By Dr Naphtali Agata Consultant (Health Sector) RSU for Africa, JICA Role of 5S-Kaizen/CQI-TQM in Improving Health Sector Governance and Accountability By Dr Naphtali Agata Consultant (Health Sector) RSU for Africa, JICA GAC Regional Health Workshop Nairobi, Kenya March 2011

Presentation Outline Background Introducing 5S-Kaizen/CQI-TQM Applying the 5S-Kaizen Principles Implementation in the Health Sector in Africa

Background: Why Quality Improvement in Provision of Services? A report is lost A long waiting for response to an inquiry A driver is unable to get an officer to attend to an emergency or for mission travel A loss of critical clients A high staff turnover A failing supply chain ................... In a disorganized enterprise….

Introducing 5S Principles "5S" originally developed in the Japanese manufacturing industry in the 1960s Used as a tool for product quality control Stands for five (5) Japanese words that start with the letter 'S‘ with English/French/Swahili equivalents: Seiri （整理） Seiton （整頓） Seiso （清掃） Seiketu （清潔） Shituke （躾） Sort/Séparer /Sasambua Set/Systématiser/Seti Shine/Salubrité/Safisha Standardize/Standardiser/Sanifisha Sustain/Se discipliner, Shikilia

Introducing 5S Principles Structured processes to systematically achieve total organization, cleanliness, and standardization in the workplace It boosts the morale of the workers, promoting a sense of pride in their work and ownership of their responsibilities A gateway to Total Quality Management (TQM) A well-organized workplace results in a safer, more efficient, and more productive operation

Introducing Kaizen/CQI - TQM Kai = further; zen = good Improvement for better – Ongoing: Continuous quality improvement (CQI) Total quality management: a management philosophy that focuses on doing business to satisfy the customer – the person paying for the product (Demand side) satisfy the supplier (of goods and services) continuously improve the business processes

THE 5S-KAIZEN PRINCIPLES APPLYING THE 5S-KAIZEN PRINCIPLES

<1> Sort:. Remove unused stuff from your place of <1> Sort: Remove unused stuff from your place of work and reduce clutter (Separation/Removal) <2> Set: Organize everything needed in proper order for easy operation (Orderliness) <3> Shine: Maintain high standard of cleanliness (Cleanliness) <4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system) <5> Sustain: Train and maintain discipline of the personnel involved (Discipline)

Sort

Used and Unused information…All in a mess.

Sort Needed records are sorted….But…!

<1> Sort:. Remove unused stuff from your place of <1> Sort: Remove unused stuff from your place of work and reduce clutter (Separation/Removal) <2> Set: Organize everything needed in proper order for easy operation (Orderliness) <3> Shine: Maintain high standard of cleanliness (Cleanliness) <4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system) <5> Sustain: Train and maintain discipline of the personnel involved (Discipline)

Seiton - Set Orderliness is all about efficiency Putting everything in its proper order/ location so that it can be Accessed or retrieved quickly Easily returned to the same place Setting items in their proper order leads to Efficient workflow Enhanced productivity Correct place/position should be selected carefully in relation to how work will be done

Sort Set

5-S Labeling and tagging Simple but effective methods 1999 2001 2000 1999 Make Visible A1 A2 Labeling and tagging

After 5-S: Better organized with labeling Improved retrieval time

Retrieval time reduced from 10min to 10 seconds OPD reception at a health centre in Lusaka Set Retrieval time reduced from 10min to 10 seconds

Medical ward before 5s

Medical Ward after 5S

Telephone Desk with list of essential phone numbers

<1> Sort:. Remove unused stuff from your place of <1> Sort: Remove unused stuff from your place of work and reduce clutter (Separation/Removal) <2> Set: Organize everything needed in proper order for easy operation (Orderliness) <3> Shine: Maintain high standard of cleanliness (Cleanliness) <4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system) <5> Sustain: Train and maintain discipline of the personnel involved (Discipline)

Seiso - Shine Cleaning up the workplace and giving it a 'shine‘ Must be done by everyone in the organization (participatory) Clean environment enhances safety and productivity

NO motivation for perfection to cleaning staff …!

Shine: Participatory Your territory can be better arranged and cleaned only with your participation…!

<1> Sort:. Remove unused stuff from your place of <1> Sort: Remove unused stuff from your place of work and reduce clutter (Separation/Removal) <2> Set: Organize everything needed in proper order for easy operation (Orderliness) <3> Shine: Maintain high standard of cleanliness (Cleanliness) <4> Standardize: Set up the above three Ss as part of the routine at every section in your work place (Sort, Set and Shine as a system) <5> Sustain: Train and maintain discipline of the personnel involved (Discipline, Change of Mind-Set)

Seiketsu - Standardise Standardised sorting, setting and clean-up Defining the standards by which personnel must measure and maintain 'cleanliness‘ Encompasses both personal and environmental cleanliness Visual management such as color-coding and standardized coloration of surroundings is an important ingredient of seiketsu

Make slogans visible Standardize

Colour coding applied for visual display

Self-explanatory signboard at entrance of a hospital Enhances Transparency and is client friendly

One of pilot hospitals in Malawi

MATHARI HOSPITAL KENYA MAIN GATE One of pilot hospitals in Kenya with clear directions at entrance 31

Improvements at Mathari Referral Hospital in Kenya

Locations of office equipment designated and labeled

Details attached to each equipment to facilitate handling and use

<1> Sort:. Remove unused stuff from your place of <1> Sort: Remove unused stuff from your place of work and reduce clutter (Separation/Removal) <2> Set: Organize everything needed in proper order for easy operation (Orderliness) <3> Shine: Maintain high standard of cleanliness (Cleanliness) <4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system) <5> Sustain: Train and maintain discipline of the personnel involved (Discipline)

Shitsuke - Sustain Discipline – Positive attitude development Denotes commitment to maintain orderliness and to practice the first 4 S as a way of life  Emphasis is elimination of bad habits and constant practice of good ones  Once true shitsuke is achieved, personnel voluntarily observe orderliness and cleanliness at all times, without having to be reminded by management.

Sustain Improve attitude to learning and practice

One of pilot hospitals in Kenya: Promoting transparency and accountability

24 December 2010

CA Coast Provincial Hospital with Trophies worn 2009 & 2010

In Summary 5S – Kaizen Is a participatory process involving all levels of an organisation (QIT and WIT) Promotes transparency in running affairs of an organisation Facilitates creation of a sense of ownership among the workforce in an organisation Has a focus quality for the customer Promotes efficiency

Implementation of Strategy in Africa Group 1 Countries Implementation started March 2007 Eritrea, Kenya (Mathare Referral and CPG Hospital), Madagascar, Malawi, Nigeria, Senegal, Tanzania (Mbeya Referral Hospital) and Uganda (Tororo Hospital) Group 2 Countries Implementation started in March 2009 Benin, Burkina Faso, Burundi (Prince Regent Charles Hospital, Bujumbura), Niger, Mali, DRC and Morocco

Progress in Implementation Group 1 countries are consolidating implementation of the 5S principles and moving on to Kaizen and national role out Group 2 countries are in the first 3S of implementation In Kenya, the MOMS and MOPHS have developed a Kenya Quality Assurance Model to be implemented using 5S-Kaizen

THANK YOU AHSANTE SANA MERCI