of strategies, guidelines and regulations, and those changes need to be reflected in the training manual and teaching materials.
• On the exercises facilitators should aim at enabling the participants to identify how effective they have been on the particular subject matter, what are the challenges and possible solutions to address them.
References
Session title The framework of the RRHsSession # 3Time allocation Approximately 75 min. (including exercise)Session objectives At the end of the session, participants will be able to:
• Describe Regional Referral Hospital Advisory Boards, Regional Referral Hospital Management Teams Implementation Arrangements
• Describe Regional Referral Hospital Structure • Describe the referral system
Issues to be covered • The framework of the RRHs• RRH organogram • Management of RRH• Functions of RRH• Overview of Regional Referral Hospital Advisory Board (RRHAB)• Operation of RRHAB• Composition and roles of RRHMT members
Referral systems and implementation arrangementKey points • It is important to know how RRH is organized in terms of hospital operation
and management, including Hospital Advisory Board. • It is also important to know function of RRHs, and what are the roles of
RRHMT in relation to these structuresRemarks Currently, organogram and operation structure of RRHs are not standardized by
MoHCDGEC (May 2018). Therefore, it is important to update the contents if changes occur.
References • Guideline for RRHAB
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3.4.2. Module 2: Basic ManagementThis module is intended to provide (participants) RRHMTs with basic knowledge and skills required to perform RRHMT functions, especially function No. 1: “Planning” and No.8: “Supportive Supervision” so as to improve efficiency, effectiveness and quality of health care services and meet clients/community needs through the management of the day to day activities in a hospital setting and in programs. This module is also intended to explain overview of Basic Hospital management, and share different kinds of management concepts, which helps to strengthen the hospital management.
Participant Learning Tasks: At the end of the module, the participants are able to:
• Describe the hospital systems;• Define important aspects of management and administration,• Understand importance of effective leadership, delegation, team building and team work,• Outline ways of introducing and managing change,• Understanding importance of communication and manage meetings in an organization,• Understanding conflict, conflict Resolution and discipline in an organization
Session title Hospital SystemSession # 1Time allocation Approximately 90 min. (including exercise)Section objectives At the end of the session participants will be able to:
• Define hospital systems; • Identify components of hospital systems;• Describe the role of different structures in managing hospitals; • Describe the concept of formal and informal organizations and their relevance
in managing hospitals.Issues to be covered • Definition of the Hospital system;
• Components of Hospital system;• Functioning of Hospital system;• Process for establishment of Hospital system;• What is hospital structure;• Categories of hospital structure;• How to design the hospital structure;• Roles of organization structure;• purpose of organization structure;• Formal and informal organization structure.
Key points • Need to understand that there are different processes of work and many people in different departments are involved in each process of work. How organization is designed with proper chain of command is key to smooth operations
• Make sure RRHMT understand their importance as key structures of the hospital (brain)
Remarks Concept of “Hospital system” relatively new to hospital managers. Make sure that not to confuse between “health systems” and “hospital system”.
References
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Session title Management and AdministrationSession # 2Time allocation 90 minutesSession objectives At the end of the session participants will be able to:
• Define a concept of management, • Describe the differences and linkages between management and administration;• Describe management functions, • Describe roles of managers.
Issues to be covered • What is management?• What are characteristics of Management?• Results of Effective Management in Hospitals• Strategic management of hospital• Lean Management and Seven (7) wastes• Lean Principle• Management and Administration• Function of Management• Planning• Organizing• Staffing• Directing• Controlling• Roles of managers
Key points • Meaning of “management” need to be well understood• Management skills are necessary for effective and efficient management of any
organization• Hospital managers need to comprehensively understand management concepts
in order to be able to manage the RRHs effectively and efficientlyRemarksReferences
Session title Effective leadershipSession # 3Time allocation 90 minutesSection objectives At the end of this session participants will be able to:
• Define the concept of leadership and its related aspects• Describe the qualities of a good leader • Describe leadership strategies • Describe principles of leadership
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Issues to be covered • What is leadership?• Managers and leaders• Boss and leaders• Qualities of a good leader• Why good leadership is important?• Leadership strategies• Important of leadership behaviors• Continuum leadership behaviors• How leadership measured• Principles of leadership
Key points • Understanding leadership concepts and team building are important for managing human resources to achieve organization goals and objectives more successfully.
