SAIA step | Description | Frequency and location | FP clinic role | Facilitation |
---|---|---|---|---|
Cascade analysis tool | Excel-based system for quantifying and displaying the number of individuals who complete each step of a process to identify where improvement may be needed | Monthly SAIA meetings at clinics in the intervention arm | Clinic managers review the results of the cascade analysis monthly with study staff facilitators (Stage 1) or DOHS facilitators (Stage 2) | Facilitators populate the cascade analysis tool, and review results with FP clinic staff. Facilitators were study staff in Stage 1, DOHS staff in Stage 2. |
Sequential process flow mapping | Drawn map of clinic processes and client movement through clinics to identify modifiable bottlenecks in their workflow for HTC | At initial training and at monthly SAIA meetings at clinics in the intervention arm | FP clinic staff draw the map of their specific clinic flow | Facilitators trained FP clinic staff and oversaw process mapping. |
Micro-intervention setting | Identification of workflow modifications (termed “micro-interventions”) that clinic staff implement during the following month chosen to address clinic-specific barriers to implementing HTC | Monthly SAIA meetings at clinics in the intervention arm | FP clinic managers develop a micro-intervention that addresses a problem specific to their clinic, then implement that change over the following month. | Facilitators assist in developing ideas for feasible micro-interventions. |
Micro-intervention assessment | Micro-intervention chosen in the previous monthly SAIA meeting is assessed to determine if it was (a) successfully implemented, (b) effective in improving HTC, and (c) if the micro-intervention should be adapted, adopted, or abandoned. | Monthly SAIA meetings at clinics in the intervention arm | FP clinic managers report on how successfully the micro-intervention was implemented, and decide if it should be adapted, adopted, or abandoned. | Facilitators provide HTC updates based on the Cascade Analysis Tool and assist FP clinic managers in decision making on next steps. |
Iterative refinement | All previous steps are repeated at monthly SAIA meetings, where previous micro-interventions are reviewed, and new ones are chosen. | Monthly SAIA meetings at clinics in the intervention arm | FP clinic managers meet with facilitators and are prepared to review previous micro-interventions and set new ones. | Facilitators arrange SAIA meetings and attend monthly. |