© 2014 2 4. JICAs Approach Clean Hospital Program A part of the contents of this chapter reprints them from the following report of JICA. Thematic Evaluation.

5S-KAIZEN-TQM Approach

in HospitalsWorld Business Associates Co. Ltd., Japan

Director & Senior Consultant

Jun SUGIURA

2 ＷＢＡ©ＷＢＡ 2014

4. JICA’s Approach “Clean Hospital Program”

A part of the contents of this chapter reprints them from the following report of JICA.Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report): http://www.jica.go.jp/english/our_work/evaluation/tech_and_grant/program/thematic/


4. “Clean Hospital Program” in Africa

The Japan International Cooperation Agency (JICA) has conducted the “Program of TQM for Better Hospital Services” since 2007 in 15 African countries and promoted enhanced hospital management and improved hospital service quality by adopting “5S-KAIZEN-TQM Approach” .

(Eritrea, Uganda, Kenya, the Democratic Republic of the Congo, Senegal, Tanzania, Nigeria, Niger, Burkina Faso, Burundi, Benin, Madagascar, Malawi, Mali, and Morocco)

Manufacturers

in Japan

Hospitals in Japan

5S-KAIZEN

Manufacturers in the U. S. A.

TQMHospitals in the U. S. A.

Manufacturers in Sri Lanka

Hospitals in Sri Lanka

Hospitals in Africa

Asia/ Africa Knowledge Co-creation Program (JICA)


4. “Clean Hospital Program” in Africa

This program consists of;1. The African hospital persons and Ministry of Health executives are invited to Japan, or Sri Lanka to have training with an idea of the five S's-KAIZEN-TQM, and to visit the factories and hospitals which five S's-KAIZEN-TQM are applied.2. The participants devise the Action Plan for making organization and an enforcement schedule to carry it out in the pilot Hospital in their own country through the training.3. After going back to their country, the trainees enforce the pilot project and deploy five S's-KAIZEN-TQM in the country.4. Japanese and Sri Lanka’s lecturers will go around each African country to enhance pilot Hospital activity and the quality of health care services through five S's-KAIZEN-TQM, and to deploy the approach more extensive in the future.


5. JICA’s Approach Logic model of “The 5S-KAIZEN-TQM” approach

A part of the contents of this chapter reprints them from the following report of JICA.Thematic Evaluation "Analysis of the Outcome Generating Process of 5S-KAIZEN-TQM Approach in Hospitals" (Final Report): http://www.jica.go.jp/english/our_work/evaluation/tech_and_grant/program/thematic/


5. Logic Model of “the 5S-KAIZEN-TQM” approach

Logic tree for manufacturing companies

5S Activity

Sort Set in order StandardizeShine Sustain

DiscardUnnecessary

items

LabelNecessary

itemsEliminate

contaminationContinue

3SImprovement

education

Cleanwork place

Reduce timefor searching

Raise awareness of staff

Reduce waste of goods

Reduce wasteof facilities

ImproveCost(C)

Improve Productivity

(P)

Improve Quality

(Q)

ImproveDelivery

(D)

ImproveSafety

(S)

Improvement in organizational capacity (team work, capacity for improvement, staff satisfaction)

Increase in profit Increase in customersatisfaction

Continuous developmentof company

ActivitiesD

irect outcomes

Project purposes

Impact

Improve company managementOverallgoals Increase in sales



5S Activity

Sort Set in order StandardizeShine Sustain

DiscardUnnecessary

items

LabelNecessary

itemsEliminate

contaminationContinue

3SImprovement

education

Cleanwork place

Reduce timefor searching

Raise awareness of staff

Reduce waste of goods

Reduce wasteof facilities

Improve management of

drugs/equipment

Improve labor

efficiency

Improve “job”

quality

Prevent hospital

infection

Eradicate medical

accidents

Improvement in organizational capacity (team work, capacity for improvement, staff satisfaction)

Cost reduction Increase in staffsatisfaction

Continuous provisionof public medical service

ActivitiesD

irect outcomes

Project purposes

Impact

Improve hospital managementOverallgoals Increase in patient

satisfaction

Logic tree for hospitals in Africa



On-site project purposes in African hospitals

Overall goal

Continuous provision of public medical service ●Survey on patient satisfactionImpact

Improvement in hospital management

● Survey on patient satisfaction ● Survey on staff satisfaction● Management data● Medical treatment data