• In this era of Health Sector Reforms in Tanzania- good leadership at all levels is critical for quality delivery of health services to all the people wherever they are
• Effective Leadership is a direction to achieving RRHs goal as there is no one leadership style which is recommended for a certain organization but it depends on situation that prevail by the time of implementation
Remarks Facilitators must emphasize on the complementarity of leadership and management and ensure that RRHMT understand managers can also be leaders and vice versa.
References Management for health services GRP 1
Session title Principles of DelegationSession # 4Time allocation To be determined by the coordinatorsSession objectives At the end of this session participants will be able to
• Describe the meaning of delegation• Understand differences between” Delegation” and “Handing over”• Understand characteristics and steps for effective delegation• Understand challenges in delegation
Issues to be covered • What is delegation?• What is handing over?• Why delegate?• Benefits of delegation• Characteristics for effective delegation• Steps to be followed in delegation• What can/cannot be delegated?• Why managers do not delegate?• Why subordinates don’t accept delegation?
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Key points • Delegation of tasks is important in relieving the manager from doing tasks that can be performed by subordinates
• This is done in order for manager to have enough time to deal with other core issues and in empowering subordinate in terms of management skills and knowledge.
• This session discusses concepts and techniques for effective delegation Remarks The facilitator should emphasize more on the differences of delegation and handing
over including its applicability in hospital settings. References
Session title Change Management
Session # 5
Time allocation TBA
Session objectives At the end of this session participants will be able to:• Define change and describe relevant concepts of change management• Understanding factors influencing organizational change• Understand reasons for change resistance and strategies that will minimize it
Issues to be covered • What is change?• Factors influencing Organizational Change• Example of Factors for Change• Possible Changes in Organization• Initiating change• Why do people resist change?• Resistance to Change and Possible Solutions• How to avoid resistance to change• Follow-Up in change management• Recording the Change Process • Common mistakes by managers when managing change
Key points • Change is about complexity of processes in organizations• Managing change is complex, dynamic and challenging• Managing change in hospital is about making change worthwhile and relevant
through evaluation, planning and implementation. It involves operations, tactics and strategies.
Remarks The facilitator should emphasize on the need to involve RRH staff from the planning stage up to the implementation of any change that will occur within the hospital setting. Facilitator should emphasize on the importance of innovating and instituting change in RRHs management for delivery of quality health services.
References
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Session title Team building
Session # 6
Time allocation TBA
Session objectives At the end of session participants will be able to:• Define the following terms “team, team building, “Team work”• Describe stages of team development• Explain what makes a good team• Identify characteristics of a well-functioning team• Describe the reasons that influences team to fail
Issues to be covered • Definition• Importance of team work• How do you build a team?• Stages of team Development• Characteristics of a well-functioning team• What makes a good team?• Why do team fail?• Team medicine
Key points • Good team has to have knowledgeable people with clear and well-defined objectives well known to all members
• Behaviors of team members observed during building stages have to be expected and taken care of, as they are part of team building process
Remarks Emphasis should be on the importance of RRHMT to work as a to create synergy in performance of their roles.
