Paving a Road for Improved Referral Systems in Zambia

June 30, 2016  | Zambia  | Carlo Abuyuan, LIFT II Leland Fellow; Cheryl Tam, LIFT II Knowledge Management Officer

Globally, LIFT is incorporating quality improvement (QI) concepts into existing referral work in order to more formally identify gaps, adopt changes and track progress towards improvement. In June 2016, the Mkushi District Referral Network (MDRN) kicked off QI integration in Zambia by holding the first of three planned quarterly collaborative workshops. While LIFT’s approach to supporting referral network implementation has always included an iterative element—allowing for experience and knowledge gained across sites to bring to light best practices and lessons learned—this was the first instance of formally instituting QI into these networks.

Even though many concepts introduced during the workshops were new, stakeholders were able to apply the QI approach to their own role and work in the referral system.

Even though many concepts introduced during the workshops were new, stakeholders were able to apply the QI approach to their own role and work in the referral system.

 

From the June 13-17, LIFT trained a total of 55 volunteers from 22-LIFT-supported health facility and service provider partners in various QI concepts as well as how the QI process can be applied to strengthen MDRN referral work. The training was planned for 4 days with participants divided into two groups—the first group comprised the volunteers from partners and facilities in and near Mkushi while the second group was to cater for participants in facilities further away from Mkushi Town. LIFT led the participants through a series of participatory sessions that reviewed current referral approaches in Mkushi to help members collectively identify weak or inefficient steps to target for improvement. Referral partners learned how to visualize complex processes by creating fishbone diagrams and flowcharts. The second day focused on developing SMART (specific, measureable, assignable, realistic, time-related) QI aims, forming QI teams responsible for specific aims, creating QI change packages for each aim, and a discussion of QI data needs. Eight total QI aims were formulated (4 from each training group) with accompanying change packages. Progress towards achieving these aims will be tracked over the next quarter, and LIFT will hold the second quarterly QI workshop in September 2016.

Workshop sessions were highly participatory and included a mix of small group and individual work as well as larger group activities.

Workshop sessions were highly participatory and included a mix of small group and individual work as well as larger group activities.

 

For most of the network members, QI was at first a foreign concept; however, as the training unfolded, many began to recognize that QI was not as complex as first thought, and that simple examples helped them relate QI to their everyday lives. Because members came into the training with different understandings of referral networks based on their specific contexts, it was important to first clarify and share referral network experiences. Members then used this information to create a consolidated referral network process, outlying potential problem areas that might hinder their goals.

An example of a referral flow chart developed by one of the groups.

An example of a referral flow chart developed by one of the groups.

Two of the major challenges faced by referral network members in Mkushi include the long distances between one another and varying operating contexts based on existing service providers or resources available. Because of this, referral volunteers (RVs) and volunteer field supervisors (FSs) often work in silos restricted to their respective catchment areas. Though volunteers at each clinic have discovered their own ways to address challenges, they have not been given enough opportunities to discuss with others in the network to potentially improve referral network operations overall. The facilitation team took advantage of this gathering of both RVs and FSs as an opportunity to facilitate dialogue between the counterparts with regards to referral approaches as well as to highlight communication gaps. This workshop gave them a forum to discuss challenges, learn from each other and come up with aims guided by data to reach their ultimate goal, to improve the health and economic outcomes of vulnerable populations through referral linkages.