Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery

Abstract

Background: The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care.

Methods: We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans.

Results: After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program.

Conclusions: We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Fig. 1

Model of Provincial-wide Capacity Building: Staff from the provincial clinic and staff from the Son La People’s AIDS Committee were trained in QI methodology and mentored to develop practical skills through implementation of QI at the Son La clinic by HAIVN staff. The provincial coaching team then provided coordinated clinical coaching and QI coaching to the district HIV clinics located throughout the province

Fig. 2

Quality of Care in Son La Provincial Clinic at baseline (after clinical training and coaching alone), 6 and 12 months after adding a quality improvement coaching program. (* indicates p < .05 compared to baseline, + indicates significance not calculated due to change in indicator definition). ND: Not done. ALT: Alanine aminotransferase

Fig. 3

Quality of Care in Six District Outpatient Clinics coached by the Son La provincial coaching team at baseline, 6 and 12 months after implementation of a provincial QI program (* indicates p < .05 compared to baseline)

Fig. 4

Change in Quality of Care from Final HAIVN-supported measurement through integration into the Vietnam National QI Program in February 2013. (a) Son La provincial hospital (final HAIVN measurement in June 2012) and (b) six district clinics (final HAIVN measurement between June and August, 2012)