References
Session title Communication in the organization
Session # 7
Time allocation TBA
Session objectives At the end of the session participants will be able to;• Define the following terms; Communication, communication skills • Describe different types of communication• Identify skills for effective communication
Issues to be covered • What is communication?• Types of communication• Means of communication• Patterns of communications• Skills for effective communication• The impact of conversation on listeners• Barriers to communication• How to overcome barriers to communication
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Key points • Effective communication is the core of all leadership activities. Leaders know they can best achieve their goals if they have the cooperation of the people they work with,
• The ability to communicate effectively enables them to influence the attitudes and action of their colleague and subordinates
• Appropriate communication is a key to organization performance • Proper selection of communication patterns and channels is crucial to effective
communication• To reach set objectives, organization has to minimize the barriers to
communication
Remarks
References
Session title Managing Meetings
Session # 8
Time allocation TBA
Session objectives At the end of this session participants will be able to:• Define the term meeting• Explain the purpose of meetings• Describe the categories of meetings• Describe the process of conducting meetings
Issues to be covered • Definition of meeting• Purposes of meetings• Examples of meeting to RRHs• The process of preparation and conducting
meeting• Meeting Preparation• Conducting Meeting• Why people do not like to attend meetings?• Things people like to see in the meeting
Key points • Well planned and scheduled meetings are important for sharing the information and directives as well as solving problems, challenges and conflicts occur during implementation of various tasks/service provision
Remarks
References
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Session title Conflict Resolution and Discipline Session # 9Time allocation TBASession objectives At the end of this session participants will be able to :
• Define the term conflict• Explain different reasons of conflicts in RRH• Explain ways of conflict resolution among RRHMTs• Describe strategies for managing conflict
Issues to be covered • Definition of conflict• Why conflicts in RRHs• Contributing factors for occurrence of Conflicts• Stages of conflict in an organization• Effects of conflicts• Conflict Resolution among RRHMTs• Ways to resolve conflicts• Conflict-resolution behavior• Strategies for Managing Conflicts
Key points • Conflict may either intended or unintended obstruct the achievement of set goals of the individual or organization. However, conflict can have either constructive or destructive results.
• The presence of conflicts in an organization indicates that members are involved in something of sufficient importance that they face the tensions.
• Conflicts are inevitable as they have positive and negative effects.• It can be useful in generating better ideas and methods and they can also inspire
concerns hence stimulating emergence of long-suppressed problems RemarksReferences
3.4.3. Module 3: Human Resource Management This module is designed to provide necessary knowledge and skills to perform RRHMT functions, especially, function No. 3: Human resource management so as to improve efficiency, effectiveness and quality of health care services and meet clients/community needs.
Objectives of the module are as follows; At the end of this module participants will be able to:1. Explain the basic concepts of human resource management and planning 2. Understand Human Resource policy and procedures 3. Explain human resource planning process4. Explain the staffing process5. Understand performance management process and supportive supervision.6. Outline various ways of motivating staff7. Describe Training and development functions in human resource
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Session title Basic concept of HR ManagementSession # 1Time allocation TBASession objectives At the end of this session participants will be able to:
• Define the terms: Human Resource Management, Human Resource for Health, Human Resource Management System
• Explain the key components of Human Resource Management • Identify importance of HRH management• Describe ideal structure of HRH management System• Describe challenges resulting from poorly designed HRMS
Issues to be covered • Definition of Human Resource Management (HRM)• What is Human Resource for Health?• What is Human Resource Management System?• Key components of HRM• Expectations of employers and employees• Concepts of Human Resource and Human Capital• Importance of proper HRH management for RRHs• Importance of effective HRM systems• Ideal structure of HRH Management System• Challenges resulting from incomplete functioning HRMS
Key points In achieving the goal, the organization must have a proper functioning HRMS hence reduction in cost of care and improved quality of healthcare services provided
RemarksReferences
Session title HRH planning
Session # 2
Time allocation TBA
Session objectives At the end of this session participants will be able to: • Define the following terms; HRH Planning and HRH development plan• Describe steps in HRH Planning• Understand the importance of HRH Planning• Describe the goals for HRH development
Issues to be covered • What is Human Resource for Health Planning?• Elements of HRP-Key questions• Balance of four key components for HR planning and management• Steps in HRH Planning• Why HRH Plan is important?• What is HRH Development Goals
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Key points Proper HRHP is important for the enabling the RRHs to:• Recruit and retain staff with the right number and right skills• To assess future man power needs• Proper utilization of HR
Remarks
References
Session title Staffing
Session # 3
Time allocation TBA
Session objectives At the end of this session participants will be able to:• Describe the meaning of staffing and recruitment• Describe the steps for staffing and recruitment
Issues to be covered • What is staffing?• Steps in Staffing process• Job Analysis• Steps of job analysis:• What is recruitment?• Recruitment in RRHs
Key points • Staffing is one of five basic functions that constitute the management process.• It is continuous process of selection, development and appraisal of the
employees in order to fulfill the various roles within the organization with the suitable candidate
• Placement of staff according to right skills, number and place is an important component of any organization in order to achieve its goals and enable proper use of other resources
Remarks
References
Session title Staff inductionSession # 4Time allocation TBASession objectives At the end of this session participants will be able to:
• Understand the concept of staff induction• Describe the importance of conducting staff induction
Issues to be covered • Definition of Staff Induction• Importance of Conducting Staff Induction• Prerequisite for New Employee• Minimum Standard of the Job Description
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Key points • The aim of an induction program is to make sure that new employees are given all the help and guidance they need for them to do their job to the required standard as soon as possible.
