5 S project to improve healthcare quality
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- 2. Executive Summary Generally people have negative attitude towards Government health facilities. They have an image of unhygienic, unorganized and inefficient Government health facilities which leads to less utilisation of the health facilities. Shri P.K. Taneja, IAS, Principle Secretary (Public Health) & Commissioner of Health Department, Govt. of Gujarat had taken up this issue on priority basis and appealed his health team all over the state to follow 5 S practice to improve the quality of healthcare delivery as well as to increase the acceptance of government health system. 2
- 3. Executive Summary (cont.) So, The District Development Officer, Chief District Health Officer, Additional District Health Officer, District RCH Officer, Quality Assurance Medical Officer and whole team of Health Branch had decided to carry out a project in campaign mode using 5 S practice as quality improvement tool. Thus, 5s Campaign was an initiative taken up by Health Branch, District Panchayat, Ahmedabad, Government of Gujarat, to improve the quality of healthcare facilities and increase their acceptance among the Community. Following is the flow chart of order in which whole project was carried out in phased manner 3
- 4. Celebration of 5 S Implementation Week Crosscheck visits by MOs for Internal evaluation Action taken as per Evaluation Reports Formation of 5 S change agents committees and planning for action Again Crosscheck visit by MOs Action taken Evaluation by District Teams Training of all the staff at PHC/CHC level Strategy- making & Developing the indicators Preparation of Study material & guidelines District Level Trainings (ToTs) Evaluation of Achievement of as per Indicators Flow Chart of Activities
- 5. Impact of Project Ahmedabad District OPD IPD Delivery Laboratory Tests 2011-12 2012-13 2011-12 2012-13 2011-12 2012-13 2011-12 2012-13 3 rd Quarter (Oct-Dec) 23865 42,595 484 1827 139 612 9404 20639 4 th Quarter (Jan-Mar) 25957 43,976 588 2004 276 675 10010 16447 Following table shows that number of Beneficiaries are significantly increased after implementation of 5 S campaign. The figures of 3rd and 4th quarters of 2011-12 are compared with the same quarters of 2012-2013. 5 (Data Source Monthly Information System Report, District Panchayat, Ahmedabad)
- 6. Amount Deposited to Government As a result of 5S Campaign, large amount of old/unused material instruments - equipments were scrapped and amount is deposited back to Govt. account. 6 Facility Income (Rs.) District Hospital 1,65,112 CHCs PHCs SCs THO office 5,14,433 DHO office 60,839 Dist Training Team 1,07,000 Total (Rs.) 8,47,384
- 7. Introduction & Need for Project In the current healthcare industry, there is a lack of efficiency, due to poor organization of the workplace affecting performance of healthcare facility in Govt. healthcare system. With the growing need for quality healthcare in Govt. system, it is evident that there needs to be an increase in efficiency in order to keep up with the rising demands. The lack of patient-friendliness is also observed frequently at Govt. Hospitals. Doctors and paramedical staff pay less attention to universal precautions making them more prone to injuries and infections. 7 No attention to patient-friendliness!!! Unhealthy practice by Healthcare workers
- 8. Introduction (contd.) 8 The 5s methodology, a tool used by industrial engineers, can organize healthcare making it more efficient. 5s methodologies, when put in place, organize the work place so that it runs at its highest possible level of efficiency. Being efficient is operating at maximum productivity with the least amount of waste. 5s is a cost-effective strategy which should bee used widely public health facilities.
