5S*KAIZEN-TQM

Improving working environment
through introduction of
5S-KAIZEN-TQM approaches in public
hospitals in Tanzania
1.
2.
3.
Hisahiro Ishijma, Japan International Cooperation Agency (JICA) expert,
assigned to Ministry of Health and Social Welfare, United Republic of
Tanzania
Shizu Takahashi, Japan International Cooperation Agency (JICA) expert,
assigned to Ministry of Health and Social Welfare, United Republic of
Tanzania
Dr. Eliudi Eliakim, PMO, Ministry of Health and Social Welfare, United
Republic of Tanzania
Background(1)
• Asia – Africa Knowledge Co-creation Program (AAKCP),
Improvement working environment and quality of health services
through 5S-KAIZEN-TQM approaches was introduced into 8 African
countries, and TZ participated.
• MRH was selected as pilot hospital for AAKCP.
• After AAKCP training in Japan and Sri Lanka, 5S was introduced
MRH, and successful changed working environment at 6 pilot areas
• The good practices was reported MoHSW, and MNH was added as
another pilot hospital.
• MRH and MNH good practices were reported, and MoHSW decied
to rollout 5S-KAIZEN-TQM approaches to all national and regional
referral hospitals since 2008
• National guideline for implementation of 5S-KAIZEN-TQM
approaches developed in 2009 and revised in 2011
• It is now expanded to district hospitals level
National Rollout of 5S approach
•
•
•
•
•
•
•
Situation analysis on QI implementation in the country
Implementation guideline development
Advocacy poster printing
Training materials development
Training of master trainers
Conduct TOT
Biannual Consultation visit (1st Consultation visit is
conducted after 6 months TOT)
– Establishment of QIT
– In-house training
– Progress of 5S activities
• Biannual Progress Report Meeting
National Rollout mechanism
Obtain knowledge and skills
for working environment and
Quality service improvement
through TOT
Development
of
Implementati
on guideline
Revise the
guideline based
on feedback from
TOT, CV and
PRM
Development
to teaching
materials and
conduct TOT
Develop effective training
materials through feedback
from TOT, CV and PRM
Sharing good practice
Progress
Report
Meeting
(PRM)
Strengthe
n
implement
ation
through
technical
advices
Consultation
Visit (CV)
Consultation
Visit (CV)
Progress
Report
Meeting
(PRM)
Training of Trainers on 5S approach
Outline of TOT
Target group
•
•
•
•
Hospital Management Team
Regional Health Management Team
Council Health Management Team
Ministry of Health officials
Period of TOT
• Central/Regional level：5 days
• District level：3 days
Training method
Lectures and practical sessions
Training venue
Hospital that are implementing 5S and KAIZEN well
Master trainers
Person who participated overseas training on 5S and
KAIZEN
Methodology
1. Effect size of 5S TOTs and KAIZEN TOTs ,
conducted between 2009 to 2011 were verified
through results of pre- and post training
assessment
2. Situation of 5S and KAIZEN implementation
were evaluated at the time of first Consultation
Visit.
Effects of 5S-KAIZEN TOT
1) Effects of 5S TOT
2) Effects of KAIZEN TOT
Over Δ=.50 as significant (Koizumi & Katagiri, 2007)
|.20|≦small<|.50|
|.50|<medium<|.80|
|.80|≦large
Follow-up after 5S TOT
Progress of 5S implementation after
6 months of TOT
61~
15%
~30
35%
51 - 60
20%
40 - 50
30%
• Conduct Consultation
visit after 6 months of
5S TOT, and evaluate
progress of 5S activities
• Hospitals trained
between 2007 to 2011
were 47.
• Slow implementation or
below the average of
progress was observed
in 16 hospitals among
the 47 hospitals
Follow-up after KAIZEN TOT
KAIZEN TOT (+)
KAIZEN Success
KAIZEN TOT (+)
Practicing KAIZEN
KAIZEN TOT (+)
No KAIZEN
23%
31%
46%
• After 6 months of KAIZEN
TOT, progress of KAIZEN
activities were monitored
in 13 hospitals through
Consultation visit.
– 3 hospitals continue KAIZEN
activities and have successful
KAIZEN cases
– 6 hospitals continue KAIZEN
activities but no successful KAIZEN
cases yet
– 4 hospitals struggling to practice
KAIZEN activities
Correlation between
“Leadership” and 5S practices
80
y = 0.6385x + 11.112
R² = 0.7204
70
Average of S1-S5 practices
60
50
40
30
20
Average S1-S5
10
Linear (Average S1-S5)
0
0
20
40
60
Leadership
80
100
• During the
Consultation visit,
Leadership and
progress of sorting,
setting, shining,
standardizing and
sustain activities were
evaluated.
• Positive correlation
was observed between
“leadership” and
“implementation of 5S
activities” (R2=0.72036)
Findings
• Knowledge and skills obtained on 5S-KAIZENTQM approaches through Training of Trainers is
not always connected with daily practices of 5SKAIZEN activities. Commitment from hospital
management and leadership are the key for
successful and sustainable QI program.
• All hospital practicing 5S-KAIZEN-TQM
approaches established QIT and WIT, and
structuralize QI program implementation.
Lessons learnt
• It is important to emphasize the following
activities for sustainable practices of 5S activities:
– Establish functional QIT in hospital
– Improve training contents on monitoring and
evaluation skills.
– Strengthen internal monitoring and evaluation
– Supportive Supervision from external
organization such as MoHSW, RHMT, or
CHMT
Thank you!
Any question?

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