January 27, 2015
Story by Gregory Kennedy; photo courtesy Steve Peirce
Sometimes the most effective tools aren’t the ones you hold in your hands, but the ones you deploy with your mind.
Tanzanian university students recently gained a “toolkit” of new strategies for identifying gaps and bringing positive change to their nation’s public health care – thanks to the classroom visit of experts from Alberta Health Services (AHS) and the University of Calgary’s Cumming School of Medicine.
This collaboration, in support of the new masters of public health program at the Catholic University of Health and Allied Sciences (CUHAS) in Mwanza, brought new perspectives to 15 keen students drawn from public health administrators, physicians and nurses.
“I think they were just charged at having a means to approach their problems,” says Steve Peirce, Director, Process Improvement South for AHS in Calgary, who journeyed to Africa in October 2014.
“I think they were excited about the Alberta Health Services Improvement Way (AIW) because it gives them some tools to take all the stuff they’re learning… and figure out ways to operationalize and apply their new knowledge.”
The AIW model — an organization-wide approach for solving problems, making improvements and managing change — was created by AHS as a way to provide a consistent and effective framework as well as a shared language for change and improvement efforts across the province.
Joining Peirce in the classroom on the CUHAS initiative were: Dr. Silvina Mema, an AHS resident in public health and preventive medicine; and Kenna Kelly-Turner, program co-ordinator for the public health and preventive medicine resident training program at the U of C.
“Our African students were very enthusiastic about learning the content. They were motivated,” says Dr. Mema. “Most of them are funded by their local public health unit. The expectation is that they will learn something and come back to take the lead in making life better and healthier for their communities.”
“I see AIW as being a big part of our master’s program,” says Sospatro Ngallaba, Dean of the School of Public Health at CUHAS. “It’s very much an enabling strategy to help us deploy the principles of public health.”
A rapidly growing city of about a million people, Mwanza — Tanzania’s second-largest centre after Dar es Salaam — lies on the southern shore of Lake Victoria, a few hours’ drive from the Serengeti National Park wildlife sanctuary to the east.
“What was most remarkable to me was how similar the class was there to an AIW class within AHS,” says Peirce. “You go to a different country, and the culture’s different, the people are different, the education system is different and the hospital looks and feels much different.
“But once the MPH students got in the classroom, motivated to do a better job for their communities, the discussions were remarkably similar to the ones we have with our health care people here in Alberta.
Students were asked to identify gaps in the public health of their communities, then suggest how they might use their newly acquired AIW tools to help close the gaps.
“We have one technique we call the five whys — you keep asking why, why, why until you get to the root cause of a problem,” says Peirce. “They really seemed to catch on to that.”
Some of the opportunities that the participants identified to improve public health in their own communities include: changes to contribute to reduction in infant mortality; improved adherence to clubfoot treatment protocols; improved use of cattle dips to reduce tick borne diseases; and increased HIV testing for children.
Adds Dr. Mema: “We’re looking forward to strengthening our collaboration with CUHAS. Our work really aligns with the national strategy in Tanzania of implementing quality improvement in health care.”
Jennifer Hatfield, Associate Dean of Global Health and International Partnerships for the U of C, says: “Our partnership with AHS is at the core of our ability to deliver on our educational mandate.”
“I’m thrilled that this is one of our first bridges to AHS; to enable the people of AHS to share their programs and their skills globally. Our partners in Tanzania see this opportunity as one that will enjoy a very long life. We’re going to build their capacity in Tanzania over the next few years to deliver their healthcare programs.”
FACTBOX 1: All about AIW
The Alberta Health Services Improvement Way (AIW) is the standard approach to process improvement within AHS.
It was developed in 2009, in part to help bring the various zones together by speaking one common language and having one common set of tools for how AHS goes about with process improvement.
AHS employs 28 members on its process-improvement team provincially, plus another 100 colleagues who work in clinical quality improvement groups at the zone level.
“One hundred thirty people can’t move this big AHS ship of 120,000-plus,” says Peirce, “so our big mandate is to spread the skills, the knowledge and the understanding through AIW, and ultimately our people can do their own improvements in a structured sort of way.”
To date, more than 9,000 AHS employees, physicians and partners have taken the introductory AIW training course.
Its techniques and tools are based on Lean, the Six Sigma system and others.
FACTBOX 2 What is Six Sigma?
Six Sigma is a set of techniques and tools for process improvement. It was developed by Motorola staff in 1986. Today, it is used in many industrial sectors.
Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in manufacturing and business processes.
It uses a set of quality management methods, including statistical methods, and creates a special infrastructure of people within the organization using designations similar to the martial arts (champions, black belts, green belts, yellow belts, etc.) who are experts in these methods.
Each Six Sigma project carried out within an organization follows a defined sequence of steps and has quantified value targets, for example: reduce process cycle time, reduce pollution, reduce costs, increase customer satisfaction, and increase profits.
FACTBOX 3: What is Lean?
Lean, which is based on the Toyota Production System, is about systematically identifying and then eliminating waste. Every process has inherent waste in it like waiting, transportation, defects, etc., and the Lean methodology uses various techniques to first define the waste in a process and then minimize it (workplace organization, pull scheduling, change-over reduction, etc.)
The AIW takes some of the jargon out of the Lean and Six Sigma language to create a common, shared language for improvement work, so that it is easily understood by everyone in AHS.
