FOR IMMEDIATE RELEASE
August 6, 2002

Reproductive Health Organizations Use Industry Technique to Improve Performance

Reproductive health organizations in many developing countries are using a process pioneered in industry to improve the quality of their services, according to a new report from the Johns Hopkins Bloomberg School of Public Health.

Performance Improvement (PI) helps organizations create the conditions for high employee productivity. Reproductive health organizations use it to focus on meeting the needs of service providers and other staff members, according to the latest issue of Population Reports, published by the Johns Hopkins Population Information Program.

PI helps reproductive health organizations diagnose and fix job performance problems and can be inexpensive to carry out. "Performance improvement is especially useful in resource-poor settings," according to the report, "because it focuses attention on often-neglected causes of performance problems, such as unclear expectations or infrequent feedback, that need not be costly to correct."

The PI process is carried out by stakeholders—the staff members, clients, managers, and others who are affected by a performance problem or are interested in solving it. These stakeholders usually need help from facilitators. The steps of the process are:

1. Consider the institutional context of the performance problem—particularly the perspective of clients and communities—and get agreement among stakeholders about the problem and how to approach it.
2. Define desired performance based on national or international standards.
3. Describe actual performance based on observations and interviews with staff members and clients.
4. Measure or describe the performance gap—the difference between desired and actual performance.
5. Find the root cause of the performance gap such as lack of knowledge and skills, unclear job expectations, or lack of supplies and equipment.
6. Select interventions—stakeholders generate ideas for solutions that incorporate best practices, if possible.
7. Implement interventions, and
8. Monitor and evaluate performance.

Beginning with a pilot project in 1998, reproductive health organizations have used PI to:

• Respond to demands by clients for improved reproductive health services in the Dominican Republic.
• Learn why providers are not following guidelines for infection prevention despite their training in Ghana.
• Perform national needs assessments for reproductive health care, examine organizational performance problems, and decide on priorities in Armenia, Burkina Faso, Nigeria, and Tanzania.
• Establish standards of care and help clinics meet the standards for licensing or accreditation in Guatemala and Honduras.
• Help decentralize health services in Tanzania.
• Identify barriers to service provision by community midwives in Yemen.
• Design incentives for private providers to counsel clients and provide family planning services in India.

The PI process prevents common pitfalls of problem solving. People often jump to conclusions about the cause of a performance problem, and they choose familiar solutions, such as training. The PI process encourages stakeholders to analyze problems carefully and think through the links between performance gaps, root causes, and solutions.

Leadership is crucial for the PI process, according to author Robert Lande. "Leaders of an organization using the PI process need to take into account and plan for the varying responses of the staff members to change. Most people change slowly and in stages." Leaders encourage people to change by articulating and communicating clear reasons for change and planning the PI process so that it yields quick results.

The report describes different applications of the process in a variety of reproductive health care settings. It serves two audiences. The first chapter is an overview for managers who will make the decision to use the process and need to know the fundamentals, costs, and expected results. The remainder of the report details the steps, tools, and techniques for readers who may become PI facilitators.

Population Reports is an international review journal of important issues in population, family planning, and related matters. It is published four times a year in four languages by the Population Information Program at the Johns Hopkins Center for Communication Programs for more than 170,000 family planning and other health professionals worldwide, with support from the US Agency for International Development (USAID). USAID administers the US foreign assistance program, providing economic and humanitarian assistance in more than 80 countries worldwide.

For more information contact: Stephen M. Goldstein or Kim Martin at Johns Hopkins Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA. Tel: 410 659-6140; Fax: 410 659-6266 e-mail: press@jhuccp.org. PRESS ROOM: http://www.jhuccp.org/pressroom/

© 2005 The Johns Hopkins University. All rights reserved.
Security and Privacy Policy, 111 Market Place, Suite 310, Baltimore, MD 21202, webmaster@jhuccp.org

Photos courtesy of Photoshare, a service of The INFO Project.