16 September 2015

Fixing the South African public health sector

Preliminary results from a ground-breaking hospital improvement plan rolled out at four state hospitals in Gauteng show it is possible to significantly reduce patient waiting times – a key complaint area of many using public hospitals.

A UCT Graduate School of Business (GSB) professor is working with staff at four of the country’s worst performing hospitals in Gauteng to improve flow, reduce waste and overall waiting times and ultimately boost service delivery in the country.

Speaking at the GSB on Friday, Emeritus Professor, Norman Faull, founder of the Lean Institute Africa explained details of the hospital turnaround programme at Chris Hani Baragwanath, Leratong, Sebokeng and Kopanong hospitals during 2014-15. He said waiting times were reduced by between 19-65%, resulting in massive improvements for patients.

Despite many bureaucratic and departmental hitches, Faull said the programme was a big success with many hospital staff requesting more training and further coaching.

Averaging the results at the four hospitals, waiting times were reduced by 56% for the amount of time it took to get patient files, 45% in waiting times and up to 50% faster service was achieved in the pharmacies.

Faull said the patient folder situation at some hospitals were in a “lamentably disordered state” and often requires significant daily walking by staff to retrieve and return folders. At one community health centre he estimated the daily walking back and forth with folders involved a daily distance of 56km.

“That is a Two Oceans marathon!” he said.

In such a situation an improved layout eased staff’s workload and speededservice to the patients.

Last year Faull was appointed as an advisor for the Department of Performance Monitoring and Evaluation (DPME) within the Presidency. Independently, in 2014 he was asked to implement the principles of lean management at four of Gauteng’s largest hospitals.

According to Faull, three months after being initiated into the programme one hospital CEO said: “I am beginning to understand how my hospital works.” And there was no irony in his statement. The executive had begun to ‘Go See’ the frontline activities for himself – a key message of the programme.

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“There are parts of the public sector where abnormal has become normal.

Staff don’t expect things to work and broken equipment remains so for months;

people make commitments with little intention of keeping to them. Time keeping is a particular area of ‘abnormality’ whether it’s doctor punctuality at clinics or officials attending a workshop. It is an extraordinary situation,” Faull said.

He added that this did not mean that there weren’t also very conscientious and competent people in the public sector who themselves are frustrated and worn down by the state of affairs.

Lean management theory has its roots in the Japanese automotive industry (The Toyota Way) and focuses on eliminating unnecessary procedures, time-wasting efforts and ensuring fluent operations. Faull has 30 years of teaching experience in the field and has worked with a consulting agency started by some of his former students, which has worked in over 70 countries, establishing a wealth of research about the benefits of lean management, how it builds capacity, improves efficiency and improves staff morale.

One of the biggest concerns Faull encountered in his work in the public sector and with public sector officials was the “disconnection by leadership”. And said he saw this in the gap between the commitment of MECs and facility heads; the officials in the gap fail to take ownership of the actual improvement process, not even attending crucial facility-level meetings or in one instance, government officials were unable to agree on a date for a training workshop.

“Lean management works. There is an overwhelming amount of research that shows this. But it has to be a rhythm of management practice: daily, weekly, monthly follow-ups and so on. It is an issue of practice and habit-formation.

If we want to make real progress with problems in the public sector, these principles have to become part of the daily routine, not something done once or for a few weeks and never again,” Faull said.

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