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 MEMBERS
• Meseret kumilachew---------------- quality focal
• Abere tafere ----- ---------------------- MCH focal
• Esubalew yeshamibaw -head of health center
• Esubalewu meseret------- member from MCH
• Etsework minichil------------pharmacy head
• Yitayal yiheyis --------------- HIT
• Emebet ------------lab techinician
 List problems
• Early identification of pregnant women(80%)
• Low performance of syphilis test(34)
• Partograph utilization (90)
• Low PNC service waiting for 24hrs (0)
• Low skilled delivery attended(22)
• High still birth (1.4)
 Problem priortization
s.n List of problem Frequnc Feasibili Level of Importa Total
o ey(10) ty(10) control(10) nce (10) score(40)
1 Early identification of 8 10 7 4 29
Px
2 syphilis test 7 7 10 6 30
3 Parthograph 5 8 9 10 32
utilization
4 PNC service for 24 10 8 7 10 35
hrs
5 Skilled birth 10 8 7 9 34
attendant
6 High Still birth 3 5 6 6 20
 n g
a i ti
s w d a
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P r 2 lt h
fo hea
 Problem statment
• In the last one year at, Ashuda health center
there were low(0%) PNC service waiting for 24
hrs this leads to maternal (5%) and neonatal
(4%) complication.
 AIM STATMENT
• We ashuda health center qi team aims to
improve PNC service waiting for 24hrs from
10 % to 90% from August 14/2011 up to
January 14/2012 E.c
 Contributing factors
• Data
• Leader ship
• Community
• Geography
• supply
 FISH BONE DIAGRAM
DATA LEADRE SHIP
Root cause analayisis

No regula meeting No well equpied maternal waiting room

LOW PNC SERVICE WAITING FOR 24

POOR ROOM ARRANGMENT

Poor data reviewing system

Lacke commmitment

HRS(10%)
Lake of oreintati on

NO NOCOMMUNITY MOBLIZER NO VEHICLE

Budget allocati on from community
Poor transportion

No functional care giver Long distance

No home like enviroment Quick to return

COMMUNITY GEOGRAPHY
 DRIVER DIAGRAM
PRIMARY DRIVER SECONDARY DRIVER INTERVENTION

Peer to peer data reviewing

data POOR DATA RECORDING SYSTEM

Lack of orientati on Orient all staff

service waiting for
24 hrs from 0% to
Improve PNC

Poor room arrangment Rearange room accordingly

leadership Lack of commitment motivate providers
100%

communit NO ALLOCATED BUDGET FOR CARE allocate budget by

y GIVER
mobilizing community
No community mobilizer ASSIGN ACCEPTED PERSONNEL

POOR TRANSPORTION SYSTEM

geography Avial Ambulance
NO VEHICLE for thos waiting PNC
mother
 Measuring change idea
aim Change idea Out come Process measure Balancing
measure measure
Peer to peer review No PNC cards reviewed Total
budget
Improve PNC service waiting for 24hrsfrom 0%to 100%

crisis

Total No OF PNC mothers waiting

Staff orientation No staff oriented No of
mother
atted
delivery

Rearrange room No room arranged

Motivate provider no providers

motivated
Allocate budget Total budget allocated

Assign local leader No kebele on which

local leaders assign
Avail ambulance service No mothers returned by
ambulance to home
 Change idea
A. Peer to peer data reviewing
B. Orient all staffs
C. Rearrange room accordingly
D. Motivate providers
E. Allocate budget by mobilizing the community
F. Assign local leaders religiously
accepted personnel
G.Avail ambulance service to return home
 Prioritizing matrix
1 2 3 4 5(most
importance)

2 E,F

3 D

5(the A,B,C.G
easiest)
 PDSA cycle 1
Over all aim( Improving PNC service waiting for 24hrs from 0% to 100% at ashuda health center by the end of junuary 14
2012)
Problem analysis ( fish bone ,driver diagram,why why’s)
PDSA aim(we ashuda health center qi team aims to improve PNC service waiting for 24hrs by implementing staff orientation
from 0% to 20% )
Describe your idea to change. Address the identified cause of the problem? (What) (staff orientation )
List the activities/tasks to carry out your idea (How) Where will it happen?
Activities Who is responsible? When will it happen?
-plan day to give head of health center 14/12/2011 head office
orientation
prepare place for qi team 14/12/2012 ashuda heaith center
orientation
prepare available qi team 14/12/2012 ashuda health center& health
materials for orientation office
call all staff for qi team 14/12/2012 ashuda health center& health
oreirantation office
Data collection
How frequent? What is the data source/ tool to
Data/Indicator to collect Who is responsible? (daily, weekly, monthly) use?
card’s deliverd mother MESERET WEEKLY delivery & PNC registration

no staff oreinted meseret 15/12/2011 mianut ( ቃለ ጉባኤ)

What is your prediction? It improves PNC service waiting for 24 hrs from 0% TO 20%
 PDSA cycle2
Over all aim( Improving PNC service waiting for 24hrs from 0% to 100% at ashuda health center by the end of Junuary 14
2012)
Problem analysis ( fish bone ,driver diagram, why why’s)
PDSA aim(we ashuda health center qi team aims to improve PNC service waiting for 24hrs by implementing Rearrange room accordingly
from 0% to 30% )
Describe your idea to change. Address the identified cause of the problem? (What) (Rearrange room accordingly)
List the activities/tasks to carry out your idea (How)

Where will it happen?

