Final Report

12/Mar/2016

Miki KUMADAJapan Overseas Cooperation Volunteers

Batch ; 25-4Profession ; Nursing

Assignment ; Kericho County Referral Hospital

Topics� Outline of the assignment

� Activity in 1st year

� Activity in 2nd year

� Result of the study

� What I faced as challenges

� What I gained

About my assignment� Occupation ; Nursing

� Assignment ; Promote 5S/KAIZEN activity

� Basic activities ; 3S in pilot areas, Documentation,

facilitation of QIT

� Performance activities ; Visualization, Presentation

Outline of the hospital� Kericho County Referral Hospital

(County hospital/Level 4)

� Bed capacity ; 270

� Number of staff ; 400

� Common disease ; Pneumonia, Malaria

� Out patients attendance ; 450/day

� Number of delivery ; 15/day

� Waiting time ; 6 hours

History of 5S/KAIZEN-TQM*

� QIT was established ; 2005 ( 10members )

� Reestablished QIT ; 2007

� Introduced by JICA ; 2011

� Training, Benchmarking ;2011

2011年に導入されたものの、2012,13年の記録はほとんどなく、

ただ何もせずボランティアを待っていたというのが現状だった。

* TQM = Total Quality Management

2011

導入時

2014

赴任時

完全に元に戻っている…

Activities of 1st yearMay 2014 - Mar 2015

� JOCV assigned ; May 2014

� 3S at 3 Pilot areas (OPD, Casualty, WD5) ; May-Aug 2014

� Presentation at CME (5S/KAIZEN Introduction) ; Sep 2014

� Site visit in Tanzania (Muhimbili & Mtwara hospital) ; Sep

2014

� 3S at Dental, Eye unit, CCC ; Oct 2014

� Offer Mr. Kinyangi to strengthen following up ; Feb 2015

� Accept visitors from JICA ; Mar 2015

タンザニアでは半年に1回保健省からの視察があり、5Sが定着しているのに、ケニアではない

ことに気づく。JICA保健セクターにフォローアップ強化をお願いする。

Before After

ひとりで何往復もして不要物を捨てた。そしたらほとんど空になった。

Before

After

我が病院の救急トレイ。ものがなんとなくあるだけ、マシな方で、ほとんど空っぽの病棟もある。

Activities of 1st yearPresentation at CME

(5S/KAIZEN Introduction) ; Sep 2014

Activities of 1st yearVisitors from JICA ; Mar 2015

In documentation…

� Currently it is only the JOCV assigned by JICA that is

actively involved in implementing 5S. She has been

able to move through the pilot sites and help in sorting

and setting in these areas gain. However the staff are

not very supportive even when she has strived to

conduct on-the-job demonstration of 5S activities.

3月の訪問で来たコンサルタントがまとめてくれた各病院の5Sの現状。

ケリチョ病院の課題のところに、はっきりとJOCVだけが頑張ってると書かれてしまう。

Department

Management QIT

WIT WIT WIT WIT

保健セクターから指導されて、病院の病棟ごとの職場改善チーム(Work Improvement Team)

を作ることになる。

Activities of 2nd yearApr 2015 - Mar 2016

� Establish WIT* at 7 pilot areas ; Apr 2015

� Presentation at CME (Hospital infections) ; Apr 2015

� Exchange visit program with JICA, Machakos L5

hospital ; May 2015

� 3S at WD2, Labour, Rehabilitation ; May 2015

� Attend JCIE press tour ; Jun 2015

WIT*を作り、トレーニングを企画。ひとりで病棟をラウンドして、WITの再編やらトレーニングの

リマインドしてと、準備すれば延期の繰り返し。

病院訪問される機会も増え、チームのモチベーションが上がったと思っていたけど、

上がったのは私だけで、空気に腕押し状態が続き、ついに心が折れる。

* WIT = Work Improvement Team

� 5S forum/Exchange visit program to Machakos ; Aug 2015

� Attend training on 5S/KAIZEN-TQM (Rose in Japan & Tanzania, Lizbeth in Egypt) ; Aug 2015

