15. Online Project Nomination Form
Email Address
asai.makoto@jica.go.jp
FromNatGov
on
NameOfGroup
Japan International Cooperation Agency
NameOfFocalPoint Makoto Asai
Title
Program of Quality Improvement of Health Services by 5S-KAIZEN-TQM
Approach
StreetAddress
Nibancho Center Building 5-25, Niban-cho, Chiyoda-ku
City
Tokyo
StateProvReg
Tokyo
Country
Japan
PostalCode
102-8012
PhoneBusiness
+81352269173
PhoneMobile
PhoneFax
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-KAIZENTQM) 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.
1. Introduction
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 2: KAIZEN activities for participatory problems solving in the service
front
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.
4. History
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 5SKAIZEN-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.
2 - MainPartners
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3 - Achievements
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4 - Sustainability
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5 - Innovation
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6 - Replicability
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7 - Contribution
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8 - Awareness
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9 - Other
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