Preliminary research conducted by the Mexican Institute of Social Security/Solidarity (IMSS/S) and the Quality Assurance Project in Michoacan, Mexico, exposed shortcomings in both interpersonal communication and counseling among supervisors, doctors, and clients. IMSS/S implemented a four month pilot intervention that consisted of participatory supervision and provider self-assessment. During this time, specially trained supervisors added an hour of training on interpersonal communication and counseling (IPC/C) to regular site visits. The instructors utilized job aids and collaborated closely with the doctors they were overseeing. After having received training on IPC/C improvement methods, doctors began to periodically audio-tape and conduct self-assessments during their own consultations in order to analyze the quality of service they were providing to patients. A paper was subsequently developed to describe details of the intervention, which included form templates.

The Quality Assurance Project used three indicators to evaluate the impact and quality of the IPC/C pilot intervention, which included the following criteria:

• Providers' facilitative and informative communication
• Patients' communication

A post-intervention analysis of 60 doctors was conducted, which revealed that facilitative and informative communication per consultation was significantly higher in the program group of doctors (48.0 and 16.6, respectively) than it was by members of the control group (30.0 and 16.6, respectively). An in-depth examination of 28 doctors exposed that while both groups improved considerably during the study, more significant gains were obtained by the program than the control group for both types of provider communications. That said, the largest observed discrepancy was in regards to the level of facilitative communication between the two groups. Very little variation between program and control groups in patient communication was discovered.

Improvements resulted from the combination of intervention activities, and doctors valued the outcomes of the study. Specifically, they endorsed the adoption of a more supportive relationship with supervisors and indicated that listening to themselves on tape enabled them to assess and improve upon their communication with patients. Concluding results show that both supportive supervision and self-assessment activities reinforce IPC/C training, while also encouraging doctors to both reflect upon and strengthen their interpersonal communication skills.