- 9. The 5s methodology is based on the following five major steps. Each of these steps can easily be implemented in healthcare to increase the efficiency and quality of patient care. The 5s works by creating an easy-to-use work environment. JAPANESE ENGLISH MEANING Seiri Sorting Classifying Seiton Setting Organizing Seiso Shining Neatness & Cleanliness Seiketsu Standardize Preparing the SOPs & Protocols Shitsuke Sustain To be in Discipline & continuous efforts for quality improvement 9
- 10. HOW TO APPLY 5 S TO EACH AND EVERY ITEM ? A Simple Flow Chart
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- 12. Benefits of 5 S Practice Reduction of waste in every process Drugs-Equipments- Inventory organised in better way Additional space can be acquired in the same room Saves time Prevent accidents safety Safe Employee Significant impact on entire performance of the center increased productivity effectiveness - efficiency Continuous quality improvement Motivation and cheerful working environment for the staff 12
- 13. AIMS & OBJECTIVES To Sensitize all the Healthcare Providers regarding the importance of 5 S Concepts for better health care delivery and develop the 5 S culture to sustain it. To make the optimum use of available healthcare recourses throughout the district. To improve the healthcare services of the district in terms of Quality. To Improve the Image of Govt. Healthcare Facilities among the Community and to improve its acceptance. To Improve the OPD, IPD, Govt. Institutional Deliveries and Lab. Services. The ultimate goal is to decrease the IMR & MMR up to the lowest possible level. 13 IMPROVEMENT IN QUALITY
- 14. 14 PERIOD OF IMPLEMENTATION Implemented in August 2012 and still ongoing Activity Period of Implementation Strategy Making & Planning at District level August 2012 Preparation of 5 S Training Module, Guidelines, Posters etc. September 2012 Sensitization Trainings at District Level September 2012 Trainings at PHC-CHC level 1st & 2nd week of Oct. 2012 Celebration of 5 S Implementation Week 4th week of Oct 2012 Cross check Visits by MOs 1st Week of Nov. 2012 Action taken as per report given at cross checking Nov. 2012 2nd Cross check Visits December 2012 Visit by District Teams Janu. Feb. 2013
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- 16. Centers Participated in Implementation No. Type of Center Number 1 Primary Health Centers 43 2 Community Health Centers 11 3 Taluka Health Offices 7 4 District Hospital 1 6 District Health Office 1 7 District Training Center 1 8 Health Sub Centers 148 Total 213 16
- 17. 17 5 S CAMPAIGN AT A GLANCE 1) Strategy making Planning at district level & allocation of roles - responsibilities 2) Development of 5 S material (Checklist, study material, posters etc.) 3) District level Trainings of Trainers 4) Trainings at Health Centers 5) Formation of Committees of Change agents & Pre-photos 6) 5 S week celebration ( Implementation of 5 S) 7) Crosscheck visits by Medical Officers for internal evaluation 8) Action taken by Centers for Quality Improvement 9) Re-visit by Medical Officers for Re-evaluation 10) Action taken by Centers 11) Evaluation visits by District Level Officers and Feedback 12) Measuring the Impact of the project (Evaluation as per pre- decided indicators) 13) Third Party Evaluation
- 18. 18 All stages are described in brief in following slides.
- 19. 1) District level meeting for strategy making Under chairmanship of District Development Officer, a special task force was formed and detailed discussion was carried out for accurate planning and a specific strategy was developed to implement whole project in time-bound manner without affecting National Health Programs and other routine work. 19
- 20. 2) Extensive Efforts for Exquisite Planning Planning note was circulated to experts and revised final strategy was formulated. 5S QCI award link data5Sbrief planning of activities.pdf Role & Responsibility were allocated from district to the peripheral level. 5S QCI award link dataRoles - Responsibilities .pdf 20
- 21. Indicators were decided for monitoring and evaluation purpose. PHYSICAL INDICATORS OTHER INDICATORS Pre and Post photographs of the centers Improvement in scoring of 5 S Audit Checklist Increase in following parameters... (1)OPD (2)Indoor (3)Govt. Insti. Deliveries (4)Lab. Services 21
- 22. 3) Development of Various 5 S materials Training Module Study-material was developed in form of a 5S Margdarshika (Module cum Guidelines) in simple Gujarati language which could be easily understood by all. 5S QCI award link data5-S CAMPAIGN INFORMATION SOP old.pdf 22
- 23. 23 5 S Campaign Logo Series of Posters 5S QCI award link data4 - 5_S POSTERs.pdf
- 24. Checklist for Assessment Keeping in mind the present status of health centers & objectives, An audit checklist was prepared to be used for implementation as well as monitoring & evaluation purpose. Certain scoring was also given to the each component of the Checklist which scores would be used to monitor the progress. 5S QCI award link data5S audit check list .pdf 24
- 25. Reporting format A Reporting format was also prepared which was to be used each by health centers for uniform and accurate reporting. 5S QCI award link dataReporting format - 5S campaign.pdf 25
- 26. 5 S Photo plate 5 S Wall clock 26
- 27. 5 S Foam Sheet 27
- 28. 5 S Educational Game The Game was downloaded from a website and used for making the understanding easier during 5 S Training. 5S QCI award link data5 S game pdf.PDF 28