� Presentation at CME (Actual goals of 5S/KAIZEN) ; Sep 2015

� Training for WIT ; Oct 2015

� Site visit at Thika L5 hospital (pre-assignment); Nov 2015

� Research on 5S/KAIZEN ; Ongoing

Activities of 2nd yearApr 2015 - Mar 2016

ついに自分たちでトレーニングをやった！と喜んでいたのもつかの間、ティカ（ナイロビ郊外の街）の病院に行くとスタッフの意識の違いを突きつけられる。

Activities of 2nd yearEstablish WIT at 7 pilot areas ; Apr 2015

Activities of 2nd yearExchange visit program ; May 2015

Activities of 2nd year5S forum/Exchange visit to Machakos ; Aug

2015

Activities of 2nd yearTraining for WIT ; Oct 2015

Through my activities…

例えば人が倒れてもドクターが誰もランチから席を立たない、救急外来でも正しいファースト

エイドができない。そういう現状を見て、人を助けることに興味がないのに、どうやって5S・改善

に興味を持たせられるのだろう？この活動はケニア人の医療の質を本当に上げているのか？

というか彼らの考える医療の質って何なんだろう？と疑問があふれだす。

Study on 5S/KAIZEN-TQM

� Purpose ; to capture existing obstacles and to propose

possible future directions for JICA volunteers’ activities

… through measuring demands to 5S/KAIZEN by

Kenyan staff …and clarifying what volunteers are

required. …to look into other possibilities of volunteer

activities to contribute to improve the quality … besides

5S/KAIZEN.

…to improve the relationship and collaborative works

between …QIT and JICA volunteers.

5S・改善が本当にこの国に必要なのか？そのためのボランティアっているのか？

調査しようと思った。

� Target of the study ; QIT members at 3 hospitals which (will) have JICA volunteers

Study on 5S/KAIZEN-TQM

（別地域の3つの病院の比較）

Hospital 5S introduced JOCV

assignment

Number of QIT

members

Kericho 2011 May/2014 8

Machakos 2013 Oct/2014 12(5+7)

Thika 2011 Mar/2016 20

ボランティアがいる、もしくは入る予定の３病院を対象。

ケリチョは導入もボランティアのアサインも早く、5Sに関しては古い病院であるはず。スタッ

フの意識等に違いがあるのか?

ThikaKericho

Machakos

Study on 5S/KAIZEN-TQM � Quantity of responses

7

1

Kericho

66

Machakos

Respondent

Non-Respondent

12

8

Thika

What kind of activities

have you been involved in?

1. Implementing 5S

2. Implementing KAIZEN

3. Receiving 5S/KAIZEN training

4. Providing training

5. Others

0 20 40 60 80 100

1

2

3

4

5

kericho

kericho

0 20 40 60 80 100

1

2

3

4

5

Machakos

Machakos

0 20 40 60 80 100

1

2

3

4

5

Thika

Thika

が、5Sの次のステップである改善をやった人はケリチョにはひとりもいなかった

Why have you been involved?

1. To be ordered by superior

2. To obey the regulation

3. To clean up the hospital

4. To avoid medical accident

5. To earn money

6. Others

0 20 40 60 80 100

1

2

3

4

5

6

Kericho

Kericho

0 20 40 60 80 100

1

2

3

4

5

6

Machakos

Machakos

0 20 40 60 80 100

1

2

3

4

5

6

Thika

Thika

受け身な1,2の答えに対して自主性のある3、積極性のある4が多いのはどこの病院も一緒に

見える。

Staff of your hospital is capable in

sustaining 5S activities?

6

1

Kericho

6

0

Machakos

Yes No

10

11

Thika

Why yes? -Kericho

� With training and continual support, it can be achieved

� Require support from top management

� Require availability of resources of implement and sustain 5S/KAIZEN

� Because we have developed work improvement teams

� There has been training and implementation in pilot areas some of which are doing well

� Staff themselves have shown great interest in 5S activities hence have passion towards it.

質問: なぜスタッフが5S継続の能力があると思うか？

もうスタッフのローテーションで消滅したのに、WIT* を作ったからと答える人さえいる。

* WIT = Work Improvement Team

Why yes? -Machakos

� We already have the evidence of their training

� With daily practice and training of every staff, sustainability is possible

� If given the knowledge of 5S/KAIZEN because those trained have made some changes

� The have positive attitude and support from the top managers

� The staff are willing and have the right attitude

� The attitude is positively changing

マチャコスでは、スタッフの意識があるから、という理由がちらほら。

Why yes? -Thika

� Most of the staff that were trained with me were so much willing to learn

� Adequate support from the management, ongoing construction renovation of department, presence of QIT and WITs

� They have the will (attitude) or all capable to change

� The leadership supports

� They have the will

� The hospital management is supportive

� They are always eager and willing to implement anything that improves quality of care

� We have trained them

� They have a positive attitude towards the whole thing

ティカだとスタッフの意識があるからという意見がこんなに増える。

What do you think the

difficulty in sustainability is?