• Staff Induction is important in order to prepare staff to take new roles for effective achievement of the organization goal
Remarks Facilitator should emphasize on the difference between staff induction and staff orientation.
References
Session title Performance appraisalSession # 5Time allocation TBASession objectives At the end of this session participant will be able to:
• Define the term Performance appraisal• Explain the reasons of conducting Performance appraisal• Describe the processes of Performance appraisal
Issues to be covered • Performance Appraisal• Reasons needed for conducting Performance Appraisal• Performance Appraisal Processes• Principles of Performance appraisal• Importance of Performance Appraisal
Key points • Performance appraisal provides a brief summary of evaluating staff and is a starting point for supervisors/employers to understand the employee.
• Performance appraisal is necessary for determining how to achieve organization objectives, how to determine talents from our staff, strengths and weakness.
• Health staff have right to be appraised /Assessed from their work. • Preparation and processes of Performance appraisal should be fair and open.• Agreeing on objectives to be appraised between supervisor and supervisee is of
important.Remarks Understanding implementation of OPRAS seems one of the common issues in RRHs.
Therefore, practical way of implementing OPRAS needs to be taught during the session.
References
Session title MotivationSession # 6Time allocation TBASession objectives At the end of session participants will be able to: -
• Define the term ‘Motivation’• Describe the nature/characteristics of motivation• Understand factors for motivation and demotivation • Explain the outcome of motivation
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Issues to be covered • What is Motivation?• Nature / characteristics of motivation• Motivation and demotivation factors• Common Demotivation factors• Outcome of motivation
Key points • It is important for Manager(s) to have the ability to motivate subordinates.• This is crucial for improving performance• If done right, outcome benefits employee and organization• If done wrongly, end up with demoralization, dissatisfaction, poor performance,
low productivity, etc.• In general, as motivation increases, productivity increases. Then, time and costs
decrease while quality and satisfaction increase.• People also differ and needs differ from one individual to another and all need
to be fulfilledRemarks Difference between” incentive” and “motivation” need to be clarified.
Ways of increasing motivation of staff are key issue for health managers. Sharing the actual practices of improving the motivation among staff will be useful.
References
Session title Supportive SupervisionSession # 7Time allocation TBASession objectives By the end of session, the participants will be able to:
• Define the term ‘Supportive supervision ‘• Describe the importance of Supportive Supervision• Describe key important features of S. Supervisory process• Understand Coaching, Modeling and Mentoring relationship• Describe methods of giving supervision feedback• Explain effective communication in supervision
Issues to be covered • Definition of Supportive Supervision• Coaching, Modeling and Mentoring• Importance of Supportive Supervision• Advantage of Supportive Supervision• Key Important Features of Supervisory Process• How do you give Supervision Feedback?• Effective Communication in Supervision• SS tool for RRHMT• Differences between inspection approach and supportive approach
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Key points • Supportive supervision promotes continuous improvement in the quality of care by providing necessary leadership and support for quality improvement processes and by promoting high standards, teamwork, and better two-way communication.”
• Therefore, supervisors need to equip with good supervision skills and knowledge, and conduct SS in “positive manners”
Remarks It should be explained clearly different between supportive supervision and inspection.
References
Session title Human Resource for Health Information System (HRHIS)Session # 8Time allocation TBASession objectives At the end of this session participants will be able to:
• Understand the concept of HRHIS• Understand the importance of HRHIS in CHOP preparations.