Activities Who is responsible? When will it happen?
discuss with staff head of health center 14/1/2012 head office
rearranging room
reach on agreement qi team 14/1/2012 ashuda heaith center

prepare available materials qi team 16/1/2012 ashuda health center& health

for arranged class office
open class for waiting of qi team 17/1/2012 at the back ashuda health center
pnc service office
Data collection
What is the data source/ tool to
How frequent? use?
Data/Indicator to collect Who is responsible? (daily, weekly, monthly)
no rooms giving service MESERET 18/1/2012 existing rooms at health center
mothers wating
no rooms not giving meseret 18/1/2012 mianut
service
What is your prediction? It improves PNC service waiting for 24 hrs from 0% TO 30%
 PDSA cycle3
Over all aim( Improving PNC service waiting for 24hrs from 0% to 100% at ashuda health center by the end of January 14
2012)
Problem analysis ( fish bone ,driver diagram, why why’s)
PDSA aim(we ashuda health center qi team aims to improve PNC service waiting for 24hrs by implementing peer to peer data reviewing
from 0% to 50% )
Describe your idea to change. Address the identified cause of the problem? (What) (peer to peer reviwing )
List the activities/tasks to carry out your idea (How)
Where will it happen?

Activities Who is responsible? When will it happen?

time for peer to peer mch focal 14/2/2012 head office
discussion
time for discussion qi team 14/2/2012 ashuda heaith center
programm
prepare available materials MCH staff 16/2/2012 ashuda health center& health
for discussion office

Data collection
What is the data source/ tool to
How frequent? use?
Data/Indicator to collect Who is responsible? (daily, weekly, monthly)
no Delvered mothers cared MESERET every month pnc registration, delivery
reviwed card/registration
No waiting mothers cards meseret every month mianut
reviewed
What is your prediction? It improves PNC service waiting for 24 hrs from 0% TO 50%
Bar graph of skill delivery at ashuda health center
attended from august to sept 20
% of deliveerd mother
100%
100% 100%
100%
90% 100%
80%
70%
60%
50% july
40% Aug
29%
30% sept
17% 25%
21% 29%
20% 17% 21% 21% 29% target
8%
10% 17%21%
0%

time
Run chart of PNC wainting for 24 hrs from august14,2011
sept20,2012

No of PNC service waiting for 24 hrs

1.2
Peer to peer data reveiwing
1

ers
0.8 REARRANGE ROOMACCRDINGLY

e provid
0.6 AUGEST
SEPT
Column1
0.4
Motivat
Column2

0.2
Giving staff oreintation
0
week1 week2 week3 week4 week5 week6 week7 week8

Time in week
 Performenace of PNC mothers waiting for 24 hrs from
delivered mother for 4 months at ashuda health center.

months deliveries PNC for 24 hrs Percentage{%)

August 25 6 24%
September 17 14 82%
October 18 12 67%
November 15 12 80%
 Percentage of delivered mother & PNC
waiting for 24hrs
90 82 80
% of mothers waiting for 24hrs

80
67
70
60
50 delivery
PNC
40
percentage
30 25 24
17 18
20 14 15
12 12
10 6

0
August September October November
% of mothers delivered waiting for 24hrs
(PNC)
120
%OF MOTHERS WAITING FOR 24HRS

100
PNC
80 median
Target
60

40

20

0 TIME
August Semptember October November
 Run chart of mothers waiting for 24 hrs from
August 14,2011 to November 20,2012 E.C at
ashuda health center
90
REARANGE ROOM AVIAL AMBULANCE SERVICE TO RETURN HOME
80
% WAITING MOTHERS FOR 24HRS

MOTIVATE
70 providers
REARRANGE ROOM ACCORDINGLY
60
50
40 Column2
Avial ambulance service to return home
30
20 staff oreintion
10
0
AUG Sep OCT NOV
 ACTION PLAN
List of Gab Responsible timeperiod Remark
activities person
Motivate motivators Qi team 20/3/2012
mothers -
providers 20/4/2012 E.C
Moblizing Community Qi team By end of
community mobilizes January
14,2012
Assign local Local leaders Qi team By the end of
leaders for January
mothers 20/2012E.C
revenu
Allocate budgt budget Health center End of
for mothers head 30/5/2012E.C
 NK
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