(1)Eradicatemedical

accidents

(2)Preventhospital infection

(3)ImproveManagement of

drugs/ equipment

(4) Improve “job” efficiency

(6)Improve organizational

capacity

Continuous reduction of

medical accidents


hospital infection

Continuous improvement in efficiency of inventory and order management

• Continuous reduction of patients’ waiting hours• Continuous reduction of working hours

Continuous improvement in capacity of

voluntary activities

On-site

Projectpurpose

Outcom

e

Continuous improvement in “job” quality

(5)Improve “job” quality

Key Performance Indicators

ＷＢＡ©ＷＢＡ 20149


On-site project purpose in African hospitals

Project purpose in manufacturing

1 Eradicate medical accident Improve safety

2 Prevent hospital infection Improve safety

3 Improve management of drugs and equipment

Improve productivityImprove cost

4 Improve “job” efficiency Improve productivityImprove cost

5 Improve “job” quality Improve quality

6 Improve organizational capacity

Comparison of the project purpose in between African hospitals and manufacturing



ImpactCauseDirect

outcome 1OutputActivityDirect

outcome 2Intermediate

outcome

Prerequisite that 5S-KAIZEN cannot

deal with

5S activity KAIZEN activity TQM

Improve “job” quality

Improve organizational

capacity

Basic structure of the logic model



Improvement in hospital

management Survey on

patient satisfaction with

treatment

Impact

Medical accidents (safety)


medical accidents Ratio of

medical accidents

(No. of cases)

Number of in-hospital accidents

Fewer errors in patients’

information

Easily retrieve proper medical records.Sort patients’ records (S1) and store them according to rules (S2)

Cause OutcomeOutputActivities

Post patients’ information in a place easily seen (e.g. bedside) (S2)

Errors in patient

information

Errors in drugs/

medical device

handling

Sort (discard) unnecessary drugs/ medical devices (S1)

Label on drugs/ medical devices (S2).

Place drugs/ medical devices in predetermined locations (S2).

Deficiency in work

environment

Sort unnecessary items in hospital (S1).

Secure safe passageway and indicate them (S2).

Shine hospital (S3).

Set a rule on sharing patients’ information and follow it (S4).

Set a rule on sharing/ handling drugs/ medical devices and follow it (S4).

Deficiency in medical skills/

knowledge

Education/ training for medical skil ls/ knowledge

Deficiency in equipment

maintenance

Deficiency in drugs/

medical devices

Invest in drugs/ devices; Improve infrastructure

including water/ electricity (fund procurement)

Shine devices (S3).

Set a rule for regular inspection (S4).

Identify patients properly.

Reduce errors in sharing patients’ information.

Less time to retrieve patients’

information

Continuous improvement in

method to identify patients’

information

Easily find necessary drugs/ medical devices

Easily identify proper drugs/ medical devices.

Easily find proper drugs/ medical devices for use.

Reduce errors in sharing/ handling drugs/ medical devices.

Fewer errors in drugs/ medical

devices

Less time to retrieve drugs/

medical devices

Continuous improvement in method to store drugs/ medical

devices


method to handle drugs/

medical devices

Secure more space for easy move.

Reduce touching, catching, and tripping.

Reduce slippery floors.

Fewer accidents in

traveling

Less time for traveling

Continuous improvement in method to travel

in hospital


layout

Easily find abnormalities.

Prevent accident due to abnormality before it happens.

Early detection of abnormal

devices


method to maintain devices

Fields that 5S-KAIZEN cannot deal with

（Direct Outcome 1）（Direct Outcome 2）（IntermediateOutcome ）

Improving “job” quality

Improving organizational

capacity

5S activity KAIZEN activity TQM

Example of logic model for eradicate medical accidents



Example of indicators to eradicate medical accidents

Cause Sample indicator for output Sample indicator for direct outcome Sample indicator for intermediateoutcome

Sample indicator for impact

●Organized files and medical records S1（）● Medical records stored according to rule S2)（

● Patient information posted near the patient S2（）

● Established rules on sharing patient information S4)（●Work performed according to rule S5)（

● Discard of unnecessary drugs/ medical equipmentS1)（

● Labeled drugs/ medical equipment S2（）

●Drugs/ medical equipment stored at designatedplaces S2)（

● Established rules to discard/ store/ handle drugs/medical equipment S4)（

●Discard of unnecessary items in hospital S1)（

● Pathways with safety ensured and directions postedS2)（

● Regular cleaning in hospital S3)（●Predetermined frequency, content, and assignmentof hospital cleaning S4)（

● Regular cleaning/ maintenance of equipment S3)（

● Established rules to inspect equipment S4)（

● Number of close calls●Number of patients falling/ hurting● Number of claims from patients●Frequency of cleaning hospital