Issues to be covered • Definition of HRHIS• How HRHIS operates• Reports Produced• Importance of HRHIS
Key points • Human Resources for Health Information system is the key tool in HRH planning, retaining, attrition and recruitment
• HRHIS is mostly important system which will enable the RRH to have updated HRH information
• RRHs need to have updated HRHIS for HRH planning and developmentRemarksReferences
3.4.4. Module 4: Basic Financial, logistics and Information Management
This module is designed to provide necessary knowledge and skills to perform RRHMT function, especially, function No.4: “Financial management”, No.5: “Material resource management”, No.6:” Information management and research”, and some part of No. 10: “Emergency preparedness and responses” so as to improve efficiency, effectiveness and quality of health care services and meet clients/community needs
Objectives of the module are as follows; At the end of the module, the participants will be able to:
1. Understand the importance of managing and using information in their respective working
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environment.2. Understand various concepts and procedures in financial management3. Describe various sources of health financing in RRHs4. Understand various concepts in logistics management5. Describe logistics management procedures
Session title Hospital Information System and RecordsSession # 1Time allocation TBASession objectives At the end of this session participants will be able to:
• Describe the importance of managing information in their respective working environment.
• Use the available information to make right decisionsIssues to be covered • Definitions on information
• Why manages information?• Information management approach• How to manage information• Types of hospital management• Sources of health information• Medical record management
Ø ConfidentialityØ Filing systemØ Information tracingØ Hospital statisticsØ Management ladder and information management
Key points • Information is the life blood of any organization including those in Health care service provisions
• Without proper management of hospital records RRHMTs cannot execute their roles effectively:Ø Decision making and planningØ Monitoring and evaluation of health servicesØ Research and improvement programsØ Conflicts and emergency case management
• Important to know what kind of data and information need to be collected in the RRH for hospital management
• Important to have clear understanding of responsibility on data and information collection, analysis, storage, and report
• As RRHMT, it is important to analyze collected data and information to use for decision making
• It is necessary to organize and manage adequate information of the right quality• It is the responsibility of RRHMTs to address all information related challenges
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Remarks It is important to explain how information management (periodical collection, analysis, utilization and record keeping) is the key for proper operation of hospital services as “Information” is the power for health managers.Current situation on weak medical record handling and keeping need to be well shared. It is necessary to emphasize that computerization is not the solution. If medical records are not well managed on paper based, it is useless to introduce electronic medical record system. First things to do is to strengthening “record keeping”
References
Session title Financial ManagementSession # 2Time allocation TBASession objectives At the end of this session participants will be able to :
• Understand the basic concept of accounting and financial management. • Describe the importance of the effective management of RRH’s financial
resources• Describe various tools in accounting and financial management
Issues to be covered • Basic concepts of accounting and financial management• financial management• Tools for financial management• Financial statement• Accounting management• Common income categories of RRHs• Missed opportunities
Key points • Effective financial management: -Ø Improves provision of quality health careØ Assists future budgeting or planningØ Assists when reporting to various levelsØ minimize audit queries
• RRHs need to follow GOT Financial regulations to manage hospital financingØ Evidence based financingØ Proper recording keeping
Remarks • Limited financial resources for health need to be efficiently managed to adequately contribute to quality delivery of health services
• It is important that health managers understand financial procedures to be able to manage financial resources for health efficiently and also that financial information should be shared within the management timely
• The session provides health care managers financial management concepts and procedures to improve their financial management skill
References •
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Session title Logistic ManagementSession # 3Time allocation TBASession objectives At the end of this session participants will be able to :
• Describe logistics management system and process• Identify types of hospital commodities• Appreciate the roles of Medicines Therapeutic Committee in Hospital
Commodity Management• Identify challenges in RRHs logistics management
Issues to be covered • Definition of Logistic Management• Definition of Health commodities• Logistic roles of Medicine Therapeutic committee• Health commodity Management Cycle• Method of procurement• Ordering procedure• Storage• Controlling capital equipment
Key points • It is very important to use available information for better planning and management of commodity logistics
• Given many existing challenges, RRHMTs need to focus on internal systems to improve commodity logistics managementØ What to order (Selection)Ø How much to order (Quantity)?Ø When to order (Timing)
Remarks • Ultimate goal of a logistics system is to ensure health commodity availability to meet the needs of the clients that it serves
• Availability of health commodities is a serious challenge for most RRHs.• Collaboration of relevant stakeholders is necessary in ensuring health
commodities availabilityØ Central Government (MOHCDGEC & MOFP)Ø MSDØ Health Facilities including RRHs
• There is urgent need to improve the logistic system performance In order to achieve smooth operations of RRHs to meet the stakeholders expectations
• Smooth rotation of Health Commodity Management Cycle is the key for successful logistic management. Thus, it is important to eliminate bottle necks of each step in the cycle.
