Challenges

Hospitals in developing countries face serious problems with health-service quality owing to a lack of adequate human resources, poor management of equipment and medicines, and operational inefficiency. Global development discourse, in the meantime, has neglected the issue of hospital performance, giving more attention to strengthening primary-health-care disease-specific programmes.

Toward a Solution

The Southern-developed 5S-KAIZEN-TQMmodel offers a tried and tested solution to this challenge. It was originally developed in the Japanese industrial sector and launched in the Castle Street Hospital for Women in Sri Lanka. Later, the Japan International Cooperation Agency (JICA) developed it into a simple, feasible way to improve hospital management and health-care quality in resource-constrained settings using a change- management approach.

A simple, affordable tool and implementation method, 5S-KAIZEN-TQM emphasizes a team-based practice and a step-by-step methodology. These features ensure incremental and thoughtful collective action that gives hospital personnel a positive outlook on the potential to improve service quality. As such, 5S-KAIZEN-TQM creates processes and spaces for mutual learning among participating countries.

How does 5S-KAIZEN-TQM work?

‘5S’ represents a set of five entry actions for creating a better working environment: Sort, Set, Shine, Standardize and Sustain; ‘KAIZEN’ is a participatory performance and productivity improvement approach through incremental and reflective team actions; and ‘TQM’ (Total Quality Management) is the approach for system-wide management in pursuing higher-quality products and services.

A total of 22 countries, including more than 500 health facilities, have adopted the model in Africa, the Arab States and Asia through JICA cooperation, promoting knowledge-sharing and co-creation among participants. The United Republic of Tanzania is a 5S-KAIZEN-TQM champion and serves as a pivotal country for its expansion throughout Africa. A recent JICA survey shows a net improvement in the country’s hospital cleanliness, waste segregation, work environment, patient satisfaction, patient waiting time, incidence of phlebitis associated with intravenous cannulation, the number of rejected laboratory samples, and overcrowding of patients. Hospital revenue has in turn risen thanks to better application of health insurance. JICA continues to facilitate the model’s knowledge-sharing and co-creation aspects among Southern countries, providing financial, technical and logistical support.

5S-KAIZEN-TQM involves ministry officials and key medical professionals in programme design and implementation and as such is institutionalized into the national health management system. The model is user-friendly – designed to help users to learn and apply it in their own work environment. It is suitable for diverse country and sector contexts, its application entails minimal costs, and its simple design means that there is no need for expensive technical consultants.

Sustainable Development Goal targets: 3.3, 3.b, 3.c, 3.d