Background: The Lean-Kaizen approach of implementing patient-centered systems change by reducing waste and adding value has been widely used in health systems in the US to provide incremental process improvement. This approach to streamlining health care processes has been under-utilized in resource-poor regions of the world, even though the Lean-Kaizen approach was developed in under-resourced post-war Japan. We piloted the use of Lean-Kaizen methodology in a health system in a remote tribal region of Southern India to improve quality of care in a region with severe resource constraints.
Purpose: To determine whether a brief Kaizen intervention can catalyze change in three distinct departments after 90 days in an under-resourced tribal health system in Sittilingi, India.
Description: We worked with staff at the Tribal Health Initiative in rural Sittilingi, India, a 24-bed hospital and outpatient department that serves an impoverished population of approximately 20,000 with a large burden of infectious and non-communicable diseases. A day-long Kaizen workshop was run by the director of the Kaizen Institute of India, and sixteen staff members from the Tribal Health Initiative were present, including the head physicians, head nurse, and all section managers. After participants were taught basic Lean principles, the group was divided into three teams, representing the outpatient department (OPD), the medical ward, and the pharmacy.
Each team spent one hour collectively observing and identifying deficiencies in each area, and developed a list of the highest-priority challenges that needed to be addressed. Subsequently, the larger group re-convened, and the deficiencies identified were discussed. The group identified one specific quality improvement goal in each department. For the OPD, long patient wait times were identified, for the medical ward, equipment failure was identified, and for the pharmacy, lack of medication verification was identified. Subsequently, the head physicians organized workgroups for each focus area, and every two weeks, email updates were circulated about the activities related to each area. After 90 days, the status of each area was reviewed.
The inpatient team had outlined a chain-of-command for reporting equipment failure on the medical wards, and had implemented a policy for checking ward equipment every two weeks and contacting the appropriate person for equipment failure. The OPD team identified that the major cause of high wait times for outpatients was linked to physician schedules that prioritized inpatient rounds over outpatient visits. A rotating schedule assigning one physician to act as “primary ward attending” and one as “primary OPD attending” was created by the team to decrease OPD wait times. The pharmacy team had created a simple verbal call-back system between pharmacy staff members ensuring that the medications being handed to patients matched the medications listed on the prescription.
Conclusions: A brief Lean Kaizen teaching session coupled with concrete goals in a 90-day timeframe are effective at catalyzing change for quality improvement in resource-poor settings.