Frequently Asked Questions (FAQs) on the ACQUIRE Leadership Program

While uniting in our shared commitment to improve patient safety, especially as we observe this year’s World Patient Safety Day, the Quality Improvement & Patient Experience Working Group of the ACQUIRE African Community of Practice, held an inaugural webinar discussing “ Building a Culture of Patient-Centered Care: Leadership’s Role in Driving Behaviour Change.”   This was to mark the first activity in our efforts to kickstart and dive deeper into enhancing patient safety and quality improvement across the continent, and Insightful strategies were highlighted by three industry professionals: Evelyn Muthoni, Elizabeth Shonko, and Walter Kiptirim, covering the whole spectrum of culture development. From building, monitoring, and maintaining that culture, for a more sustainable outcome.

Key Highlights On The Role Of Leadership In Building A Culture Of Patient Care

Building Culture

1. Own The Process

As a leader, it’s only when you understand why the idea is so important, that you’ll be able to communicate the same to your team. “You can’t sell what it is that you don’t own,” Evelyn Muthoni. Therefore, with a better understanding of why culture matters to you, the drive and passion for quality will be able to be seen, and cascading to the rest of the staff will be made easier.   To better ensure involvement, challenge yourself by asking, “Are you present in driving this agenda? How much of your time do you invest in this and others as you’re pursuing this journey? How involved are you in finding solutions to patient-related gaps? Is it everyone else’s problem, but yours? You can only influence all functions if you are concerned, present, and investing your time in the process and in people involved in those processes.” Elizabeth Shonko.

1. Integrate in Strategies

Continuous Quality Improvement can be strategically implemented at two levels: Organizational and sub-national or county level and at the national level.   Any organization with a strategic plan, organizational values, and organizational objectives, including Organizational and county work plans, must have Quality Improvement and Patient Experience as part of them because as candidly explained by Walter, “leaders need to implement the strategies, which usually informs how the organization will achieve certain deliverables within a certain period… so that as you implement, you’re implementing what you promised.”   “Equally, measure and quantify the actions, then include those particular QI activities in teams, at all levels, starting with adding them in job descriptions to increase ownership at an individual level. For easier implementation, making it simple and starting small, will eventually lead to an overall Total Quality Management”.   Additionally, at the system level, focusing on people (beneficiaries, patients, health workers, and leaders), processes – services offered, and technology used to document these processes, is necessary for Quality to be institutionalized. Simply put, the human capital driving the technology – innovation uses the process data to inform decision-making and value creation for all.  

1. Communicate Your Vision

In addition to being a good communicator, a leader needs to be able to draw a clear vision of how they need quality to be in their hospital: “What is the why? What impact do you want from this? What are those outcomes that you want? How do you want your errors to look like? How do you want your efficiencies to be? What will be the effect of these in the service? And How will you be able to do these things?” Evelyn Gathoni.   Paint a picture of what success looks like to you and map out how you’ll know you’re on track. You’ll be able to get more people on your boat if you can clearly communicate the why and the how.

1. Foster Accountability 

We need to hold people accountable, especially where patient feedback is concerned:  When we get the patient’s feedback, how is it that we are holding people accountable? Do we let them know? Is it that they are not doing it the way it’s supposed to be done? And then, how is it that you are participating in that accountability?   All this should be done by focusing on healthy accountability because when there is healthy accountability, it focuses on learning, adaptation, and growth.    When people fall short of your expectations, can they be able to trust you enough to know that even when you’re holding them accountable, you’re more concerned about their growth, you’re more concerned about how much they are learning and adapting to the current situation?   Finally, If things don’t go right, what system do you have in place to tolerate good-faith mistakes and foster a just culture? In a way that’s not encouraging negligence but holding people accountable for their actions.

Monitoring Culture

1. Measure and Quantify Performance Indicators

When establishing the performance of quality quantifiable, set targets as per the level of the facility since they differ. Allocate the quality indicators and projects as per the Level. Level two could be different from level five. Document the same on a QI dashboard that will be able to achieve even measurable, independent, and visible to all bringing accountability leaders need to support.    Standardize the measurements so that indicators cut across. Priority for the donor, the county, and the national government need to be part of the policies, looking at performance across the board.

Maintaining Culture

1. Apply Positive Reinforcement 

Celebrating the smallest of wins, by methods ranging from certificates to awards and recognition, is one of the ways you can be able to sustain momentum when it comes to quality. They make the receiver know that it matters to you as a leader and that their small actions have an impact on the overall organization.   Equally, at the national level, an annual award and recognition should be established, to function as the unifying factor for everybody to look up to, to get encouraged and motivated to deliver quality healthcare, even towards the clients they serve at the lowest level possible.

