Measuring the quality of supervisor-provider interactions in health care facilities in Zimbabwe.

OBJECTIVE Measuring performance is the first step on the road to improving it. This report presents the results of an exploratory study sponsored by the Quality Assurance (QA) Project to describe and quantify the quality of supervisor-provider interactions in health care facilities in Zimbabwe in 1999. Supervisors were district and municipal nursing officers who are responsible for guiding, assisting, and motivating health providers at government and missionary health facilities. DESIGN The study's design was qualitative. It involved the triangulation of data from various sources: structured observations of supervisors, audiotaping of supervisor-provider interactions, recording of all supervisory activities, and interviews with supervisors and supervisees. A team composed of current and past supervisors, along with researchers, determined the supervisory practices that would be measured. STUDY PARTICIPANTS Sixteen district-level government, municipality, and Zimbabwe National Family Planning Council supervisors from four provinces participated in the study. RESULTS The study found that supervisors devoted <5% of their time to patient care issues. The supervisors' main strengths were in giving feedback on technical standards, discussing and analyzing data, and developing a rapport with the providers. They were most deficient in making suggestions, seeking client input, problem solving with the providers, and building on previous (and future) supervisory visits. None of the supervisors observed achieved the threshold set in advance by the team for exemplary performance. CONCLUSION The study concludes with recommendations to the Ministry of Health and Child Welfare on how the quality of supervision in Zimbabwe could be improved.