References
3.4.5. Module 5 Quality and Safety of Hospital ServicesThis module is designed to provide necessary knowledge and skills to perform RRHMT function, especially, function No. 2: “Monitoring and reporting”, No.9 “Health promotion and disease prevention” , and No. 10: “Emergency preparedness and responses” so as to improve efficiency, effectiveness and quality of health care services and meet clients/community needs.
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Objectives of this module are as follows;At the end of this module participants will be able to :1. Describe the common - quality terms and its’ dimensions2. Understand the current situation of QI activities in Tanzania3. Understand 5S-KAIZEN - TQM approach 4. Understand Safety Improvement Measures 5. Understand Customer Care and Client Satisfaction
Session title Descriptions of common quality terms and its’ dimensionsSession # 1Time allocation TBASession objectives • Define the term Quality, Quality Improvement, Quality Control, Quality
Assurance and Quality Management, • Differentiate between Quality Control, Quality Assurance, and Quality
Management • Describe the Dimensions and 6 domains of Quality • Understand the concepts of Continuous Quality Improvement, Total Quality
Management, and Lean Management Issues to be covered • What is quality?
• General definition of quality• definition of quality in health sector• definition of QC, QA, QI and QM• The layer of quality concepts• Dimension of quality• Domains of quality• What is CQI?• What is TQM?
Key points • Every human being in life needs a degree of quality products, health services, or something which fit its purpose. However, there is a challenge of conformance with those requirements, or products that are free from defects or contamination, to meet customer satisfaction.
• Quality improvement starts from “Positive attitude”• Quality improvement is a continuous process, and it is not a one day/ spot
activity • High reliable Organization is a result of good leadership and good management
of an organization • RRHMT have a big role of ensuring quality of health services
Ø Creation of quality and safety culture among staffØ Increase awareness of quality and safety among staffØ Support quality and safety improvement activities in the hospital
Remarks Awareness on quality improvement is the purpose of this session. Health managers need to understand the necessity of QI activities and management of quality. Definition of words used in quality is misunderstood or wrongly used by health managers. Therefore, quality terms should be well defined.
