Stanford Graduation- Charting the Path for Quality Improvement Learning and Growth

On 28th October 2021, ACQUIRE held its first frontline health care workers graduation on Quality Improvement (QI) programme in patient care across four hospitals in two African countries (Ethiopia and Kenya). This graduation was a culmination of a 6 month learning activity enabled by the collaboration between ACQUIRE and Stanford Medicine’s EQuIP Global (Enable Quality, Improve Patient Care). The two hour virtual graduation marked the conclusion of the formal part of an ongoing learning process for the participants. In attendance were participants from the four hospitals; Asela Teaching & Referral Hospital – Ethiopia, Jimma University Medical Centre – Ethiopia, AIC Kijabe Hospital – Kenya and Kenyatta National Hospital – Kenya, representatives from Stanford and the three ACQUIRE co-founders.

Screenshot of virtual graduation.

The goal of the programme was to tap into Stanford’s global expertise and experience with collaborative learning groups and share this expertise with frontline health care workers in hospitals. The teams choose a topic and embarked on collecting and analysing data using documents, run charts and cause & effect diagrams to come up with appropriate interventions for their respective topics. They then shared the results of their collaborative input through a seven minute presentation each and showcased the aspects of QI skill set picked up along the way; root cause analysis, measurements as well as team & project management skills.

Hospital:Members of the team:Smart Goal/Problem Statement:  Big Win:  
Asela Teaching & Referral HospitalTsion AdnewAkalu ErmiasNero Ambo  Increase immediate Post Partum Family Planning Service in the hospital from 12% toInstitutionalized the training of health care workers to empower women  This means more women are educated and informed of the options available to them.   Direct decrease in pregnancy related maternal morbidity and mortality as well as neo-natal morbidity.
Jimma University Medical Center  Yonas BiratuAbdisa EbaEbissa Bayana  Reduce surgical site infections rate from 11% to 6% using multimodial strategies to prevent SSI and secondary infections.  Small daily routine improvemnts like the consistent use of safety checklists and training of new staff in the OR led to stunning results.
Jimma University Medical CenterFekensa HailuBayisa BerekaAbdulwahid AwolSamira Awel  Improve utilization of nursing care plan and documnetation in pediatrics ward from 26.6% to 90%.By decreasing the format from 10 to 5 pages the hospital saves 34,000 ETB annually.   In addition, the time taken to complete the nursing care plan was reduced from 1 hour to 30 minutes. This saves 1,290 hours per year.
Kenyatta National Hospital  Caroline MalinguAlex Ndung’uTriphosa MutungiElizabeth KoiguJoseph OchiengNelly KepkemboiRhoda KalonduMary Muchiri Increase the rate of utilization of Cefazolin for Surgical Antimicrobial Prophylaxis (SAP) from 14.5% to 90% inorder to reduce surgical site infections.Better allocation of resources  and time as a result of drug requisition process re-design.   Availabilty of Cefazolin in the theatre pharmacy for instance has led to reduced motion to pharmacy and therefore freed up the nurses to perform other duties.    
Kenyatta National Hospital  Agneta ChelimoLillian OkothPeter SakwaJohn Ndung’uAnnete KingwaAyub AlembiFlorence MiritiCharity Kianji Increase utilization of pressure ulcer care bundle from 9% to 50% in medical wards.Reduced development of pressure ulcers and therefore decreased cost of care for both the hospital and the patients.
AIC Kijabe Hospital  Leornard BettSalome GathoniFaith ChikatiDennis MutungaNiceta NjueCan the admission process be bearable please?   Reduce admission related complaints from 16% to 8%.Unexpected results: After creating a clear platform for patients to raise complaints the number rose beyond 40% on average against the expected reduction.   Attempting 2 costly/expensive interventions was not practical or productive. ” We learned fast and stopped them early enough”.   Fail small, fail early, fail cheap and fail forward.
AIC Kijabe Hospital  John OmondiJames BoroJesse BiwottRobert NduatiImprove the hospital’s wide emergency preparedness (statistics based on SafeCare assess report)  from 30% to 70%.Increased fire safety awareness amongst staff from 15% to about 70%. This led to decreased fire incident risk.

The collaboration, according to Dr Lydia Okutoyi, ACQUIRE co-founder, brought meaning and form because relationships were formed across board and this will lead to QI experts in the region. A challenge was further posed to the participants to apply the QI skillset to regular life; beyond the work environment, inorder to reap the most benefit from this valuable learning experience. The graduation, allowed them the opportunity to pause and reflect on what they had accomplished, and prepare to look forward to future projects. Dr. Mary B. Adams, ACQUIRE co-founder, put it aptly in her reflections when she stated; ” Consider the ways you can take the amazing asset of having grown relationships of trust with other team members to launch you forward not just on an individual sustainability plan but as a platform for working together in the future”. In closing, J

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