REDUCTION OF KISWA HCIII NEW OPD ATTENDANTS’ WAITING TIME IN NAKAWA DIVISION, KAMPALA DISTRICT

CQI Fellows 1. Mpaata Owagage 2. Ajuna Albert

A joint effort of MHSDMU/Mak

Supervisors: Dr. Ibrahim Kirunda Dr. Diana Atwine (Institutional)

REDUCTION OF KISWA HCIII NEW OPD ATTENDANTS’ WAITING TIME IN NAKAWA DIVISION, KAMPALA DISTRICT

CQI Fellows Mpaata Owagage

A joint effort of MHSDMU/Mak­SPH and Kiswa HC III staff

Supervisors: Dr. Ibrahim Kirunda Dr. Diana Atwine (Institutional)

Baseline situation

Introduction/Background

Project objectives

Project outcomes

Problem identification

Lessons learnt

Challenges

Problem statement & justification

Next steps

Acknowledgements

Presentation Outline

Problem statement & justification

Presentation Outline

“...of all the hardships a person had to face none was more punishing than the simple act of waiting.” ― Khaled Hosseini, A Thousand Splendid Suns

“...of all the hardships a person had to face none was more punishing than the simple act of waiting.”

A Thousand Splendid

Introduction/Background

• MHSDMU was established in September 2009 by H.E the President.

• A department within State House mandated to Monitor Health Service Delivery in Uganda.

• A good indicator of health service delivery is how long a patient spends at a health unit

Introduction/Background

MHSDMU was established in September 2009 by H.E the President.

A department within State House mandated to Monitor Health Service

A good indicator of health service delivery is how long a patient spends at a

Introduction continued.. Introduction continued..

KISWA HC III

• Located in Nakawa Division of Kampala City in Bugolobi

• Operated by the Health Department of KCCA

Problem identification

• Orientation of Kiswa HC staff in CQI concepts • Selection of CQI team

• Brainstorming •Multi­voted on 8 problem areas •Prioritized “Reducing Patients waiting Time for new patients at the HC in OPD as the problem that needed urgent address.

Problem identification

HC staff in CQI concepts

voted on 8 problem areas Reducing Patients waiting

Time for new patients at the HC in OPD” as the problem that needed urgent address.

CQI Team Brainstorming exercise

Problem Identification Problem Identification

Problem statement & justification

Following a Time and Motion study on new patients’ waiting time in Kiswa HC III, it was found out that: •A patient took an average of 94 minutes at the facility. •This created patients’ dissatisfaction •Some patients would return home unattended to. •In some cases, patients’ conditions would worsen leading to avoidable death

Problem statement & justification

Following a Time and Motion study on new patients’ waiting time in Kiswa HC III, it was

A patient took an average of 94 minutes at

This created patients’ dissatisfaction Some patients would return home

In some cases, patients’ conditions would worsen leading to avoidable death.

Baseline situation

Back to reception to capture patients prescription details

ToPharmacy for Drugs

Exit

Registration Clinical room

KISWA HCIII PATIENTS FLOW CHART

Delays

Baseline situation

Back to reception to capture patients prescription details

ToPharmacy for Drugs

Delays

Time/min

Stations

Baseline Situation Contd Graph showing average patients’ waiting time at the different duty stations at baseline.

Stations

Baseline Situation Contd Graph showing average patients’ waiting time at the different duty stations at baseline.

•On average the facility receives 101 new patients daily in OPD •A new patient takes an average of 94 minutes at the facility. •Clinical room, Lab and Injection room register the longest delays •No duty rosta •No reporting register

Baseline Continued…

On average the facility receives 101 new

A new patient takes an average of 94

Clinical room, Lab and Injection room register the longest delays

Baseline Continued…

TARGET FOR IMPROVEMENT

• The intervention sought to reduce new OPD patients waiting time from 94 minutes to under 30 minutes

TARGET FOR IMPROVEMENT

The intervention sought to reduce new OPD patients waiting time from 94 minutes to

Overall objective was to provide quality and timely health care to all OPD attendants of Kiswa HC III by reducing waiting time from 94 minutes to less than half an hour by July 2012.

Project objectives

was to provide quality and timely health care to all OPD attendants of Kiswa HC III by reducing waiting time from 94 minutes to less than half an hour by

Project objectives

Specific objectives

1. To create a smooth patient flow enabling all OPD attendants to navigate through all the relevant points of care within 30 minutes by July 2012. 2. To increase Kiswa HC III clinical staff levels from 55% to above 70% by July 2012 3. To create an efficient staff duty allocation and support system thereby ensuring maximum output from all staff by July 2012 .

