• ashirk@gmail.com
  • Kijabe, Kenya
on improving processes. . .

on improving processes. . .

When I moved to Kijabe almost 8 years ago, I was planning on working at the bedside, on teaching, on building our life here. What I didn’t know then (and I feel like few new graduates know), is how much I was going to eventually be involved in the day to day administrative processes of the hospital. Our patients are generally very happy with our patient care, but endlessly frustrated with our processes – how to get admitted, how to get discharged, how to maneuver an increasingly more complicated system.

For the last year I have been out the Discharge Quality Improvement Committee – I know, sounds super intriguing – spy level excitement – but seriously, if your whole stay is good and your leave with a healthy baby but frustrated with a tedious system, we have taken joy out of what should be a celebration of health and God’s healing.

In August, nursing, finance, IT, security, pharmacy, and I sat down to map out our process and it looked like this:

It was an insane, almost unnavigable 17 steps, and most teams had no idea how each other’s steps were working. So tediously, over weeks, we modified and adjusted and changed the steps one by one and we made a lot of progress. Complaints dropped, the queue at the cashiers’ window dropped in size and we patted ourselves on the back

We even presented it at the 1st annual research day and our team got first place for research overall and for Quality Improvement (see the poster below).

However, after about 4 months of success it broke again. Really broke – almost all the way back to where we were at the beginning as closed windows opened back up and previously fixed systems reverted back to the status quo. So we met again, and this time we went back to an idea that seemed impossible a year ago – Can we discharge from the bedside, and make it one of the best things, instead of one of the worst things, about the hospital. Our billing advisor piloted with some of our patients and it seemed work. So we all came together to decide the impossible was possible and presented it to the senior management team. And in 2 weeks, we are going to completely revamp a process

After I presented that we were moving to bedside discharge at research day, a few people from other hospitals came up and asked how in the world we had received the backing of the administration to try this? In the end, I think we have an administration that longs for things to be better and honors collaboration and creativity.

So below is the new process. If you have made it this far in my post about processes, can you pause and pray it goes well? Our cashiers are moving into the role of discharge specialist in about 2 weeks and we are really excited that this will make so many things about how we care for our patients better – that it will encourage accountability and build stronger teams.

And that it will encourage the team that has fought so hard for this to try even more impossible things. . .