Improving working environment through introduction of 5S-KAIZEN-TQM approaches in public hospitals in Tanzania Hisahiro Ishijma, Japan International Cooperation Agency (JICA) expert, assigned to Ministry of Health and Social Welfare, United Republic of Tanzania Shizu Takahashi, Japan International Cooperation Agency (JICA) expert, assigned to Ministry of Health and Social Welfare, United Republic of Tanzania Dr. Eliudi Eliakim, PMO, Ministry of Health and Social Welfare, United Republic of Tanzania

Background(1) Asia – Africa Knowledge Co-creation Program (AAKCP), Improvement working environment and quality of health services through 5S-KAIZEN-TQM approaches was introduced into 8 African countries, and TZ participated. MRH was selected as pilot hospital for AAKCP. After AAKCP training in Japan and Sri Lanka, 5S was introduced MRH, and successful changed working environment at 6 pilot areas The good practices was reported MoHSW, and MNH was added as another pilot hospital. MRH and MNH good practices were reported, and MoHSW decied to rollout 5S-KAIZEN-TQM approaches to all national and regional referral hospitals since 2008 National guideline for implementation of 5S-KAIZEN-TQM approaches developed in 2009 and revised in 2011 It is now expanded to district hospitals level

National Rollout of 5S approach Situation analysis on QI implementation in the country Implementation guideline development Advocacy poster printing Training materials development Training of master trainers Conduct TOT Biannual Consultation visit (1st Consultation visit is conducted after 6 months TOT) Establishment of QIT In-house training Progress of 5S activities Biannual Progress Report Meeting

National Rollout mechanism Sharing good practice Strengthen implementation through technical advices Obtain knowledge and skills for working environment and Quality service improvement through TOT Progress Report Meeting (PRM) Development to teaching materials and conduct TOT Consultation Visit (CV) Consultation Visit (CV) Development of Implementation guideline Progress Report Meeting (PRM) Revise the guideline based on feedback from TOT, CV and PRM Develop effective training materials through feedback from TOT, CV and PRM

Training of Trainers on 5S approach Outline of TOT Target group Hospital Management Team Regional Health Management Team Council Health Management Team Ministry of Health officials Period of TOT Central/Regional level：5 days District level：3 days Training method Lectures and practical sessions Training venue Hospital that are implementing 5S and KAIZEN well Master trainers Person who participated overseas training on 5S and KAIZEN

Methodology Effect size of 5S TOTs and KAIZEN TOTs , conducted between 2009 to 2011 were verified through results of pre- and post training assessment Situation of 5S and KAIZEN implementation were evaluated at the time of first Consultation Visit.

Effects of 5S-KAIZEN TOT 1) Effects of 5S TOT 2) Effects of KAIZEN TOT Over Δ=.50 as significant (Koizumi & Katagiri, 2007) |.20|≦small<|.50| |.50|<medium<|.80| |.80|≦large

Follow-up after 5S TOT Conduct Consultation visit after 6 months of 5S TOT, and evaluate progress of 5S activities Hospitals trained between 2007 to 2011 were 47. Slow implementation or below the average of progress was observed in 16 hospitals among the 47 hospitals

Follow-up after KAIZEN TOT After 6 months of KAIZEN TOT, progress of KAIZEN activities were monitored in 13 hospitals through Consultation visit. 3 hospitals continue KAIZEN activities and have successful KAIZEN cases 6 hospitals continue KAIZEN activities but no successful KAIZEN cases yet 4 hospitals struggling to practice KAIZEN activities

Correlation between “Leadership” and 5S practices During the Consultation visit, Leadership and progress of sorting, setting, shining, standardizing and sustain activities were evaluated. Positive correlation was observed between “leadership” and “implementation of 5S activities” (R2=0.72036)

Findings Knowledge and skills obtained on 5S-KAIZEN-TQM approaches through Training of Trainers is not always connected with daily practices of 5S-KAIZEN activities. Commitment from hospital management and leadership are the key for successful and sustainable QI program. All hospital practicing 5S-KAIZEN-TQM approaches established QIT and WIT, and structuralize QI program implementation.

Lessons learnt It is important to emphasize the following activities for sustainable practices of 5S activities: Establish functional QIT in hospital Improve training contents on monitoring and evaluation skills. Strengthen internal monitoring and evaluation Supportive Supervision from external organization such as MoHSW, RHMT, or CHMT

Thank you! Any question?