A Guatemalan Nurse Works for Better Staff Performance—and Better Services for Patients

This post was originally published on the IntraHealth International blog. With funding from USAID’s LAC Bureau, CapacityPlus also provides technical assistance to strengthen the health workforce in HIV commodities security in countries in the Latin American and Caribbean region.

“I like providing support and care to patients,” says Rosa Lara de Forela, the subdirector of nursing at the Pedro de Bethancourt National Hospital in beautiful Antigua, Guatemala. “The most satisfying thing I’ve found in my profession is giving direct attention to each of the patients that I encounter in the different departments of the hospital. I like to serve mankind. That’s my passion.”

Rosa’s sentiment is echoed by countless health workers. Why else would so many commit their lives to such a demanding, challenging, and often underappreciated profession, if not for their desire to serve others?

IntraHealth’s USAID|Central America Capacity Project (CAMCAP) strives to empower health workers to better serve communities in need by marrying that passion to the necessary technical support. This way, we can promote high-quality clinical care, particularly for people living with HIV.

CAMCAP has been collaborating with ministries of health and social security institutes in 58 hospitals in five Central American countries since 2009—Belize, Costa Rica, El Salvador, Guatemala, and Panama.

In Guatemala, CAMCAP worked with the Ministry of Health and the National AIDS Program in 15 hospitals to apply IntraHealth’s Optimizing Performance and Quality (OPQ) methodology, which systematically analyzes the performance of health workers, organizations, and systems. This helps to establish appropriate interventions that improve health service performance and quality, as well as to build on program strengths and successes.

OPQ teams made of managers, supervisors, and health workers work with CAMCAP staff to develop an evaluation plan for each hospital and integrate it into workplace processes. The plans serve as ongoing feedback devices for workers and managers to measure changes in performance and quality.

Rosa’s hospital was one of the most successful in Guatemala in applying the OPQ methodology. CAMCAP helped the hospital to reduce stigma and discrimination for clients with HIV and improve waste management and biosafety, all through holistic changes to organizational systems, incentives, tools, the physical environment, staff skills and knowledge, and individual attributes.

Through the commitment and hard work of its staff, Bethancourt Hospital has become a model hospital and a best-practice example of the successful application of OPQ. From 2010 to 2012, Bethancourt Hospital and its staff have achieved a 114% increase in its overall performance, from 34% at baseline in 2010 to 73% at the third measurement in 2012.

As the head of all nursing staff in Bethancourt, Rosa has modeled excellent leadership within the OPQ team. She not only motivated and supervised staff to increase their hand-washing, but also managed donations of soap and paper towels to the hospital.

And after the OPQ team identified the need to ensure that clients with HIV do not experience stigma and discrimination from health workers, Rosa made sure new staff orientations and in-service trainings would address those issues.

Overall, Rosa has helped the hospital’s health workers to be more motivated, confident, and optimistic about their work.

Client satisfaction was another performance-improvement factor that Rosa’s team identified, so CAMCAP worked to help health workers improve patient care through ensuring patient privacy and confidentiality, calling patients by their names and tending to physical discomforts more quickly.

Rosa often goes a step further. “When I go to different hospital departments and I encounter a patient who has physical but also emotional problems, I like to provide emotional support,” she says. “I like to talk with them, help them spiritually too, not just physically. Direct care is what I like the most.” 

Rosa is particularly sensitive to performance and quality issues for her fellow nurses. By the direct nature of their work and their sheer number, nurses can have the greatest impact in closing performance gaps.

Guatemala and countries around the world need more health workers who, like Rosa, value a more holistic approach to care and are passionate about the work they do. IntraHealth looks to build on these strengths and give health workers the tools and support they need to find and solve their own challenges.

Amanda Puckett interviewed Rosa for the CapacityPlus “I’m a Health Worker” video series.

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