© JICAs Approach Clean Hospital Program A part of the contents of this chapter reprints them from the following report of JICA. Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report):

© Clean Hospital Program in Africa The Japan International Cooperation Agency (JICA) has conducted the Program of TQM for Better Hospital Services since 2007 in 15 African countries and promoted enhanced hospital management and improved hospital service quality by adopting 5S-KAIZEN-TQM Approach. (Eritrea, Uganda, Kenya, the Democratic Republic of the Congo, Senegal, Tanzania, Nigeria, Niger, Burkina Faso, Burundi, Benin, Madagascar, Malawi, Mali, and Morocco)

© Clean Hospital Program in Africa This program consists of; 1. The African hospital persons and Ministry of Health executives are invited to Japan, or Sri Lanka to have training with an idea of the five S's-KAIZEN-TQM, and to visit the factories and hospitals which five S's-KAIZEN-TQM are applied. 2. The participants devise the Action Plan for making organization and an enforcement schedule to carry it out in the pilot Hospital in their own country through the training. 3. After going back to their country, the trainees enforce the pilot project and deploy five S's-KAIZEN-TQM in the country. 4. Japanese and Sri Lankas lecturers will go around each African country to enhance pilot Hospital activity and the quality of health care services through five S's-KAIZEN-TQM, and to deploy the approach more extensive in the future.

© JICAs Approach Logic model of The 5S-KAIZEN-TQM approach A part of the contents of this chapter reprints them from the following report of JICA. Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report):

© Logic Model of the 5S-KAIZEN-TQM approach Logic tree for manufacturing companies

© Logic Model of the 5S-KAIZEN-TQM approach Logic tree for hospitals in Africa

© Logic Model of the 5S-KAIZEN-TQM approach On-site project purposes in African hospitals

© Logic Model of the 5S-KAIZEN-TQM approach On-site project purpose in African hospitals Project purpose in manufacturing 1Eradicate medical accidentImprove safety 2Prevent hospital infectionImprove safety 3Improve management of drugs and equipment Improve productivity Improve cost 4Improve job efficiencyImprove productivity Improve cost 5Improve job qualityImprove quality 6Improve organizational capacity Comparison of the project purpose in between African hospitals and manufacturing

© Logic Model of the 5S-KAIZEN-TQM approach Basic structure of the logic model

© Logic Model of the 5S-KAIZEN-TQM approach Example of logic model for eradicate medical accidents

© Logic Model of the 5S-KAIZEN-TQM approach Example of indicators to eradicate medical accidents

© Quality Improvement of Medical Devices

© 2014 Human Factor Organization for Management Education & Training Management of Operation Management of Moral Technology/Skill Maintenance Technology Building (Facility) Medical Device Operation Technology Quality Evaluation Technology 6. Quality Improvement of Medical Devices KAIZEN/5S 5S: Create space Create time Expose problems Standardize operation Follow rules Educate people Continuous PDCA

© 2014 Cause ActivitiesOutputOutcome 6. Quality Improvement of Medical Devices Deficiency in Work environment Deficiency in device maintenance Deficiency in technology /skill Sort unnecessary items (S1) Secure safe passageway (S2) Shine devices (S3) Set rules for regular inspection (S4) Bundle and fix cables (S2) Make habit to follow rules (S5) Education/Training for technology/skill Deficiency in Spare parts Invest in spare parts Secure more space for easy move Reduce touching, catching and tripping Reduce cutting cables Easily find abnormalities Clarify inspection rules Rules are followed Regular inspection is done Reduce device troubles Capable to introduce new devices Early repairing is possible Continuous quality improvement of medical devices Fields that KAIZEN/5S can not deal with (Logic model) Improving job quality Improving organizational capacity

© Quality Improvement of Medical Devices (Indicators) CauseActivitiesOutputOutcome 1Outcome 2 Deficiency in Work environment Sort unnecessary items (S1) Number of discarded devices Number of newly introduced devices Operation rate of medical devices Secure safe passageway (S2) Number of accidents with devices Bundle and fix cables (S2) Number of troubles with cables Number of device troubles Deficiency in device maintenance Shine devices (S3) Frequency of cleaningNumber of early repair Set rules for regular inspection (S4) Number of new rules and revised rules Implementati on rate of the periodic inspection Make habit to follow rules (S5) Frequency of regular inspections

© Conclusion

© Conclusion 1. KAIZEN is; 1) Voluntary bottom up activity by work groups 2) Continuous PDCA spiral 3) One of tools to improve quality 4) Not independent from managers, but depending on managers direction 5) Easy to begin but difficult to continue active 2. Hospitals in Japan and in the US; 1) Should reduce medical cost 2) Should decrease medical accidents 3) Should improve patient satisfaction 3. Key factors of success to introduce KAIZEN are; 1) Top managers leadership and initiative 2) Developing people 3) Successful experiences 4) Setting measurable indicators

© Conclusion 4. Japanese hospitals are active on improving; 1) Productivity 2) Quality 5. The US hospitals are active on improving; 1) Quality 2) Safety 6. JICAs Clean hospital program in Africa was introduced; 1) Example of logic model of 5S-KAIZEN-TQM was explained 2) Table of Indicators for each step of logic model was shown 3) It was explained how to use the logic model 7. Logic model for quality improvement of medical devices is proposed. Thank you for participating in the seminar till the last.