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
