This is the third in a four-part series that will address four essential areas for health systems strengthening.

Photo: Todd Shapera

Following a recent training for executive hospital leaders from Nigeria Hospitals, LMG Project director Dr. James A. Rice, participated in a day of discussions about the hospital of the future and strategies Nigeria and other low- and middle- income countries will want to consider for their future vitality and sustainability.

Four random groups of executives were invited to quickly identify important obstacles to:

• Improve clinical quality
• Enhance patient satisfaction
• Increase efficiency (reduce costs)
• Enhance stakeholder engagement

The following ten obstacles should be used by health leaders and hospital executives for discussions with their physician, nurses, staff and governing body about how best to implement sensible actions that could remove, reduce or work around each of theobstacles to patient satisfaction.

What is stakeholder engagement and why is it important?

Stakeholders are a diverse and important group that includes at least these: staff, physicians, patients, suppliers and vendors, policy makers, middle managers, purchasers and payers for health services, media and the community at large. They all have an interest in how we do our service delivery, and have ideas about how to do it better. They need to be invited in and supported to look for better ways to strengthen the performance of our health programs and facilities. They need to be engaged.

Their greater engagement not only improves the chances that we get better ideas about how to improve, but they are more likely to help own the problem and then  the solution so they are more likely to help get the improvement plans implemented. They may even help secure resources we need for action.

An overall conclusion then is that the hospitals of the future need not just high IQ managers, but high Engagement Quotient managers or the ability to successfully engage others in problem solving and solution implementation.

Obstacles to Enhance Stakeholder Engagement:

1. Lack commitment from CEO to make sincere invitations for workers, physicians and nurses to participate in process of improving our working conditions.
2. Lack vision that motivates workers and other stakeholders to become engaged in planning and process improvements.
3. Poverty of patients and workers makes it difficult to secure incentives to make changes, so why try?
4. Lack of training about how best to do better engagement and continuous process improvement.
5. Managers do not listen well, we need training how to do it, and the motivation from others to try it.
6. Lack culture of trust and respect and rapport among workers, physicians, nurses, patients and community.
7. Weak communication in general across departments, professions and levels of workers.
8. We lack feed-back loops to track progress to plan, and to monitor degrees of success.
9. Lack basic business planning capabilities.
10. Lack time and time management skills to make time available for smarter stakeholder engagement and team work.

The key for CEO success in addressing a defined list of obstacles to efficiency is to take the list and get your team to discuss them, refine them, and then add to them. Then prioritize the list down to the top five and assign a small team to do something about each one. Develop practical actions that can yield many results by reducing, removing or working around each of the top obstacles. Those results will embolden you and your staff to try the next five obstacles on the list.

Three actions to consider would be:

1. Invest in educating a team of staff innovators that can then study, over a 30 day period, ways to be efficient in similar hospitals in Nigeria and in other countries. Help these staff become internal advisers and trainers for other teams across departments/service units of the hospital;
2. Support a 2-3 pilot projects that can show early gains that can stimulate others to try additional efficiency ideas. Find creative ways to recognize and reward these small successes with thank you notes to workers and their families, time off, travel to education program, dinner out or small bonuses etc.;
3. Invite in advisers from similar hospitals or health facilities to give cases studies and explain how they did their improvements.