1. Attitude

2. Turn over

3. Knowledge/ Training

4. Support/ Funding

5. Leadership/ Ownership

6. Others

0 10 20 30 40 50

1

2

3

4

5

6

Kericho

Kericho

0 10 20 30 40 50

1

2

3

4

5

6

Machakos

Machakos

0 10 20 30 40 50

1

2

3

4

5

6

Thika

Thika

何が難しいか、は病院のそれぞれの色が見える。

トップとミドル層をトレーニングしたティカは、誰もスタッフのローテーションを理由にしない。

What do we need to do?

-Kericho� Continuous training

� Allocation of funds for 5S activities, provide enough resources

� List quality/KAIZEN on staff annual performance contracts

� Involvement and commitment from top management

� Induction of staff in implementing sites on 5S/KAIZEN

� Establishing a reward system to keep staff motivated

What do we need to do?

-Machakos� Staff training and sensitization whether on job training

or formal training on 5S activities, benefits etc.

� Benchmarking in departments or other health facilities

implementing KAIZEN

� The availing more space

What do we need to do?

-Thika� Intensive training of all staff, Keep capacity building

� Benchmark with best practice hospital

� Monetary allocation

� Motivate staff by involving them in activities

� Encourage the leadership

� Improves the QIT

� Support from administration

Why do you need JOCV?

Any expectation?- Kericho

� To oversee the activity and compare with Japanese standard.

� As a mentor, motivator, expectative train on Kiswahili for easy communication

� Provide the leadership and guidance assist.

� To steer implementation of 5S

� To train, to enhance sustainability, to achieve the goals

� JOCV has kept 5S/KAIZEN in the spotlight and active thus stimulating the other members of staff

� We should receive at least 3 volunteers for many departments within the hospital to be sorted effectively.

JOCVに何を求めるか？ケリチョはなんとリーダーシップを求めていたことが判明！

Why do you need JOCV?

Any expectation?- Machakos� Attitude is very positive about 5S/KAIZEN in her presence

� Continuous motivation to the staff, however the JOCV may not be here forever and thus at one time, we must learn of operate without her.

� The commitment/ expertise and for continuation

� Key person in implementation of 5S.

� The volunteer introduce the 5S to areas(departments) which have not heard 5S/KAIZEN

� Assist and mentor us in quality improvement

� The JOCV has much to teach in appreciation of knowledge

Why do you need JOCV?

Any expectation?- Thika� The KAIZEN started from their country, We hope they have a wide

arrange of experience

� For continuously of inviting and enhancement of KAIZEN activities

� To motivate staff by making together(team work)

� Share experience

� Continuous support in capacity building

� We need somebody hand on with no other duties

� Training/ M&E

� To observe the action and activities

What was the difficulty？

� Language

� Attitude change

� Budget

� Culture

� Motivation

ポレポレ文化と相反するタイムマネジメントを言わなきゃいけないし、1時間ものを探し続けても

平気な人たちに、小さな整理整頓を言ってもそれは響かない。

私は文化を変えに来たのではないし、でも文化と5Sどっちも優先するのが難しい。

そもそも日本でできた5Sをこの国でボランティアがやることは正しいのか？という葛藤がずっと

続いた。

私だって人間なのに、どこにモチベーションを置いたらよかったのか？

せっかくキレイにしても翌日にはぐちゃぐちゃにされていて、がんばり続けるのは辛い。

What I gained？

� Language

� Skills of presentations

� Develop a trust relationship

� Small but important changes

ひとりで頑張りすぎずにもっとメンバーを頼って待っていられればよかった。

今なら待っていればできるメンバーだと分かっている。

私に任せっきりだった5Sを自分たちでやりたいと言うようになったし、

ミーティングも、来たときは２時間待ちが普通だった。今は30分で開始できる。

小さくても私にとっては大きな変化。

まとめ、後輩へ� 文化の元に成り立つ習慣、そして意識を変えるのは一隊員では難しい。長い期間が必要。そのうちの２年と割り切る。

� 諦めないことは大切。でも傷つきすぎないよう、自分を守るためにもときには諦める選択も。

� Qualityに目を向け、病院・地域全体をとらえた活動を。あくまで

ゴールを達成するための「手段」であることを忘れず、ゴールに目を向ける。

� オーソリティになっては本人たちの継続につながらないが、ボラ

ンティアの立場からできること、聞いてもらえることは少ない。自分たちは「存在すること」にすでに意義があることを忘れない。

Thank you for listening