Seventeen years ago, Jhpiego began integrating several quality improvement processes to improve the performance of frontline health care workers. This practical management approach is widely known today as Standards-Based Management and Recognition (or SBM-R®)—Jhpiego’s team-based change management methodology.
SBM-R consists of four simple steps:
- Set clear and simply worded performance standards with observable benchmarks;
- Implement the standards through a systematic process, watch for performance gaps and develop corrective action plans to address gaps;
- Use a team-based approach to measuring progress that motivates transformation and adoption of corrective action plans; and
- Celebrate by rewarding achievements through agreed-upon recognition mechanisms.
SBM-R applies a systems approach. It does not work on isolated problems but rather on specific aspects of service delivery, making it possible to achieve broad and sustainable improvements. Jhpiego has applied SBM-R to improve services in 30 countries and in a range of technical areas—maternal and newborn care, infection prevention, cervical cancer prevention, and a full array of HIV/AIDS and infectious disease services. Countries such as Malawi, Mozambique and Afghanistan have utilized SBM-R on a national scale and have sustained its implementation for more than five years.
By starting with simple interventions and then moving on to more complex problems, Jhpiego has documented results of SBM-R that range from improving cleanliness of facilities, increasing infection prevention practices and promoting respectful patient care, to more challenging issues such as improving evidence-based practices to prevent maternal and neonatal morbidity and mortality, assuring quality of HIV prevention and treatment services, and improving pre-service education and health management systems.
An example of the effects of SBM-R on service performance and results helps to illustrate the effectiveness of the approach. In Mozambique, 80 maternity facilities are participating in a quality improvement process using SBM-R. The figure below shows the results for 28 maternities for which data were available: as compliance with recommended standards for preventing postpartum hemorrhage (PPH) and severe pre-eclampsia and eclampsia (SPE/E) improved, health care workers increased the practice of active management of the third stage of labor (AMTSL), a method of preventing PPH.And, more important, the graph shows that maternal deaths decreased in these same facilities.