What is COPE?

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What is COPE?

COPE (Client-Oriented, Provider-Efficient services) is a relatively simple technique to improve quality of care. COPE encourages and enables service providers and other staff at a facility to assess the services they provide jointly with their supervisors. Using different types of tools, they identify problems, find the root causes, and develop effective solutions. Although going through this process of self-assessment is not training to perform tasks correctly, it makes the participants aware of good practices. Equally important, the self-assessment approach creates involvement and ownership in the quality improvement process.

COPE is cost-effective and does not involve large investments of time because some activities may be conducted while staff carry out their routine work. It is also results-oriented.

The COPE tools include:

  • A series of self-assessment guides
  • Client-interview guides
  • Client-flow analysis
  • Action plan

How is COPE Implemented?

The first COPE exercise at a site is done over a period of 2-3 days. A facilitator conducts the introduction with site supervisors who, at the same time, learn to facilitate the process so that they will be able to conduct follow-up sessions and also introduce the COPE process elsewhere. The introduction begins with an exercise to define quality services. Asking providers what services they expect for themselves or their families and how they should be provided takes providers beyond abstraction to making quality real.

  • Staff use ten self-assessment guides containing several trigger questions. The guides are based on the clients' rights and providers' needs framework. In larger sites, they break up into teams assessing the services they provide according to one or two guides each. Small sites (fewer than 10 people) may conduct the self assessment over a few weeks along with their regular work, using one or two guides at a time.
  • The client interviews were developed to increase the service providers' understanding of the client perspective. To help providers "break the ice," COPE includes a guide for conducting interviews with clients. (Sites using COPE are increasingly expanding their definition of customers to include non-users of the services and the community overall, and solicit their opinions as well. In addition internal customers--such as fellow workers not participating in the actual COPE exercise--may also be interviewed with the use of the self-assessment guides.)
  • The self-assessment guides and client interviews provide staff with information to identify problems related to the service delivery process and to develop an action plan. Staff identify and state the problems and their root causes, as well as appropriate solutions. The action plan also contains information on assignments of staff to take responsibility for given actions, and dates by when actions will be completed.

Finally, the institutionalization of COPE requires the establishment of a COPE committee. Some organizations have vested this responsibility with already existing committees or teams. As suggested, any type of quality improvement is a long-term process. To nurture this process, it is important to ensure site follow-up and management support.

AVSC's handbook COPE: Client-Oriented, Provider-Efficient Services (1995) is a resource for trained COPE facilitators and site trainers and contains tools and explanations to adapt and facilitate COPE's introduction. More information about this publication is available on the AVSC Publications page.

AVSC has developed additional modules since the publication of COPE in 1995. Recent adaptations of COPE include self-assessment modules covering critical areas in greater detail: Maternal Care, Infection Prevention, Post-Abortion Care, and Sterilization Services. Additional modules are under development.

Return to the Quality of Care page.

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