1. Build Capacity, Coach, and Mentor

Focus on mentorship and coaching by peers and not supervision. Team effort, mentorship, and coaching, where you establish a culture of quality by not blaming people and punishing them for making some mistakes, but turning them into lessons learned and encouraging them to have the correct attitude of saying, yes, I can do better tomorrow. 

1. Encourage Team Engagement and Collaboration

“Own the good and the bad as a team. Learn how to not throw your team under the bus.” When the team does not achieve the outcome they wanted to achieve, assure them that there is hope in what they can do moving forward, making sure that you are addressing the shortcomings, but also appreciating the good. 

1. Integrate Patient Feedback

“Patient is King” Evelyn Gathoni.   Feedback from patients is the best improvement tool, and some of the suggested ways of integrating it into QI processes include:

• Have multiple channels of feedback: Physical forms, suggestion boxes, social media platforms, or QR codes, to appeal to a wide range of individuals served. To at least get 30% of feedback from the people you’re serving, for a good catchment of the quality of your services and how patients perceive them.
• Make it easy for healthcare workers to collect feedback by integrating it with processes. Understand the point of the patient’s journey, from where you get feedback, to avoid missed opportunities.
• Communicate: Have a structured way of reviewing feedback and escalating/assigning it to the correct parties. And how are they then escalated down to the patient?
• Your patient feedback should be incorporated in such a way that they also get feedback.
• Gauge improvement and create long-lasting change.

 

1. Overcome Barriers

Quality Improvement and Patient care do not come without a set of challenges, but improvement is put in a way that if you have the right mindset, you’ll be able to overcome them. Some of these challenges/barriers with how to overcome them are highlighted below:  

• Knowledge gap: Provide training and information to healthcare workers-CMEs, in-person training. If in the private industry, you may also face an issue of attrition which focuses on how you have incorporated all these processes so that there is a seamless transition from one lot to the next, so things are not lost, and your culture is able to be maintained.
• Limited Time and resources: Communicate the simplicity of quality and the idea of CQI and KAIZEN that you’re taking it step by step while utilizing available resources.

• What’s in it for me? As leaders, recognize that you need to communicate the relevance of why you’re asking people to have quality as a culture, so you need to be able to communicate that quality will eventually lead to better outcomes for the patients, which will lead to patient satisfaction, which will lead to reduced errors on their end, an element of operational efficiency. What this does is it creates a working environment that enables you to continuously reproduce this good work that you wanted to do in the first place.
• Too many quality models are being implemented at the national level, with everyone running with one of their own. They need to be made interoperable, where we can learn from each other, and made simple and approachable that can be scaled and owned by everyone.
• Inadequate adoption of technology; Automation and digitization to allow personalization of quality and interoperable systems by embracing digitization.
• Too many indicators: Allow for a smaller area of measurement of quality even at the department level, building up quality from the smallest steps.

Parting Shot

Keep on reminding people that being present in the QI process is key and as much as quality takes time, the small steps of improvement will always get you to the goal. Bearing in mind to always celebrate those milestones by embracing awards and recognition, and at the same time being able to tolerate errors made in good faith. This will assure people you have that learning culture, wanting them to grow. That will help you instill that quality culture in your whole organization.  

Source: A webinar discussion by the ACQUIRE Community of Practice – Quality Improvement and Patient Experience Working Group.

  The Quality Improvement and Patient Experience Working Group – Team of Experts:   Evelyn B. Gathoni – Quality Assurance Officer at Premier Hospital With over six years in healthcare and a Bachelor’s in Medical Laboratory Science from MMUST, Evelyn has enhanced healthcare at Premier Hospital by identifying improvement areas, implementing quality controls, and leading patient safety initiatives. Her achievements include developing a quality management system and significantly reducing system-related errors while fostering collaboration and maintaining high patient care standards.   Elizabeth Shonko – Quality & Patient Safety Director at A.I.C. CURE International Hospital. Elizabeth Shonko is currently the Quality & Patient Safety Director at AIC CURE International Hospital in Kijabe, Kenya. Previously, she served as Quality Assurance and Infection Control Manager and has successfully implemented the ISO 9001:2015 standard. She has also held roles as Acting Nursing Director, managed maternity and private ward operations at AIC Kijabe Hospital, and contributed to primary health initiatives at AIC Barotion Health Centre.   Walter Kiptirim – Registered Clinical Officer, CQI Lead USAID Stawisha Pwani Project, LVCT Health. 

Mr. Walter Kiptirim is a registered Clinical Officer with a Diploma in Clinical medicine –KMTC, a Degree in Medical Sociology from the Catholic University of Eastern Africa, and A MBA –Specialization in Healthcare Leadership and Management from the United States International University-Africa. Walter is the CQI Lead with LVCT Health -USAID Stawisha Pwani Project supporting Four Coastal Counties in Kenya.