TY - JOUR T1 - Three Pivots for Improving Health Care Provider Performance JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00625 VL - 10 IS - 1 SP - e2100625 AU - Julia Bluestone AU - Erica Troncoso AU - Laura Fitzgerald AU - Lauretta Nagbe AU - Gladys Tetteh AU - Augustino Hellar AU - Edwin Ernest Y1 - 2022/02/28 UR - http://www.ghspjournal.org/content/10/1/e2100625.abstract N2 - The first pivot involves shifting from focusing on using data primarily for reporting purposes. Encouraging team members within facilities to regularly use their own data to track, review, and measure priority quality indicators promotes the quality improvement process and can improve service delivery outcomes.The second pivot involves shifting from focusing on repeated, external, quality assurance assessments, often from the district or subnational level, to using facility team-based internal service delivery indicator data reviews to implement quality improvement efforts based on these data.These pivots toward health care provider and facility manager ownership of the quality improvement process also lead to the third pivot, which involves shifting from one-time, group-based training toward workplace-based educational interventions. Team involvement in interpreting their facility data can lead to identifying targeted team-based learning needs and the potential need for individual mentoring.Many countries invest large portions of their health budgets on standalone, in-service training to enhance skills and performance of health care providers followed by repeated external supportive supervision visits, which often find similar challenges and gaps and result in a low return on investment. An increasing body of evidence points to the limitations of traditional training and supportive supervision to improve performance. A 2016 review of nationally representative surveys in 7 sub-Saharan Africa countries that examined the association of in-service training and supervision with provider quality in antenatal and sick child care found these traditional interventions were associated with only modest improvements.1 Similarly, a recent update to a landmark literature review on interventions to improve health care provider performance in low- and middle-income countries (LMICs) found that workplace-based mentorship, clinical practice, and training each had a more positive impact on performance compared to in-service training alone.2 Despite this evidence, group-based training and supportive supervision continue to serve as the default interventions … ER -