1. To create a smooth patient flow enabling all OPD attendants to navigate through all the relevant points of care within 30 minutes

2. To increase Kiswa HC III clinical staff levels from 55% to above 70% by July 2012 3. To create an efficient staff duty allocation and support system thereby ensuring maximum output from all staff by July 2012 .

ROOT CAUSES

Absenteeism of clinical staff

Long tea breaks by staff

Lack of functional places of convenience forcing staff to go to opposite petrol station for nature calls

Lack of power due to disconnection from outstanding bills causing delays in lab results

Understaffing (clinical staff)

Lack of staff uniform (Patients take long to identify staff)

No signs or direction for patients causing poor patient flow

How waiting time was reduced. EMPLOYED COUNTER MEASURES

•Weekly duty rostas introduced (3) • Info sharing with KCCA leading to warning & transfer of habitual offenders (3)

•Tea and refreshments introduced on site (3)

•Sewerage system unblocked, toilets now functional (3)

•Lobbying KCCA led to all power bills being paid, all lab tests performed on time (1)

• Lobbying led to recruitment of two extra clinical. (2)

• Staff supplied with uniform by MoH after lobbying (1)

•Signage being printed and to be installed when renovations are complete (1)

How waiting time was reduced.

“Nze wadde nviira Nsambya, ennaku zino mpita kuly’enamuwongo nenzijja e’kiswa, omuntu takyamaala’wo budde bungi nga tebamukozeeko,” At Kiswa HC III, 23 rd August, 2012

Project outcomes

“Nze wadde nviira Nsambya, ennaku zino mpita kuly’enamuwongo nenzijja e’kiswa, omuntu takyamaala’wo budde bungi nga tebamukozeeko,” BK, OPD attendant

August, 2012

Project outcomes

Project outcomes

2

65

2.2

42

2

27

3

34

0

10

20

30

40

50

60

70

80

90

100

Reg Clin Drg Cap Lab

Time/Min

Stations

Graph showing average waiting time at baseline vs average waiting time after intervention for the various duty stations

Project outcomes

31

12

94

34

17

11.5

66

Lab Inj RM Pharm TTSP

previous

current

Graph showing average waiting time at baseline vs average waiting time after intervention for the various duty stations

Sample of Introduced weekly duty rostas

Project Outcomes

Sample of Introduced weekly duty rostas

Project Outcomes

Tea and other refreshments now provided on

Project Outcomes

Tea and other refreshments now provided on­site

Project Outcomes

Lessons learnt

•A lot can be achieved through partnerships ­ IDI ,KCCA, MoH, and Mak

•Participatory approaches lead to successful Interventions

•Team work

A lot can be achieved through partnerships IDI ,KCCA, MoH, and Mak­SPH

Participatory approaches lead to successful

Challenges

CHALLENGE

Initial resistance from Kiswa HC III staff

Transfer of CQI team members mid‐ intervention

Some planned activities not implemented due to ongoing unit expansion

Poor cash flow from KCCA could affect intervention sustainability

Challenge­solution matrix

SOLUTION

•Orientation of staff in CQI concepts and motives •Participatory approach

•Co‐opting other HC staff to replace transferred members

•Activities budgeted and to proceed post fellowship.

•Continuous lobbying

Next steps

•Completion of pending activities will likely reduce waiting time further.

•Scale up intervention model to other KCCA lower level units

Completion of pending activities will likely reduce waiting time further.

Scale up intervention model to other KCCA lower level units

Conclusion “...of all the hardships a person had to face none was more punishing than the simple act of waiting.” ― Khaled Hosseini, A Thousand Splendid Suns

Although the intervention did not meet the set target of reducing waiting time to under 30 minutes (68%) by July 2012, we managed to lessen the punishment by an incredible 30%!

“...of all the hardships a person had to face none was more punishing than the simple act of waiting.”

A Thousand Splendid Suns

Although the intervention did not meet the set target of reducing waiting time to under 30 minutes (68%) by July 2012, we managed to lessen the punishment by an incredible 30%!

Acknowledgements

•CQI team at Kiswa HC III •Dr. Ibrahim Kirunda •Dr. Diana Atwine •MHSDMU •Mak­SPH •Sr. Diana •Kiswa HC Staff •Fellow Fellows

Acknowledgements

CQI team at Kiswa HC III

Renovated staff toilets have lessened the distance staff move for nature calls

Photo Gallery

Renovated staff toilets have lessened the distance staff move for nature calls

Photo Gallery

Facility has functional power (patients waiting area with T.V screen) 1 Fully functional laboratory (2)

1

Facility has functional power (patients waiting area with T.V screen) 1

2

1

Photo Gallery

Staff clad in Uniform; with fellow in (2)

2