Program of Quality Improvement of Health Services by 5S-KAIZEN-TQM Approach
Nibancho Center Building 5-25, Niban-cho, Chiyoda-ku
1 - Description
Health facilities in developing countries, especially those in African countries are suffering from various problems such as lack of resources, namely medical human resources such as doctors and nurses, medical equipment and materials, medicines, and the monetary fund for operating the facilities, additionally to the lack of information such as patients records, clinical indicator data, and epidemiological data. Such situation is combined with the resignation of the health professionals, the insufficient knowledge and acknowledgement towards the safety of and the rights for the patients on the health professionals’ side, resulting in not being able to provide the health services at a desirable level.
In order to address such situation, Japan International Cooperation Agency (JICA) has launched "Program of Quality Improvement of Health Services by 5S-KAIZEN-TQM” (Hereinafter called “the Program”) in 15 African countries (8 Countries in Group1: Eritrea, Kenya, Madagascar, Malawi, Nigeria, Senegal, Tanzania and Uganda, 7 countries in Group 2: Benin, Burundi, Burkina Faso, Democratic Republic of Congo, Mali, Morocco and Niger) since 2007 to improve the functions of the health facilities by utilizing the Japanese-style quality control method (5S-KAIZEN-TQM) which was developed in the Japanese industrial domain and which is utilized in Japanese hospitals and hospitals in other Asian countries such as Sri Lanka.
Although several programs challenged to improve the quality of hospital services by hospital management methods or procedure, the services would be worsen again after the completion of the program.
For autonomous improvement of hospital services in developing country, it is important to input the hope to hospital staff for better service through maximum utilization of present resources in the hospital. The stepwise approach of 5S-KAIZEN-TQM developed in this sub-program of Asia-Africa Knowledge Co-creation Program (AAKCP) is highly effective to improve the hospital services without huge amount of investment.
In the stepwise approach of 5S-KAIZEN-TQM, the most important feature of the long process to achieve quality health services is described with clearly distinguished three steps and two tracks as the following.
Step 1: Work environment improvement by 5S activities
Step 3 TQM as an approach to make maximal use of the capacity of the entire organization
Track 1: Step up from 5S to TQM via KAIZEN in the hospital
Track 2: National rollout of 5S KAIZEN from pilot
The program is to create new knowledge by collaboration of Asian and African people to improve productivity, safety, quality of hospital care through participatory framework originally developed in Japanese manufacturing industry and further applied in the hospital sector in developing world of Sri Lanka.
2. What is 5S-KAIZEN-TQM Approach
It is the original concept developed under AAKCP. To attain the “Change Management”, the following manufacturing management tools are combined to formulate this concept: “5S (Sort, Set, Shine, Standardize, and Sustain)”, “KAIZEN (Continuous Quality Control, Progressive Improvement)”, and “TQM (Total Quality Management)”.
It is the stepwise approach: 5S step (improvement of workplace), and KAIZEN step (improvement of working process), and it is aimed to create the” Value Co-creation” organization to provide better services, by promoting organizational changes of a hospital, and uplifting the quality of work, safety and efficiency.
3. What is AAKCP
JICA inaugurated an Asia-Africa Knowledge Co-creation Program (AAKCP) in 2005, with a view to the "promotion of Asia-Africa cooperation," an initiative launched by the Government of Japan (GoJ) in the Tokyo International Conference on African Development (TICAD) III held in 2003.
The agency embarked on "Program of Quality Improvement of Health Services by 5S-KAIZEN-TQM Approach” as a sub-program of the AAKCP in March 2007.
This sub-program aim to improve health services with the use of a Japanese-style quality management method, so called 5S-KAIZEN-TQM. The first batch was implemented for eight counties (first group) from March 2007 to November 2008 and second batch is implemented for seven countries (second group) from March 2009 to November 2010. And more, new program for first group is implemented to enhanced 5S-KAIZEN-TQM activities in target countries from September 2009 to 2012.