- 29. 5 S Desktop & Screen savers (Courtesy State Quality Assurance Cell & kaizen institute) 29
- 30. 4) District level Trainings for Master Trainers The services of a corporate trainer was hired to train the District level officers, Taluka level Health Officers and Medical Officers regarding 5 S concept. 65 Officers were trained who had worked as Master Trainers to train others at different levels. 30
- 31. District Level Training of Paramedical staff (AYUSH PHARMACIST) 31
- 32. District Level Training of Paramedical staff (LABORATORY TECHNICIAN STAFF NURSE ADMIN OFFICERS) 32
- 33. Trainings at Health Centers Level Sensitization Trainings were organized at each & every Health centers by Master trainers, who were trained at district level. Thus, all the staff was sensitized regarding 5 S and implementation of the campaign (Including Class IV, Ward AAYA, Security, ASHA etc.) 33
- 34. Trainings at Health Centers Level 5S QCI award link datatraining photos.pdf 34
- 35. 5) Formation of 5 S Committees The head of the health center had selected the most active members of his team(Change agents) and 5 S Committee was formed and responsibility of implementation monitoring was allocated. Pre-campaign photos of each centers were taken. 35
- 36. 6) Celebration of 5 S Implementation Week As per pre-planning, all centers were instructed to implement 5 S campaign activities exclusivelyduring a week (22/10/2012 to 28/10/2012) Day to day planning was done and intensive efforts were carried out for SHORTING, SETTING, SHINING & STANDARDIZING at all the centers (Campus, patient waiting area, OPD, Wards, Laboratory, Operation theater, Labor Room, Toilets, Admin Office, Record Room, Drug store etc.) 36
- 37. 37 Celebration of 5 S Implementation Week Cleaning of Campus 5 S Posters Displayed Equipments Drugs as per protocol Implementation in OT
- 38. 38 Celebration of 5 S Implementation Week Display of SOPs Red Tags on scrap material Maintaining Records-Registers Implementation in Laboratories Implementation in Dressing Room
- 39. 7) Crosscheck Visits by Medical Officers for Internal Evaluation After the implementation week, Evaluation visits were held, in which, medical officers had visited the health centers and assessed the level of implementation.(MO of PHC A was sent to PHC B, MO of PHC B was sent to PHC C and MO of PHC C was sent to PHC A) Audit checklist was filled at the time of visit and score was given. Detailed Progress report is linked herewith. 5S QCI award link dataProgress report 1 .pdf 39
- 40. 8) Action taken by Centers for Improvement After crosscheck visits, written feedback was given to each center and instructed to take action as per observations. 15 days time period was given for this action taken. 5 S Committees meetings were conducted and efforts were done for ensuring the necessary action as per feedback. 40
- 41. Continuous Motivation & Supportive Supervision from District Level Simultaneously, All the district Officers had been visiting the centers and providing continuous motivation with supportive supervision. 5 S agenda was in the center of every meeting at district level which helped in mainstreaming the 5S implementation agenda amongst routine work of health team. 41
- 42. Continuous Feedback from district level Informative, Educative and Motivational material was being sent continuously from district level 42 5S QCI award link dataHAVE U DONE THIS IN 5S.pdf 5S QCI award link dataactivities which must be carried out in 5 S campaign.pdf
- 43. 43 9) Second Crosscheck Visits by Medical Officers for Further Evaluation 2nd round of cross visits was carried out to assess the progress. The same medical officers were sent to the respective centers which were visited by them earlier. Same Checklists were filled and scores were given. Detailed progress report is linked herewith. 5S QCI award link dataProgress Report 2 .pdf
- 44. 44 10) Efforts by Centers for Continuous Quality Improvement After crosscheck visits, written feedback was given to each center and instructed to take action as per observations. The scores were compared and progress was assessed. Post-campaign photos were also taken.
- 45. 45 Efforts by Centers for Continuous Quality Improvement Good Record-keeping Patient-friendly services Implementation by FHWs at Subcenters Protocols Charts displayed in LAb.. Medicine Management
- 46. 11) Visits by Officers For Evaluation, Motivation & Appreciation After 2 crosscheck visits and after approximately 3 months of implementation, randomly selected centers were visited by district level officers, evaluation was done with the same checklist. 5S QCI award link dataProgress Report - 3 .pdf 46
- 47. 12) Impact of the project (Evaluation as per indicators) The pre-decided indicators were (1) OPD (2) Indoor (3) Deliveries (4) Lab. Services (5) 5 S Audit checklist Score (6) Pre-campaign and Post-campaign Photographs -- Indicator no. 1 to 4 are shown in following slides. -- Indicator no. 5 is shown in progress reports linked herewith. -- Indicator no. 6 (photographs) are displayed in 1st, 2nd,3rd progress reports. Hyperlink to some photographs -5S QCI award link datapre-post photos .pdf 47
- 48. 201 1-12 201 2-13 0 20000 40000 60000 3rd quarter 4th quarter 23865 25957 42,595 43,976 2011-12 2012-13 3rd quarter 4th quarter 2011-12 2012-13 2011-12 2012-13 23865 42595 25957 43976 No of Patients Registered at OPD (Data Source MIS Report, Dist. Panchayat, Ahmedabad) 48
