Quality Action Newsletter No 2 | 02/2015

Summary

Update on the work of Quality Action
Applying the PIQA quality assurance tool for interventions targeting people who inject drugs
Applying the Succeed tool at the Sexual Health Department in the UK
Experiences and impressions from applying the Succeed tool
The project “Midterm Check NPHS 2011-2017” using Schiff

Update on the work of Quality Action

by Cristina Chiotan, EuroHealthNet

The work in Quality Action is entering its final year of implementation. 2015 is an important year for Quality Action, with many ambitious activities to complete and results to achieve. We will further strengthen our efforts to promote quality in HIV prevention this year. Feedback from the use of our quality assurance and quality improvement (QA/QI) tools will inform the key quality principles and criteria for HIV prevention to be included in a Charter for Quality in HIV Prevention. We will summarise resources for policy makers and strategic planners into recommended policy statemetns, strategic actions and supporting methods. We will also prepare a core package of materials for the practical use of our five QA/QI tools. Quality Action’s concluding conference (January 2016) will give us the opportunity to summarise and acknowledge our work, present our results and strategise for the future and sustainability of QA/QI in HIV prevention in Europe.

Since it started in 2013, Quality Action has adapted three existing QA/QI tools (Succeed, QIP and PQD) and developed two new ones (PIQA and Schiff). We conducted our first round of European–level training workshops and the over one hundred participants are now attending part two of the training in Dublin, Barcelona Ljubljana and Tallinn. Quality Action partners also organised training at the national level (in Austria, Estonia, Belgium, Norway, Germany, Sweden, Poland, Slovakia and Greece), reaching even more people working in HIV prevention. Many training participants have started or even completed their practical application of QA/QI tools. In this newsletter we present their experience and impressions. The articles below are based on individual interviews that offer personal insights into the benefits and possible uses of QA/QI tools in our everyday work.

Applying the PIQA quality assurance tool for interventions targeting people who inject drugs

Based on an interview with Laurence Mortier, Psychologue, coordinatrice de prévention, HIVberodung/Santé – Croix-Rouge luxembourgeoise, Hépatites-IST-VIH

The European-level workshops were a good experience for Laurence Mortier, who decided to apply PIQA to one of the outreach projects she works on. The sessions she attended were inspirational for Laurence. The knowledge and information received in the training enabled her to become familiar with the questions used in the tool. She understood both the flexibility and limitations of PIQA. As Annemiek Dorgelo (CBO, Netherlands), Laurence’s trainer at the workshop, mentioned several times during the meeting: “It is important not to get de-motivated and concentrate on the key answers that could improve your work.”

PIQA must be considered an open tool, not a restrictive one. For example, PIQA offers a challenge right from the start: the first question asks for a definition of the project. Its questions are precise and provide lots of opportunities for reflection. Initially, Laurence found PIQA quite ambitious and thought that there were not a lot of things in her project that would reach its standards. However, while going through the questions she realised that PIQA asks for reflection on a comprehensive range of aspects, and that it is not about scoring strongly on all items. The application of PIQA has helped her redefine the project’s structure and identify the information that is most relevant for the project’s success.

Laurence pushed the quality assurance process further and tried to rewrite the project, including all responses and feedback received during the application of PIQA. She also used the results for writing up a new project and to identify the information relevant for better success and a higher impact.

“Sometimes you are missing descriptive details that are important when developing or presenting a project. PIQA helps you develop a project that has all relevant information” Laurence says.

Although it may seem like there is never time to apply a QA/QI tool, Laurence and other Quality Action partners consider the investment worthwhile and rewarding for both themselves and their organisation.

Laurence’s final recommendations are: “PIQA is short and easy to apply, especially when training has built up the necessary knowledge and skills. It is a good tool to use in small organisations that are working independently. It will give you opportunities to reflect on your work and improve it when developing new projects.”

Applying the Succeed tool at the Sexual Health Department in the UK

Based on an interview with Laura Hill, Lead Health Adviser, Sexual Health Department NHS England

Laura Hill said after the European-level training workshops: “It was fabulous! We were trained in an open and practical way”. Discussions were held on how to use Succeed and when best to apply it, on the questions it uses and learning from previous applications of the tool. “Last but not least, we also discussed how we can get a better understanding and use the results in a practical way.” After the training workshops, Laura applied Succeed to one of the team’s projects. The results, findings and recommendations have since been used to engage with stakeholders and define a clearer and more robust role for each of them. The team was able to attract stakeholder involvement and support for the application of Succeed.

Using Succeed was not always easy. Especially identifying the objectives at the beginning were a challenge. The team used the parts that were most helpful for their projects, selecting them based on the stage each project was at. They made the most out of the practical application of Succeed while avoiding a prescriptive approach and use of the findings and results.

After applying Succeed, Laura said: “It looks quite big, but it is manageable. And the benefits are great.” Succeed was beneficial not only for the organisation but also for the people working in project management and coordination. It provided a structured approach for implementation and placed the project in a broader context. The application of Succeed allowed a better perspective for assessing the project’s impact, relevance and long-term management. At the same time it highlighted stability and identified future opportunities and needs for change and development.

