Turning Back the Clock

Ayder Referral Hospital

Earlier is almost always better than later, and Amleset Tesfaye knows it. The wise, Tigrayan woman makes a living by selling fruits and vegetables at the market near her home in northern Ethiopia.

Every three months, Amleset wakes up early for a regular appointment at Ayder Referral Hospital in Mekelle. These early mornings mean the start of a long day, but just how long is often unpredictable for the diabetic woman.

For many people, a visit to the hospital for blood work means fasting. For diabetic patients, fasting can have extreme consequences. When it comes to managing blood glucose and diabetes, time is of the essence, but by early 2016, the average waiting time for patients at Ayder Referral Hospital in Mekelle, Ethiopia, was nearly two hours; however, this problem did not need to remain the reality.

Ethiopia’s Federal Ministry of Health “had a plan to train leaders and health professionals on leadership, management, and governance,” says Dr. Amanuel Haile, Medical Director for Ayder Referral Hospital. “They chose some institutions, and ours happened to be one…” that the Ministry connected with the USAID-funded Leadership, Management, and Governance (LMG) Project.

The LMG Project trainers used an experiential, team-based training program, customized from the Leadership Development Program Plus (LDP+) to reflect the Ethiopian context, to equip managers at Ayder Referral Hospital with deeper and broader leadership, management, and governance skills to meet the evolving challenges of their jobs. Nearly 60 staff have participated in the program. The team is halfway through the program, and is already seeing positive change.

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Identifying a key challenge to delivering quality health services is an important step during the training. Although long waiting times were an obvious problem to patients like Asmrom Abreha and Zemichael Gebregziaber, two routine diabetic patients at Ayder Referral Hospital, it was not seen as a critical problem for all facility staff.

However, after department heads and leaders at Ayder Referral Hospital used the Challenge Model (a key step in the LDP+), they found that long waiting times—sometimes up to three hours of more—were a widespread problem affecting patients’ access to services and a challenge to improved health service delivery. Together, the Ayder team agreed to address patient waiting times as a challenge to overcome using the approaches in the LDP+. They analyzed the root causes of the challenge to solve it with a management action and without additional resources.

As the sun rises, some of Amleset’s fellow patients are already on their way to Ayder Referral Hospital. By the time physicians arrive, around 8:00am, the patients fill waiting rooms throughout the hospital.

Prior to the LDP+, physicians would have their morning clinical audit promptly at 8:00, meaning patients continued to wait. This also forced physicians to see all patients in a short, two-hour block prior to lunchtime. Each physician was expected to see 15 to 20 patients during that period, compromising the quality and attention that each patient received.

After collaboratively identifying patient waiting time as a critical challenge to health services during the LDP+, physicians agreed to hold their morning clinical audit at 11:00am as a way to overcome the challenge and decrease patient waiting times.

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Now, physicians see patients immediately upon arrival. This simple change helped health workers at Ayder Referral Hospital reduce the two hour average patient waiting time, contributing to an enabled environment that prioritizes patient care, and people are noticing. Although staff have only participated in two of four LDP+ sessions so far, the enabled environment means less stress and more time for more personalized services to their patients.

Asmrom and Zemichael have both been coming to Ayder Referral Hospital for more than four years, and they enthusiastically affirmed the changes that have swept the hospital in the weeks since the LDP+ started, saying that they are waiting less time to be seen by physicians and that the physicians are being more respectful towards their patients. Before these changes, the time crunch meant that physicians might need to see 20 patients or more before lunch; however, now the physicians have more time to spend with each patient.

Management changes, like rescheduling meetings to prioritize patient care, often do not require additional resources, and when teams collaborate, they can conquer challenges to improve health service delivery, performance, and quality.

After only two LDP+ training sessions, patients like Amleset are already reporting improvements in services at Ayder Referral Hospital. For her, these changes mean less time waiting at the hospital, which means more time to sell vegetables before they spoil, putting more money in her pocket–in addition to her clean bill of health.

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