The program includes the training of health policymakers and pilot hospital managers of African countries (several countries at a time), aiming to make them able to formulate and implement activity plans with an adequate understanding of the concept of 5S-KAIZEN-TQM and higher levels of knowledge and understanding on the method. In the program, the participants draw up plans asă??a part of the training, bring them home, and carry out the planned activities at pilot hospitals in their own countries. Through this process, it helps the target countries introduce and penetrate the 5S-KAIZEN-TQM method.
Proposed new approach is based on the Japanese management tools originally used in industrial sector like Toyota and other companies. In 2000, Castle Street Hospital for Women (CSHW) in Sri Lanka first applied this industrial tool to health sector to decrease the high in-hospital mortality ratio. As a result of introduction of the approach, it reduced the consumption of antibiotics after the decline in nosocomial infections, improved the use of spaces freed up through the disposal of unwanted goods and generated some revenue from the sale of plastic products to recycling operators. The surplus funds raised by these efforts at improve were spent on staff welfare and improvement in the working environment with the launch of an interest-free loans scheme and the provision of workspaces for different occupational functions. These reforms resulted in an increase in those wishing to work in this hospital even though the pay and conditions were no different to those at other medical institutions. It also stimulated the staff to maintain these improved working conditions and cultivated an interest in improvement activities amongst those employees who were indifferent to them. Through this cycle of positive effects, 5S, KAIZEN and TQM activities have gradually taken root as efforts conducted throughout the hospitals.
The changes at CSHW had a huge impact on the conventional management of public hospitals. Public hospitals had been perceived by patients as unsanitary places where they were forced to wait for extended periods. The successful reform has dispelled this conventional image. On the back of these achievements, the Ministry of Health established the Quality Secretariat. And, during the development of the Health Master Plan of Sri Lankan Government, supported by JICA in 2002-2007, this 5S-KAIZEN-TQM approach became recognized as one of the important components of health sector reform. It was decided by the Ministry of health (MOH) to extend the approach to the whole country, and Strategic plan for dissemination was made and being implemented. Now, CSHW became the Center of Excellence of hospital management in Sri Lanka.
The reason for this success is to use bottom up approach “5S” as the base of continuous team approach “KAIZEN”. Because 5S is easy to understand by everybody and the achievement can be appreciated by their own eyes, this work environment improvement activity nurtures positive mindset among the workers and confidence in the team approach, which can empower both by mid-level managers and the front-line work forces.
In 2007, the 5S activities, as the first step out of 5S-KAIZEN-TQM stepwise approach of the program, was applied to 8 African countries, Eritrea, Kenya, Tanzania, Madagascar, Malawi, Nigeria, Senegal and Uganda (Group 1).
At respective country, the 5S activities were, then, installed at each pilot hospital under the support of MOH and foreign experts. Getting the 5S activities well established at pilot hospital, the first phase of the program ended. The second phase was, thereafter, commenced in 2009 for disseminating 5S to the rest of the country and also to upgrade the pilot hospitals’ practice stages from 5S to KAIZEN in all 8 countries.
Having the above ongoing program, a new additional program for another 7 countries, Benin, Burkina Faso, Burundi, Niger, Democratic Republic of Congo, Mali, Morocco (Group 2) was started from the first step of 5S installment to respective pilot hospital.
Currently this 5S-KAIZEN-TQM program for hospitals has been underway in altogether 15 African countries. Already, some African countries, such as Tanzania, have greatly appreciated the effectiveness and efficient aspects of this sub-program. As a result the Tanzanian government has scaled up the 5S-KAIZEN-TQM initiative nationwide. The AAKCP hospital management program will directly and indirectly contribute toward developing and maintaining health-related human resources, as well as strengthening healthcare systems throughout Africa. This new stepwise approach is not only developed and field tested in Sri Lanka but also successfully applied to many developing countries suffering from chronic shortage of health resources.