Defectivemaintenance of

devices

●Frequency of cleaning/ inspection ofdevices●Number of detected defects inequipment

Error inpatients'

information

●Number of mistaken retrievals ofpatient information●Number of lost information on patients●Average time required to confirmpatient information☆Number of claims from patients●Degree of understanding of staff onhandling rules

Project purpose"Continuous reduction of medicalaccidents"

●Number of medical accidents(per year)●Number of deaths due to medicalaccidents(per year)●Number of malpractices/ medicalnegligences (per year)●Number of implementations of safetymeasures (per year)

Impact"Improvement of hospitalmanagement"

☆Degree of improvement insurvey on patient satisfaction hospital facilities/ medical（treatment）☆Number of patients (per year)☆Occupancy rate of hospitalbeds (per year) （Number of inpatients/total number of beds）●Number of patientsreferred from other hospitals(per year)●Number of medicaltreatments (per year) operations, checkups,（deliveries）

Error in drugs/medical devices

●Number of times disposal was made ofunnecessary drugs/ equipment●Number of mistaken retrievals ofdrugs/ medical equipment☆Average time required to retrievedrugs/ medical equipment●Degree of understanding of staff onhandling rules

Defective workenvironment


6. Quality Improvement of

Medical Devices


Human FactorOrganization for Management Education & Training Management of Operation Management of Moral

Technology/SkillMaintenance Technology Building (Facility) Medical DeviceOperation TechnologyQuality Evaluation Technology

6. Quality Improvement of Medical Devices

KAIZEN/5S

5S:Create spaceCreate timeExpose problemsStandardize operationFollow rulesEducate people

A PDC

Continuous PDCA


Cause Activities Output Outcome

6. Quality Improvement of Medical Devices

Deficiency inWork

environment

Deficiency indevice

maintenance

Deficiency intechnology

/skill

Sort unnecessary items (S1)

Secure safe passageway (S2)

Shine devices (S3)

Set rules for regular inspection (S4)

Bundle and fix cables (S2)

Make habit to follow rules (S5)

Education/Training for technology/skill

Deficiency inSpare parts Invest in spare parts

Secure more space for easy move

Reduce touching, catching and tripping

Reduce cutting cables

Easily find abnormalities

Clarify inspection rules

Rules are followed

Regular inspection is

done

Reduce device troubles

Capable to introduce new

devices

Early repairing is possible

Continuous quality

improvement of

medical devices

Fields that KAIZEN/5S can not deal with

(Logic model)

Improving “job”

quality

Improving organizational

capacity


6. Quality Improvement of Medical Devices(Indicators)

Cause Activities Output Outcome 1 Outcome 2

Deficiency inWork

environment

Sort unnecessary

items (S1)

Number of discarded devices

Number of newly introduced devices

Operation rate of medical devices

Secure safe passageway (S2)

Number of accidents with devices

Bundle and fix cables (S2)

Number of troubles with cables

Number of device troubles

Deficiency indevice

maintenance

Shine devices (S3)

Frequency of cleaning Number of early repair

Set rules for regular inspection (S4)

Number of new rules and revised rules

Implementation rate of the periodic inspection

Make habit to follow rules (S5)

Frequency of regular inspections


7. Conclusion


7. Conclusion

1. KAIZEN is;1) Voluntary bottom up activity by work groups2) Continuous PDCA spiral3) One of tools to improve quality4) Not independent from managers, but depending on manager’s direction5) Easy to begin but difficult to continue active

2. Hospitals in Japan and in the US;1) Should reduce medical cost 2) Should decrease medical accidents 3) Should improve patient satisfaction

3. Key factors of success to introduce KAIZEN are;1) Top manager’s leadership and initiative2) Developing people3) Successful experiences4) Setting measurable indicators


7. Conclusion

4. Japanese hospitals are active on improving;1) Productivity2) Quality

5. The US hospitals are active on improving;1) Quality2) Safety

6. JICA’s “Clean hospital program” in Africa was introduced;1) Example of logic model of “5S-KAIZEN-TQM” was explained2) Table of Indicators for each step of logic model was shown3) It was explained how to use the logic model

7. Logic model for quality improvement of medical devices is proposed.

Thank you for participating in the seminar till the last.

© 2014 2 4. JICAs Approach Clean Hospital Program A part of the contents of this chapter reprints them from the following report of JICA. Thematic Evaluation.

Documents

logic model slide

tqm approach logic tree

program of tqm

jicas approach logic

africa slide

manufacturing slide

morocco slide

tqm approach basic structure