Experiences and impressions from applying the Succeed tool

By Jarek Cieszkiewicz, Head of Public Health Unit in the Department of Health of the Marshal Office of the Wielkopolska Region, Poznan, Poland

I participated in the European-level training workshops held in Barcelona in April 2014. Right at the start I noticed that the Schiff tool was not very appropriate for the project I intended to evaluate – the regional Voluntary Counseling and Testing centre where I work. The main reasons for this were the small number of stakeholders and partners engaged in the project and the local and very operational character of the project.

This is why I decided to use the Succeed tool instead. In the preparatory phase, and to complement the “questionnaire-like” character of Succeed, I thought that it would be a good idea to also use some elements of Schiff – the population and programme worksheet and the stakeholder snapshot. During the process of filling in Succeed, we started to identify and understand wider aspects of project implementation and the support and response of different partners. It also helped us avoid any biases and distortions thatmight influence it. As you may already presume, I decided that each stakeholder involved in the project had to fill in the questionnaire on their own. Later, we exchanged the information, got acquainted with and discussed our answers together and commented on them to find common ground on changes and areas to be improved. Applying, i.e. filling in the tool itself was not difficult, though it was time-consuming, but this was expected. The construction and contents of the tool are logical and easy to follow and use. It is too early to draw conclusions and implement them but the good thing is that we were able to reach agreement on this.

The most important benefit for me from applying the Succeed tool was to start perceiving stakeholders engaged in the project not only as “beneficiaries of public money” but also as “partners”.

The project “Midterm Check NPHS 2011-2017” using Schiff

By Matthias Gnädinger (Communicable Diseases Unit, Swiss Federal Office of Public Health FOPH), and Daniel Seiler (Managing Director, Swiss AIDS Federation)

Switzerland has a national strategy for prevention as well as diagnosis and treatment of HIV and other sexually transmitted infections, including syphilis, gonorrhoea and chlamydia, amongst others. The National Programme on HIV and other Sexually Transmitted Infections (NPHS) 2011–2017 is based on scientific evidence and was prepared during 2009-2010 with the participation of various stakeholders. The Federal Office of Public Health (FOPH) leads and manages the programme and works closely with other federal departments, cantonal authorities and NGO umbrella organisations.

At the end of June 2014, the halfway point of implementing the NPHS, the FOPH decided to make a provisional assessment of the programme. The results are being used to assess the degree to which goals have been achieved, to guide programme implementation in the second half of the term and to plan for the period after 2017.

The “Midterm Check NPHS 2011–2017” included two sub-projects: In sub-project 2, semi-structured interviews were conducted with 42 experts in the field of HIV and other STI. In sub-project 1, FOPH and the operational stakeholders used the Schiff tool to assess the quality of NPHS 2011–2017. Core element of subproject 1 was a workshop held 2–4 July in the Swiss Jura Mountains, with 23 stakeholder representatives and two consulting experts from Quality Action, Chantal De Mesmaeker from the Luxembourg Red Cross Society and Matthias Wentzlaff-Eggebert from the German Federal Centre for Health Education.

The Schiff questionnaire was shortened and adapted for the Midterm Check for the following reasons: we perceived the original Schiff questionnaire as far too extensive for the provisional assessment of our existing programme. The original questionnaire included some points that were either not relevant for our assessment or not relevant in the Swiss context. Furthermore, for practical reasons, we could not afford to invite stakeholders for a workshop longer than two working days. The FOPH offered board and lodging, but no financial remuneration. To ensure that we could do the whole assessment during the time available, we compromised by shortening and adapting the Schiff questionnaire to our needs and let stakeholders read the questionnaire and prepare some chapters in advance. Stakeholders attended the workshop well-prepared and no time was lost with having to explain the questions first.

The workshop was divided into two groups, regional stakeholders and national stakeholders. They regularly met in plenary sessions to exchange and discuss their results. This approach was interesting because daily business is often very different for regional and national stakeholders . The regular exchanges in plenary sessions showed where broad-based consolidation was possible.

The attendees judged the quality of the programme as a national strategy document as “good”. Respondents did not see any need for adjustments to the NPHS document. In their opinion, the NPHS strategy remains sound. They also indicated that various goals are “permanent tasks” that could not be achieved by a specific date. The question regarding quality and the degree to which goals had been achieved gave rise to a wealth of suggestions and tips for the second half of programme implementation.

In a summary workshop, the results of the two sub-projects were reviewed, discussed and formulated as an briefing report to the Federal Commission for Sexual Health (FCSH), who in turn will prioritise the recommendations for the FOPH and the stakeholders for the second half of programme implementation.

To conclude, we highly recommend Schiff to assess programme quality. Do not be shy to use it as a “set of building blocks” and adapt it to your needs. It is a rather large tool that covers every aspect of the field, making it virtually impossible to overlook anything that might be relevant in developing your programme. In assessing programme quality, however, it might be too extensive on aspects that may not be relevant in your national context.