References
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Session title Quality Improvement activities in TanzaniaSession # 2Time allocation TBASession objectives At the end of this session participants will be able to:
• Describe existing strategy, framework, and guidelines for QI• Describe QI initiative in Tanzania• Utilize QI implementation structure to improve Quality health services • Understand the role of Behavior Change in Quality Improvements
Issues to be covered • Quality strategy in TZ• QI Framework and guidelines• Documents for QI in TZ• QI initiatives in TZ and examples• Selection of QI programs/initiatives• QI implementation stricture• Roles and responsibilities of each team• Roles and responsibilities of RRHMTs• Behavior change
Key points • Have positive mindset, change of behavior, commit oneself with effective communication are the keys for successful implementation of QI
• Established functional QI structure with good institutional memories is a key for sustainable practice of QI activities
Remarks • This session explains the historical background of Quality initiatives from the MoHCDGEC
• It encourages all health workers at all levels and other stakeholders in the sector to understand innovative approaches for quality improvement and implement them at your respective health facility
• Issue of harmonization of QI program, selection of QI program are key for reducing confusion of QI practices among health workers
References
Session title 5S-KAIZEN-TQM approachSession # 3Time allocation TBASession objectives At the end of this module RRHMTs will be able to :
• Understand 5S – KAIZEN –TQM Concepts• Understand the benefits of 5S – KAIZEN –TQM approach• Understand roles of RRHMT in QI activities
Issues to be covered • What is 5S?• Details of 5S approach• What is problem?• What is KAIZEN?• Two types of KAIZEN• What is quick KAIZEN?• Benefits of KAIZEN• What is KAIZEN with QC story
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Key points It is necessary to emphasize the following points: • The target of “KAIZEN” is your work, not others’• Dissatisfaction, complains to the current situation, complains about people are
not fit to be the KAIZEN theme because it is based on “negative attitude”• KAIZEN theme must be based on positive wishes of workers such as “we
would like to be/do……”• KAIZEN starts from recognition of problem• Better not to tackle with a problem that you cannot solve within your power and
resources• Do what you can do with maximum utilization of existing resources
Remarks It is necessary to explain that how 5S-KAIZEN approach is useful for improvement of health services, and management of health resources
References
Session title Safety ImprovementSession # 4Time allocation TBASession objectives At the end of this session, participants will be able to:
• Explain the patient and staff safety• Describe ways to minimize medical errors Describe various patients and staff
safety improvement approaches • Establish medical errors reporting system in respective RRHs
Issues to be covered • Patient safety• Recommendations to improve patient safety• Staff safety• Recommendations to improve staff safety• Definition of medical errors• Level of medical errors• Swiss cheese model• Establishment of Medical incident reporting system• Safety Improvement Approach
Ø Team STEPPSØ Hazard Prediction TrainingØ Infection Prevention and Control
Key points • Medical errors should be reported and documented in order to prevent recurrence of incidents and accidents for improvement of safety of patients and staff
• RRHMTs are responsible for safety assurance of staff and patientsRemarks It is important to understand the seriousness of existing medical incidents and
accidents. Then, it is necessary to emphasize on patient safety and staff safety to increase awareness on safety improvement. Better remind the managers to consider ergonomics for staff to reduce physical stress from work place.
References
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Session title Customer care and Client satisfactionSession # 5Time allocation TBASession objectives At the end of this session, RRHMTs will be able to
• Describe terms: Client, Client Satisfaction, Client Expectation• Describe the relationship between Clients’ needs/expectations and satisfaction• Describe major factors influencing external and internal client satisfaction• Describe how to measure client satisfaction• Describe how to improve client satisfaction• Understand the current status of Client Satisfaction in Tanzania
Issues to be covered • Types of client• Definition of Client expectation• Types of Client expectation• Definition of client satisfaction• Major influencing factors for external client satisfaction• Major influencing factors for internal client satisfaction• Ways to measure client satisfaction• Client service charter• Procedure to improve client satisfaction• Client satisfaction in Tanzania
Key points • Literally everything we do, every concept perceived, every technology developed is directed with this one objective clearly in mind – “Pleasing the customer” – (Client)
• Customer pays everyone’s salary and decides whether a goal is going to be achieved or not
• Customer’s dissatisfaction can affect everybody in the organization.Remarks It is important to know that there are two types of expectations coming from patients;
1) health expectations and 2) Non-health expectations.Therefore, better consider patients psychology Patients are already feeling weak when they are visiting hospital. Thus, it is necessary to treat the patient, not disease.
References
• NOTE:The following statementwill cover each session: On the exercises, facilitators should aim at enabling the participants to identify how effective they have been on the particular subject matter, what are the challenges and possible solutions to address them.
