I recently visited IHI’s new office in Addis Ababa, Ethiopia, and got to see some of the work our dedicated staff is doing in this country in the Horn of Africa. While I certainly recognized differences between the health system there and ones I’ve seen in the US, Europe, and Asia, I also saw many similarities in the challenges we face — and the opportunities we all have for improvement.
In reflecting on my visit, I’ve taken away three lessons that can help inform large-scale improvement work anywhere in the world:
- Think strategically to guide you through uncertain times
- Use quality improvement to empower staff
- Be open to learning from others
Think strategically to guide you through uncertain times
Whether they encompass a few hospitals, a region, or an entire country, health care systems of all sizes around the world have trouble with focus. There are so many challenges to address. How do you prioritize?
Ethiopia is a big country, with a population of about 100 million in 11 regions, and we’re doing work in four of them, soon to be five, as we scale up to the whole country. We’re helping local groups and the federal ministry of health to implement a comprehensive quality strategy.
Thinking strategically about quality and improvement throughout a system provides a compass to keep you on the right path. A clear strategy focused on what’s best for patients creates a set of principles around which providers and provider organizations can unite, even when there may be disagreements along the way.
Use quality improvement to empower staff
One of the most exciting aspects of my visit was to see how empowering quality improvement can be for those providing direct care. I spoke with clinicians who really understand the Model for Improvement. With the help of our local staff, they have developed change concepts and change theories, tracked their results over time on run charts (often without the aid of computers or printers), and are now thinking about their next set of improvement projects. Despite the resource challenges they face, they’re changing the things that they can change, and they’re making the improvements that they can make. In the prototype sites for our multi-year initiative in Ethiopia, we’re already seeing promising improvement.
If people who struggle with a lack of basic equipment and limited availability of tests and drugs can feel empowered by quality improvement, then surely that can happen everywhere. But it can’t happen without leadership support. Empowerment means giving people the right skills, the permission to make changes that they deem necessary, and the time to work on improvement.
One of the other things we’ve done successfully in Ethiopia is create a line of sight from the strategy to the point of care. This is important no matter what country you’re working in. Make it clear to your teams how the changes they’re making at the point of care connect to your system’s big strategic priorities. Joy in work lies at the intersection of empowerment and connection to purpose.
In the IHI Leadership Alliance, we talk about “assuming abundance” as a core principle for system-wide change. To be sure, “abundance” can mean different things in different countries. But no matter the context, there truly is abundance in the passion, dedication, and skill of health care professionals everywhere. Harnessing and directing these assets are essential for long-term, sustainable improvement.
Be open to learning from others
During my visit, I was reminded of my former job as Chief Executive of NHS Scotland. A hospital chief executive told me, when he and his colleagues began their work on developing the Ethiopian strategy, they looked for similar national quality strategies. At the time, one of the few they could find was the one Scotland developed with guidance from IHI.
But just as Ethiopia is applying lessons learned in other countries, likewise, there are some things that we are testing and doing in Ethiopia and other countries in Africa that are entirely transferable to the US or other developed countries. Kangaroo mother care is a good example. The skin-to-skin contact between a newborn and their mother is beneficial to both the baby and the mother. This is true in Ethiopia or Ghana or Malawi. It’s also true in Louisiana and Scotland.
I returned home re-energized by what I saw in Ethiopia. The leaders and staff there are living these lessons every day. It’s truly inspiring to see people in such a large nation come together and work together to improve the health and well-being of their fellow citizens. I can’t think of any country in the world that wouldn’t benefit from their example.