I’ve always wanted to be a doctor. It was such a joy for my family when my twin brother and I got accepted into medical school on the same day.

My dad did not go to a higher education institution, so it was a big deal for him. He was managing chronic illness — diabetes and hypertension — like a lot of other people about his age at the time. He took his medications regularly, but one day he developed a blister on one of his legs. I made sure he presented to the hospital early, and he had to be admitted. We were hoping he that he’d be able to go back home in a few days. But a few days became a few weeks, and a few weeks became a couple of months. He acquired hospital infections, experienced never events, and went through things that should not happen. We lost him to something very preventable.

Some people become scared of going to the hospital because of experiences like my father’s. Over time, I started seeing the same story occur repeatedly. I realized that I could help improve the system and makes outcomes and experiences better for others.

A Community of Champions

As I gained experience, I realized that one of the most important ways to ensure quality improvement (QI) and patient safety in Nigeria is to develop a community of champions to spread the knowledge and the practice. Through the IHI Leading and Organizing for Change online course with coaching, I learned about the snowflake model of distributed leadership — a non-hierarchical approach to coordinating a team.

I started the project with three phases:

• Build a team of health care professionals with QI and patient safety knowledge.
• Help these champions establish teams where they practice so they will not be alone.
• Support these teams in implementing QI and safety projects.

I reached out to a few other champions in the country. For our first target, we aimed for 200 health care workers to take an introductory course in QI and patient safety from the International Society for Quality in Health Care by the end of 2020.

Overcoming Resistance

Most of the health care professionals we talked to believed that academic and residency training equip you with all you need to know about caring for your patients and improving systems. They did not see the need to take another course. Over time, a few participants saw the importance of this knowledge. Then, they reached out to their colleagues.

The COVID-19 pandemic began during our work. People were not certain about job stability, inflation kept going up, and even with discounts for which we’re grateful, cost and time became a growing concern.

Taking courses online also posed a challenge. We needed to find an avenue to be able to network and ask questions. We developed a community on social media platforms to ask questions, learn from each other, and share useful resources.

Sparking Improvement

Despite the pandemic, over 70 people have taken the training. We ask them to complete a questionnaire at enrollment and at completion, and the learning opportunity has been significant. Their scores have more than doubled.

Participants also influence others within their circles. One participant, who is also a consultant surgeon, presented at the West African College of Surgeons to introduce more people to QI and patient safety.

Participants consciously think about how they can improve systems, instead of putting the blame on a government entity or an individual person. Right now, we don’t routinely collect data from our health institutions. For the second phase of the project, we are working to understand how we can measure from the baseline over the course of the project and see how things have changed.

Many participants have shared concept notes — initial drafts of their aim, measures, and planned changes to start QI projects at their institutions — and we give them guidance.

Lessons Learned

During the Leadership and Organizing for Change class, I picked up this the definition of quality improvement: using what you have, to become what you need, to get the results that you desire. You probably already have more than enough. Leverage the existing resources, like courses or your network. Here are some other lessons I’ve learned:

• Distribute your leadership. You don’t need to shoulder the whole responsibility yourself. Our team of experts helped share ideas and review the implementation. This makes the process easier and sustains the passion for the work.
• Develop a community. People didn’t take the course and go. We put all of them together to form a network. I was lucky that I had a mentor who guided me through my learning. Knowledge alone is not always enough.
• Modify as you go. We did not abandon the project because of challenges like COVID-19. We were persistent. When you run PDSA (Plan-Do-Study-Act) cycles, some of your changes will do very well and some might not achieve your target. You and your team continue to learn along the way.

What’s Next

Clinicians, public health professionals, people in health care data analysis, pharmacists, nurses, and other health care professionals have completed phase one. Now, we’ll support them to spread the word to others at their institutions and start teams to practice the work together.

We’re also working to support QI and patient safety groups that bring together students in medicine, nursing, and pharmacy to learn from each other. In the future, we’d like QI and patient safety to become part of the routine learning in medical schools across the country.

Balogun Stephen Taiye, MBBS, MPH, PMP, FISQua, is a public health physician, data scientist, ISQua Ambassador, and Lucian Leape Patient Safety Scholar.

You may also be interested in:

IHI Africa Forum (4–6 May 2021 | Online)

IHI Patient Safety Essentials Toolkit

A Framework for Safe, Reliable, and Effective Care