Solving Nigeria’s healthcare challenges: by Femi Aina

There are more Nigerian doctors working and excelling outside Nigeria than those in Nigeria

Nigeria’s healthcare industry must be one of the greatest paradoxes of modern world, Nigeria has the most cerebral, intelligent and hardworking professionals in healthcare- but this is only visible when outside the shores of this country.

Even with dire shortage of doctors in our hospitals, there are still more Nigerian doctors working and excelling outside Nigeria than those in Nigeria. A surreal joke in the healthcare industry is of the Nigerian money-bag that goes abroad for world class medical treatment delivered also by a Nigerian Consultant in the foreign country.

Another paradox is the seeming blindness of private investors to see any opportunity in our healthcare industry while foreign investors do- Mo Ibrahim, the telecoms guru recently invested in Lagoon Hospitals via Satya Capital, and Liberty Group of South Africa bought the controlling interest in THT- one of our fledging HMOs, in fact Rana Mehta of Technopak- an Indian health consultancy is firmly of the opinion that Africa is the next frontier for global health investors. No wonder the eminent Lawyer- Femi Falana recently sued the Federal Government to court over our atrocious healthcare system.

Our healthcare problems are many and varied; we have one of the worst healthcare indices in the world e.g. maternal mortality, under five years mortality, malaria prevalence, HIV, Infectious Diseases. These problems cannot be solved by simply throwing money at our problems like the Federal Government recently did by approving increased pay for doctors with other healthcare professionals queuing for their own share of increment, even then the doctors still yet are requesting for more pay. Our healthcare challenges need much more than money to resolve- it requires a paradigm shift from the present way of doing things. We need to imbibe a culture of excellence for us to start solving these problems.

Imbibing culture of excellence involves many things like change management, ability of healthcare managers to sell a worthwhile vision to healthcare professionals, metrics to back up improvement needs and claims. We need to create an environment where every healthcare professional is geared and motivated towards providing excellent service delivery to the populace right from the Federal Ministry of Health to the smallest Primary Healthcare Centre in a state like Gombe.

We need to create an environment of continuous improvement in service delivery and focus on quality service based on measurable parameters, which will also serve as a form of motivation for healthcare professionals- this may arrest the pernicious and continuing brain drain in the sector. A way of accomplishing this is to make some part of remuneration performance-based. We need to adopt management systems and methodologies that will focus employees’ duties of rendering quality service, with a foundation of evidence- based statistical metrics. There is need for boundary less collaboration amongst healthcare professionals with only the Patient as the focus of all activities embarked upon within our healthcare centers. This collaboration should be geared towards improving quality measures including length of hospital stay, cost of healthcare service/patient/disease

A way of accomplishing these objectives is to deploy Six Sigma in our Healthcare sector. Six Sigma is a metric to aim for i.e. 3.4 errors in a million opportunities. Six Sigma assures that the possibility of medical errors is practically reduced to nothing. Six Sigma is also a philosophy which shows everyone in an organization the direction to follow and reflect a way of doing business. Six Sigma is also a methodology which is a systematic approach, a set of statistical tools, a vehicle for people involvement with the focus on rendering superior service to improve customer satisfaction.

Six Sigma is the step by step approach of reducing variation in every process of the organization in order to satisfy the customer. This is undertaken in a project environment by dedicated personnel. Six Sigma is a business process that allows hospitals to drastically improve bottom-line by designing and monitoring everyday business activities in ways that minimize waste and resources, while eliminating lapses in quality at the earliest possible time.

Six Sigma is different from other quality improvement methodologies in that it supports improvement in quality and customer satisfaction only as a means of improving the bottom-line of the organization. Six Sigma was initiated in 1979 by Motorola, the methodology has saved Motorola $2.2 billion since then, Jack Welch, one of the greatest CEOs ever, deployed it in General Electric in 1995, by 1997 GE had saved $300 million using Six Sigma.

Other companies that have deployed Six Sigma include Nokia, Ford, Toshiba, and Lear. Financial companies that deployed it include Citicorp, American Express, Merrill Lynch. Organisations in Nigeria that have deployed this methodology include Sheraton Hotels.

Six Sigma helps to develop a culture that supports continuous improvement based on financial gains. This is especially important in a service industry like the healthcare industry. Stakeholders in a highly evolving industry like the healthcare industry in Nigeria, with increasing patient knowledge and awareness and demand for high quality service in an environment of dwindling resources, need to be versed in Six Sigma methodology.

Six Sigma helps to reduce waste, streamline processes and make the hospital lean and mean with the ability to respond to new situations while at the same time constantly improving their processes. Innovative solutions and practical working processes are the only way to make healthcare centers effective and efficient especially in high volume areas of a typical healthcare facility like the pharmacy, radiology, laboratory, admissions and discharge and the waiting room. The hospital increases capacity to deliver quality service to increasing patient volume by Six Sigma-trained clinical and non-clinical staff.

Six Sigma deployment is very important in healthcare centers, especially in areas like operating theatre and outpatient patient where the margin for error is minimal to nil, as the focus is to prevent rather than detect errors. Six Sigma helps to establish quality metrics in the hospital, which is monitored and compared after the deployment of Six Sigma methodology. Lean Six Sigma considers the expenditure of resources for any goal other than the creation of value for the patient to be wasteful, and thus a target for elimination, therefore the whole focus of the organization is spending to satisfy the customer and creating value for the customer.

Lean typically seeks to eliminate the seven types of waste like Overproduction, Correction (defects), Inventory, Motion, Over-processing, Conveyance and Waiting. The focus of Lean Six Sigma is increasing customer satisfaction as a means of improving the bottom-line of the organisation. Our healthcare centre gain by improving their Internally Generated Revenue (IGR) by reducing waste, avoiding costly errors and having more patients. The major aims of Six Sigma include Customer Satisfaction, Reduction of variation in processes, Employee Motivation, Statistical Based Improvement efforts and Excellence in Quality Service Delivery.

• Aina, a medical doctor, project manager and Six Sigma practitioner, lives in Lagos.