Overcoming Obstacles to Improved Efficiency

Jim Rice

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

 

 

 

 

 

 

 

 

Photo: Rui Pires

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.

Obstacles to Improve Organizational Efficiency

  1. Inadequate skills, training among staff, and good data and data systems on current costs to do cost finding and cost reductions
  2. Lack of trust among workers, and poor working conditions that hold back willingness to be innovative or take risks to improve efficiency
  3. CEOs that micro manage, managers do not know how to delegate, and are afraid to try
  4.  Lack engagement of physicians and nurses in the process
  5. Lack tools and training to do process improvements as means of being more efficient, as well as lack ability to invest to save money, be more cost effective
  6. Lack accountability systems to measure change and improvements
  7. Lack willingness to provide recognition and rewards for good ideas to improve efficiency and reduce costs
  8. Poor electrical power and infrastructure that gets in way of fresh approaches for supply chain improvements, and care process improvements
  9. Budgets so low already hard to see how to reduce further
  10. No standards to follow, no case studies showing successes

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 3-5 and assign a small team to do something about each one. Develop practical actions that can yield quick wins by reducing, removing or working around each of the top obstacles. Those wins will embolden you and your staff to try the next 3-5 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.

Samples of improved efficiencies in US hospitals can be found here: http://www.ruralcenter.org/sites/default/files/RAP%20Reports.pdf

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