Kaizen approach would be great for public healthcare

KNH

The Kenyatta National Hospital in Nairobi.

Photo credit: File | Nation Media Group

The Japanese people have an age-old heritage of commitment to excellence and continuous improvement in all the facets of life.

Fascinated by the Japanese way of life and ethic, management experts have, in recent decades, strived to adopt the Japanese Kaizen culture, a concept of continuous improvement designed to enhance processes and reduce waste.

While private sector players had the first taste of the cherry and accrued benefits from Kaizen, players in the public sector are fast catching up and reaping benefits.

Kaizen is fundamentally a supply chain concept applicable to all business functions. It is most magnified in supply chain activities and is essential to any organisation’s long-term competitive strategy.

Having been involved in Kaizen operations in the public sector, I’d recommend it for adoption at the national and county levels in all our public service endeavours.

Self-discipline

Kaizen builds self-discipline and commitment that, when implemented well in the workspace, this continuous improvement becomes a lifestyle that can be transposed into other spheres of life, including social and personal spaces.

Kaizen is often considered the building block of all lean supply-chain methods. It encompasses other supply chain concepts like six sigma, which is a very effective process that uses statistics and data analysis to analyse and reduce errors or defects in operations. The difference is that six sigma is a project-focused and executed over a defined timeline.

Kaizen is loosely based on three pillars.

Housekeeping is the first pillar of Kaizen. It is the method of managing the workplace, called Gemba, to improve continually. The central concept of this pillar is that one service or product is made valuable before it moves on to the next stage.

A fundamental framework shapes the pillar of housekeeping. First, the workplace needs to be clean, neat and efficient.

This way, materials and tools are easy to identify, locate, use and maintain, so there is no wastage or shortage of materials and goods. The goal is to have all items quickly found when needed, thereby improving the speed at which the Kenyan patient is served.

In a Kaizen environment, any waste should be clearly labelled with a red tag and removed from the process to improve efficiency. All county health facilities can practise this as a primary step, which is also a perfect building block for standardisation in all units.

For example, our medical stores at county health facilities should be well categorised and arranged on the shelves, with bin cards showing current stock levels and movement status.

The second pillar is the elimination of wasteful actions. They can be classified into three; Muda (waste), Mura (unevenness) and Muri (overburden). Using a logistics example of four tons of product to be ferried by a one-ton pick-up, it is Muda (waste) to make eight trips carrying half a ton each.

It is muri (overburden) to take this entire load using two trips as each vehicle will be loaded with two tons, exceeding its capacity.

Similarly, it is Mura (unevenness) to ferry fluctuating loads in all the trips as the vehicles will either be overloaded or under-utilised. The ideal situation is for the one-ton car to make four trips.

These wasteful actions lead to the loss of resources both directly and indirectly as priorities need to be aligned. The intended consequence of the Kaizen application is that it will achieve better planning that leads to much-needed predictability of both immediate and related tasks.

Keeping with our health facility illustration, this can be transposed into other activities, including the medicine order cycle by the health facilities.

The health leadership in our counties should adopt benchmarks focusing on restocking inventories, ideally every two months, instead of waiting until the shelves are dry.

If all the health facilities end up placing their orders at the exact moment, it will lead to a bullwhip effect, sending wrong demand signals to the product manufacturers. This will not only lead to the elimination of stock-out situations, but it will also have a positive knock-on effect on the manufacturers and transporters, who will schedule matters accordingly.

The third pillar is standardisation, which is a requisite for lean manufacturing. This is the process of developing standards to which production is performed and can be done to match pre-set specifications like World Health Organization (WHO) standards. Standardisation of processes in production will make any project auditable and scalable.

Processes and workflows

Pharmaceutical companies need to meet stringent regulatory compliances applicable to them. Therefore, it is vital to demonstrate the ability to meet these specifications every time.

Standardisation of processes and workflows will make this possible. All the major international pharmaceutical companies have successfully reaped benefits using Kaizen thinking.

Kenya is a manufacturing leader and a hub for the East & Central Africa region and thus very well placed competitively to manufacture health-care commodities for the region and beyond. We also now have the African Continental Free Trade Area (AfCFTA) agreement, geared at enabling all African countries to trade with each other seamlessly.

For example, raw materials can be sourced from Ghana, processed in Kenya and the final product ending up in Senegal. This extends more opportunities to our local operations, boosting local manufacturing potential and attendant ripple effects.

This combination of international standard production and efficiency at the facilities level is a precursor to medical tourism in Kenya, whose benefits will knock on the entire economy.

Standardisation is intended to eliminate waste, including the eight main types of waste identified in lean manufacturing. Standardisation lowers costs, increases productivity and creates more stable workflows.

Before this pillar is implemented into practice, managers should ensure that it is appropriate for the business and accepted as a fair and achievable practice by everyone involved in the process. The pillar must be regularly reviewed to verify that it works correctly after implementation.

Ultimately, a good standard should create the safest, easiest and most efficient way to perform a job.

Kaizen is not just about improving profit margins. It is about challenging traditional approaches to change for the greater good.

It is about improving everything continuously and empowering everyone to participate in problem-solving.

It is about being economical, saving money through minor improvements to spend this saved portion on further improvements—one task at a time.

Kaizen’s adoption in the Kenyan health-care system would ultimately ensure timely and efficient delivery of services to the Kenyan patient.


Edward Njoroge is a Supply Chain and Management Specialist with a bias towards Public Healthcare Transformation Solutions. [email protected]

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