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CHAPTER 4: Measurement of the Training Course/Program
Measurement of knowledge improvement is one of the indicators to judge the effectiveness of the training program. Therefore, it is recommended to conduct assessment for the course. The assessment modalities were developed to guide assessment of learners on competencies specified in the course. The assessors are advised to use the assessment plan relevant for each session to assess learning outcomes stipulated within the BHMT short course. It is advised that the facilitator make sure the assessment is conducted in a strict manner. The conduction of the assessment is compulsory and will contribute to the certification award. The assessment modality for this course will be:
4.1. Pre- test and post-test assessmentThe pre-test assessment will be conducted to the enrolled students before commencing of the course. This will enable the facilitator to evaluate the prior knowledge of the participants on RRH management. We advise the course coordinators to send out the course materials to the enrolled participants so that they can prepare themselves prior to the course. To evaluate the acquisition of knowledge after the course, participants will be given a post-test, which will be containing the same questions attempted during pre-test. However, the questions for pre and post-test will not be the same in every batch. Participants will be given up to 60 minutes to complete the test. The knowledge assessment tests consist of three sections: Section A: TRUE and FALSE questions; Section B: (multiple choice questions) and Section C (short answer questions). It is suggested to conduct post assessment one day before closure of the training.
After the assessment, the following things need to be calculated with assessment calculator;• Mean of both pre-assessment and post assessment• Standard deviation (SD) of both pre-assessment and post assessment• Effect size from pre-assessment and post assessment
Effect size can be judged as follows1;• Small effect size Δ: |.20|≤small<|.50|• Middle effect sizeΔ: |.50|<medium<|.80|• Large effect sizeΔ: |.80|.≥large
Effect size (Δ) should be higher than 0.80. If the result is higher than 0.80, we consider that the training course was conducted effectively. In addition to the above, training institution can apply their own means of measuring learning effect and effectiveness of the course.
1 Koizumi, R., & Katagiri, K. (2007). Changes in speaking performance of Japanese high school students: The case of an English course at a SELHi. ARELE, 18, p.81-90.
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4.2. Course evaluationQuality of the training course should be improved continuously. Therefore, it is necessary to be evaluated. One of the good ways to evaluate the training course is evaluation by the participants of the training course. Therefore, it is recommended to conduct post course evaluation by the participants of the training course. As this exercise is conducted towards the end of the course, facilitators should make sure that every participant is given enough time to complete and submit the evaluation form.
The following issues need to be evaluated;
• Relevance of the course • The course contents coverage • Understanding level of the course contents • Usefulness of each course content • Facilitators teaching skills and knowledge • Request for modification of the course contents
4.3. Analysis of the results and action to be takenPost assessment as compared to pre-assessment reflects improvement of the knowledge and effectiveness of the training of participants. Results of the course evaluation on the competence of the facilitators from participants and the results from the post assessment are the information that facilitators have to analyses to improve quality of the training for the next group of participants. This has to be a continuous process so that participants will be provided with the highest level of training quality. It is necessary for the course coordinator to give the results and feedback of the course before the participants leave the training Institution. The feedback will include both the pre and post-test scores and completed course evaluation.
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CHAPTER 5: Basic Management Training; Institutional Framework
Continuity of the BHMT training to the level and standards prescribed in the previous chapters depends largely on different actors playing different key roles:
5.1. Roles and responsibilities of MoHCDGECMoHCDGEC will be responsible for coordinating implementation of the training in RRHs in line with its policies, guidelines, circulars and directives:
• Select and Instruct health training institutions to establish Basic Hospital Management Training course,
• Review training materials together with relevant stakeholders if changes occur, • Device the mechanism of receiving and reviewing the implementation status of the action
plans prepared during the course in collaboration with respective institutions, • Conduct supportive supervision to evaluate the impact of the BHMT on healthcare service
delivery at the RRHs
5.2. Roles and responsibilities of Training institutions• Training institutions will establish Basic Hospital Management Training course, • Develop training schedule and prepare general information of the course, • The training program will be advertised and the information will be sent to RRHs for
seeking the participants of the training course, • Prepare conducive environment for teaching and learning, • Continuous improvements of the training materials as the training continues to ensure
effectiveness of the training
5.3. Roles and responsibilities of RRHMTRRHMT need to plan / allocate budget for hospital managers to attend the Hospital Management Training for newly appointed members and as a refresher course to members of HMTsOn completion of training an Action Plan must be prepared by participants focusing on the challenges outlined in the training. Facilitators must effectively guide the process. Trained RRHMT members must disseminate the knowledge to other colleagues and be sure to put it into practice to improve RRHs healthcare service delivery.
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Supported by Japan International Cooperation Agency (JICA)
