This past November, I had the opportunity to visit a
non-profit disabilities hospital called CCBRT in Dar-es-Salaam, Tanzania with some
colleagues from Mozambique. I prepared
a photo album with some lessons from that
visit. CCBRT is applying a set of
management principles called “Lean” that dramatically influenced my thinking on
ways that healthcare delivery could be improved at the community level. Mike Grogan was our host and coordinated
one-on-one meetings with CCBRT’s leadership team over three days. Mike has served as a Lean Management
Consultant to help guide CCBRT through its first two years of a “lean
transformation.” Reflecting on his
experience, he said that he should have “started smaller and slower” and “spent
more time with the leaders” to foster greater capacity and sustainability. I have taken his words to heart and envisioned
the possibilities for the application of Lean in small primary healthcare
settings in Mozambique. Last week,
Dr. Kathleen Walker, Fulbright Professor
at Catholic University, suggested Beira as a possible setting.
Lean
is a set of management principles and tools for continually eliminating waste
and creating value in the process of delivering goods/services to a
customer. It was developed by the
Toyota Motor Corporation during a time of post-World War II reconstruction in
Japan to challenge the global dominance of U.S. mass-production car makers Ford,
General Motors, and Chrysler.
In 1990, a book called "The Machine that Changed the World" presented hard evidence, acquired during a global study by researchers
from MIT, which showed that Toyota’s lean-production system was far superior to
Henry Ford’s widely adopted mass-production system. At the time the book was released, Toyota was half the size
of Ford by volume, but manufactured a greater variety of cars in essentially half
the time, half the space, with half the defects, half the inventory, and half
the workforce per car produced. The
principles of Lean have been transferred into almost every industry, including healthcare.
Over
the last 15+ years, adaptation of the Lean management approach to healthcare systems
throughout the United States, Canada, and Europe has proven to be extremely
successful, with notable examples being ThedaCare in Neenah, Wisconsin and Virginia Mason
Institute in Seattle, Washington. Lean is also applicable to Mozambique’s cultural context
because it fosters organic dialogue and solutions. This helps organizations pursue their unique mission while
retaining core values. It does not
claim to provide an instant “fix”, but Lean does challenge organizations to
continually identify problems and find ways to improve.
Lean’s guiding principles include:
- Developing an attitude of continuous improvement
- Creating value and maximizing limited resources
- Striving for a unity of purpose among all involved
- Respect for the people who do the hands-on work
- Reliance on visual roadmaps and feedback
- Standardization with flexibility to redesign
For
example, a tool for measuring the effectiveness of HIV treatment programs for
the prevention of mother-to-child transmission has been developed by Dr. Sarah
Gimbel and a team of researchers from the University of Washington and Health
Alliance International. Dr. Gimbel
published an article in October 2014 entitled “The
prevention of mother-to-child transmission of HIV cascade analysis tool:
supporting health managers to improve facility-level service delivery.” Researchers tested the
tool in five primary care facilities in Beira. Dr. Gimbel et. al. call for training hospital management
staff to use the cascade analysis tool to identify stages in the treatment
process with the highest drop-off rates and then explore solutions to bolster
retention. The article highlights
a specific case where only 20% of eligible newborns received prophylaxis
therapy. “Lean thinking” would systematically
find out why, through multiple layers of explanations, to uncover the root
cause, make an evidence-based change, and measure the effects for reevalutation. I see a possibility to use the cascade
analysis tool to assess the challenges of a small primary healthcare facility
in Beira and use Lean to find appropriate solutions with the hospital team.
I
regularly communicate with lean practitioners who are involved in international
development efforts and wish to see the application of Lean to healthcare in Mozambique,
including:
- Colin Emerson, Lean Engineer, Cable Quest
- Mike Grogan, Lean Management Consultant, CCBRT
- Robert B. Camp, President, Getting to Lean
- Andrew Parris, Senior Process Advisor, World Vision
- Ken Lake, Finance Manager, Samaritan’s Purse
I have a variety of tools that will be utilized,
such as:
- Work progress tracking
- A3 prioritization grids
- Quality visualization boards
And management exercises, like:
- Gemba walks
- Team-building exercises
- Defining a True North
I
am confident in the power of Lean and my abilities to collaborate with
like-minded colleagues in a small healthcare setting. I recently shared
my proposal with Daniel
Lee and Dr.
Marcelo Castrillo with Abt Associates in Maputo. We agreed that the
Lean approach could help advance some work that Abt Associates has already
begun in Beira. Now, I plan to visit Beira for two weeks to meet with
Mozambican healthcare leaders and seek to form a partnership based on mutual
understanding and trust. If real improvements are made, and we all agreed
to continue collaborating, I believe that we can make a strong start to
improving a facility’s quality of care this year.
If
you are a healthcare professional and would like to learn more, please contact
me by email: Silas.Dickie@gmail.com; or phone: +258
82 291-2329. I would be delighted
to hear from you!