Hisahiro Ishijima, Noriyuki Miyamoto, Fares Masaule and Raynold John
The purpose of this study is to see how the 5S-KAIZEN-TQM approach can contribute to improve the management of healthcare waste (HCW) in the regional level public hospitals in…
Abstract
Purpose
The purpose of this study is to see how the 5S-KAIZEN-TQM approach can contribute to improve the management of healthcare waste (HCW) in the regional level public hospitals in Tanzania.
Design/methodology/approach
This study employed an explanatory case study framework and focused on improvement of HCW management by assessing the information obtained through the direct observation and systematic interviewing during the consultation visits and external hospital performance assessment (EHPA) and the self-administrated questionnaires as sources of evidence.
Findings
Based on the observations, 100% adoption of the 5S approach was observed in 25 of 28 regional referral hospitals (RRHs). At these RRHs, segregation of HCW management has been improved by applying color codes and symbols for establishing self-explanatory system on proper segregation. In addition, seven out of 28 RRHs applied the KAIZEN process and reduced occurrences of improper waste segregation.
Research limitations/implications
This study has the following limitations in terms of the information. The data were collected through the direct observation. Moreover, areas for the implementation of the KAIZEN vary from hospital to hospital, and only 25% of RRHs completed the KAIZEN processes for improvement of HCW management. Caveats are, therefore, needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing the 5S-KAIZEN approach in Tanzania and other African countries for improvement of HCW management.
Originality/value
This is an original study to provide evidence about the usefulness of the 5S-KAIZEN-TQM approach for improving HCW management in a low-income country in Africa.
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Hisahiro Ishijima, Kaori Nishikido, Masashi Teshima, Sayumi Nishikawa and Eman Abdul Gawad
The purpose of this paper is to identify how the introduction and dissemination of the 5S-KAIZEN-TQM approach positively influence the Egyptian health sector and its…
Abstract
Purpose
The purpose of this paper is to identify how the introduction and dissemination of the 5S-KAIZEN-TQM approach positively influence the Egyptian health sector and its sustainability. It also seeks to encourage effective and efficient introduction of the 5S-KAIZEN-TQM approach into the health sectors of low- and middle-income countries.
Design/methodology/approach
The pilot program introducing the 5S-KAIZEN-TQM approach into five Egyptian public hospitals spanned over 13 months from January 2016 to February 2017. During the pilot program, a series of interventions occurred to introduce the approach, such as seminars on the 5S and KAIZEN approach, consultation visits and progress report meetings. Data and information were collected through conducting interviews, observing directly and evaluating the implementation progress of 5S-KAIZEN-TQM activities.
Findings
The study identified the following factors in effective and efficient dissemination of 5S-KAIZEN-TQM activities in the Egyptian health sector: restructuring the quality management structure to establish Quality Improvement Teams and Work Improvement Teams in hospitals, generating strong leadership and commitment among leaders, conducting effective in-house trainings on the 5S-KAIZEN-TQM approach, monitoring and following up on 5S-KAIZEN-TQM activities and introducing the 5S-KAIZEN-TQM approach using non-clinical sections, which could also influence the sustainability of the activities.
Originality/value
This study holds value in its clarification of meaningful ways to disseminate and encourage the sustainability of the 5S-KAIZEN-TQM approach in Egyptian public health facilities. Moreover, officials from the Ministry of Health and Population and hospital managers in Egypt can use the findings to plan and disseminate this approach nationwide.
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Hisahiro Ishijima, Eliudi Eliakimu and Jonathan Mcharo Mshana
The purpose of this paper is to assess causal relations between the implementation of the 5S approach and the reduction of patients’ waiting time at out patient departments (OPDs…
Abstract
Purpose
The purpose of this paper is to assess causal relations between the implementation of the 5S approach and the reduction of patients’ waiting time at out patient departments (OPDs) of hospitals in Tanzania.
Design/methodology/approach
Patients’ waiting time was measured under the cluster randomized control trial (c-RCT). In all, 16 hospitals were chosen and divided into treatment and control groups using block randomization. Before the intervention, a baseline study was conducted at OPDs in all 16 hospitals. After one year of the intervention, the end-line study was carried out in both the groups. A comparison of the average waiting time reduction and Difference-in-Difference (DID) analysis was carried out to see the effect of the 5S approach on the reduction of patients’ waiting time.
Findings
Statistical significance in reduction of patients’ waiting time was seen in the medical records sections (p=0.002) and consultation rooms (p=0.020) in the intervention group. The same trend was also seen using DID analysis (−15.66 min in medical record, −41.90 min in consultation rooms).
Research limitations/implications
This study has the following limitations in terms of the data. The data were collected for only three days at the time of baseline survey, and again for three days at the time of the end-line survey from 16 hospitals. Moreover, piloted areas for the implementation of the 5S approach vary from hospital to hospital. There might be a bias in the measurement of a patient’s waiting time. Caveats are therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for implementing quality improvement programs in Tanzania and in other African countries for improvement of time factors.
Originality/value
This study used c-RCT, and has proven the effectiveness of the 5S approach in improving the working environment and reducing patients’ waiting time at OPDs in several hospitals at district level in Tanzania.
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Hisahiro Ishijima, Eliudi Eliakimu, Shizu Takahashi and Noriyuki Miyamoto
The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale…
Abstract
Purpose
The purpose of this paper is to identify factors that influence the implementation of the rollout of the 5S approach in public hospitals in Tanzania, and share the way to scale this up for similar setting in developing countries.
Design/methodology/approach
The effect size was calculated from pre- and post-assessment results of Training of Trainers (ToT) to examine the effectiveness of ToT. A questionnaire with 14 explanatory variables was developed and completed based on information collected during Consultation visits (CVs) and progress report meetings (PRMs). Then, data were analysed to identify the influencing factors in relation to outcome variables (CV average score).
Findings
Among 14 explanatory variables, five explanatory variables showed statistical significant association with the CV average score. Those are: “Feedback and information sharing,” (p=0.031), “Quality Improvement Team roles and responsibility” (p=0.002), “5S knowledge,” “Involvement and commitment,” and “5S guidelines use and availability,” (p=0.000). When the explanatory variables were controlled by levels of hospitals; “involvement and commitment” was the only explanatory variable for national level hospitals. For regional referral hospitals, “QIT roles and responsibility” (p=0.02) and “5S knowledge” (p=0.03) were statistically significant. For district hospitals, “involvement and commitment” (p=0.01) and “availability of guideline (p=0.001)” were statistically significant.
Research limitations/implications
This study has the following limitations. The data were collected from existing reports and presentation materials only. There might be reporting bias, as PRM data is self-reported from the hospitals. Caution is therefore needed in extrapolating the study results to other settings. Despite these caveats, the findings will provide important insights for designing and implementing QI programs in Tanzania and in other African countries.
Originality/value
The authors' conceptual framework is based on the existing literature on the science of diffusion and scale up of innovation in the health sector. Few studies are known from resource constrain settings in Africa which assess the determinants of the process of nationwide scale-up of proven interventions.