How A Japanese Philosophy Can Improve Maternal Health Care in Kenya

What do a local food bank in Seattle and a Japanese corporate philosophy have in common with Jacaranda Health’s maternity hospitals in Nairobi? Good question.

When we saw today’s article in the Seattle Times, the city’s daily newspaper, “Japanese philosophy yields good changes at food bank.” , we knew we had to read it because that Japanese philosophy, known as “Kaizen”, is the same one Jacaranda Health employs within our own maternity hospitals to offer the highest quality care to the women and families we serve. What is Kaizen? According to the article the corporate philosophy first used in the United States by Toyota “emphasizes continuous improvement through small changes.”  In other words, it’s a method that relies on small, continuous improvements on everyone’s part (all employees) to boost productivity, safety, and effectiveness while reducing waste (wasted time, wasted space, wasted resources, etc.).KahawaWest_ExamRoom

As the article notes, “The food bank needed a system, one that maximized efficiency, speed and customer service but required very few resources.”

You can see now how this might be extremely useful in healthcare settings, right? In fact, it is standard in many US-based hospitals but Jacaranda Health’s Executive Director, Nicholas Pearson, realized that by bringing this Japanese philosophy to bear on health care in low-resource settings like Kenya, extraordinary things might be possible.

Jacaranda Health is on a mission to improve the quality of maternal health care in Kenya to help as many women and newborns get through pregnancy, childbirth, and postpartum safe and healthy. Though maternal mortality rates are decreasing globally — including in sub-Saharan Africa where the majority of maternal deaths occur — we still have a long way to go. Eight-hundred women die every day from complications related to pregnancy and childbirth. Most of these deaths are preventable; especially by improving the quality of care within health faciliites where, in urban areas in particular, increasingly more women are birthing.

After hiring Eric Wachira from Kenya Airways, as Jacaranda Health’s Quality Improvement Lead, we set to work on assessing how to incorporate quality improvement measures into our own hospitals from the way an operating theatre is set-up (to encourage ease of flow), and standardizing where each and every instrument is placed to demarcating the rooms, removing all clutter, and organizing workspaces. But we also look to the ways certain systems are organized: are the days “flowing” efficiently so that women aren’t waiting too long for appointments? So that individual appointments flow? Are forms standardized appropriately? No stone is left unturned in the quest to identify how to ensure high-quality, patient-centered care at a low-cost through continuous improvement.

Knowles-Coursin_Jacaranda14Even a few seconds of saved time and saved energy adds up to tremendous overall benefits to the organization. Take the food bank in in Seattle, for example. Back in Seattle, the Rainier Valley Food Bank first addressed it’s “meat station” where meat was stored for its customers in an ill-advised old freezer which staff continuously feared would break down from overuse when people served themselves. As well, its position in the back of the room stressed customers out because they could see people taking the meat and feared there would be nothing left by the time they got to the station.

By moving the meat to a “repurposed walk in freezer” and moving the station to the front of the room, it saved every guest 45 seconds. It may not sound like a lot but notes the article, “when multiplied by the 538 people who passed through the 1200 square foot warehouse last Saturday” it’s a significant time-saver.

At Jacaranda Health, we don’t just incorporate our continuous quality improvement into the operations of our two maternity hospitals on the outskirts of Nairobi. We also package them to share with other facilities. Last year, the Kenyan government visited Jacaranda’s Ruiru Hospital, impressed by our outstanding Level 3 Safecare accreditation (quality rating). They asked us to train health leadership at three of their district and sub-district hospitals, as well. In 2015, we are working with health care leaders and workers within these facilities sharing how relatively simple improvements can make a big difference in quality, safety, and satisfaction for clients. Sometimes the benefits happen quickly: removing unnecessary items from a workspace may immediately improve the speed by which staff can find particular items. However, even though these systems and tools for change are powerful, change takes time.

Jacaranda Health is creating tools for better day-to-day clinical quality as we embed a culture of quality into our operations. What this means for women and newborns in Kenya is that we’re working to ensure they receive the highest quality maternity care, from the most well-trained nurse midwives and other care providers, no matter where they receive that care.

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