- 49. 3rd quarter 4th quarter 2011-12 2012-13 2011-12 2012-13 484 1827 588 2004 2011- 12 2012- 13 0 1000 2000 3000 3rd quarter 4th quarter 484 588 1827 2004 2011-12 2012-13 49 No of Patients Registered at IPD (Data Source MIS Report, Dist. Panchayat, Ahmedabad)
- 50. 3rd quarter 4th quarter 2011-12 2012-13 2011-12 2012-13 139 612 276 675 2011-12 2012-13 0 200 400 600 800 3rd quarter 4th quarter 139 276 612 675 2011-12 2012-13 50 No of Deliveries Conducted at PHCs (Data Source MIS Report, Dist. Panchayat, Ahmedabad)
- 51. 3rd quarter 4th quarter 2011-12 2012-13 2011-12 2012-13 9404 20639 10010 16447 2011-12 2012-13 0 10000 20000 30000 3rd quarter 4th quarter 9404 10010 20639 16447 2011-12 2012-13 51 No of Laboratory Tests Conducted at PHCs (Data Source MIS Report, Dist. Panchayat, Ahmedabad)
- 52. 13) Third Party Evaluation Third party evaluation was carried out by the representative of IIHMR, Bangalore who had visited the selected centers. The report had indicated that significant improvement was satisfactory at most of the PHCs, whereas CHCs had shown somewhat lesser improvement. The evaluation report is linked herewith. 5S QCI award link dataThird party evaluation report of 5S project.pdf 52
- 53. Appreciation From the State Level Shri P.K. Taneja, IAS, Hon. Health Commissioner, Govt of Gujarat had continuously motivated and appreciated the campaign activities through Email and appealed all other districts to replicate the same. Shri Dr. Paresh Dave, Hon. Additional Director, Health dept., Govt of Gujarat, had praised the project and sent an appreciation letter. 53
- 54. Funding No extra fund or grant was used at any level for this project. Whole project was conducted with the fund, which is yearly allocated from NRHM to the respective CHC / PHC, was utilized. The fund Rs. 1, 10, 000 /- was utilized at district level for trainings, printing of posters modules and for IEC-BCC purpose. Ironically, more than 8 lakhs Rs. were deposited to Government account after scrapping the unused materials as a result of 5 S Campaign. 54
- 55. Salient Features Of The Project Coverage : - Large number of Health Centers and Health Offices(213) of Ahmedabad district were covered under implementation. - Around 425 Change agents (Doctors & Paramedical staff) were trained and sensitized all over the district. - Rural population of whole Ahmedabad rural areas (15 lakhs) could have been benefitted in terms of better quality health services at their doorsteps. 55
- 56. 56 Innovativeness : - Such kind of implementation of 5 S practice in campaign mode was the totally innovative concept to bring about the quality in Government healthcare delivery throughout the district. - 5 S Assessment Checklist was specifically developed keeping in mind the strengths and weaknesses of Government Health System. - Innovative ideas were used for spreading the awareness of 5 S practice amongst change agents i.e. photo plates, posters, wall-clock, game etc
- 57. 57 Replicability : -- The Education material, Module, Guidelines, Posters, Audit Checklist, Reporting Format etc. all are prepared and available. So that any Healthcare Institute can easily replicate this. -- Hon. Additional Director, Public Health, Govt. of Gujarat has already instructed all other districts of Gujarat State to replicate this 5 S model to improve quality of healthcare services. -- Documentation is also done in terms of Photographs. So implementation is easy to understand.
- 58. 58 Sustainability : -- One cannot admit that 5 S is implemented fully at all the centers but It is sure that most of the centers have understood and started to follow the 5 S practice which could be sustained with sincere and continuous efforts . -- The sensitized change agents can easily carry forward the efforts for sustaining the 5 S implementation. -- The Health Staff has felt the importance and usefulness of 5 S practice which will automatically lead to sustaining. -- The District Health Team has been making sincere efforts to sustain the 5 S practice as per the guidance and motivation of the state level as well as from the District Development Officer, District Panchayat, Ahmedabad.
- 59. 59 Less Expense - Maximum results : -- There was no special fund or grant was needed at any stage of the whole project which was the most salient feature. -- The effect on number of OPD, IPD, Deliveries and Laboratory tests was very significant. Acceptance of Govt. Health Centers in Community can be understood from these figures. - In short, the project was very much cost-effective also.
- 60. Acknowledgement Shri P. K. Taneja, IAS, Principle Secretary and Commissioner of Health, Govt. of Gujarat For being mentor and providing great motivation from the state level Shri Dr. P.V. Dave, Additional Director, Public Health, Govt. of Gujarat For Inspiring and appreciating which was the boosting effect for us The Quality Council of India, New Delhi For continuously appreciating our efforts which has been the motivational force for Health Team, Ahmedabad (Awarded us in 2010-11 for Best Healthcare Practice & in 2012-13 for Nutrition Mission Project) Dr. J . L Meena, State Quality Assurance Officer, Gandhinagar. Shri B. N. Pani, IAS, District Development Officer(Ex.), District Panchayat, Ahmedabad Shri Dr. N. J. Patel, Regional Deputy Director, Health & Medical Services, Ahmedabad Region, Ahmedabad. All Officers and Members of Health Team, District Health Society, Ahmedabad. 60
- 61. Quality Health Services, Our Ultimate Goal THANKS.