Patient-Centered Care in Rwanda

As part of the leadership team t the IHI Open School, University of Michigan Chapter, I had the opportunity during the past academic year to learn about the provision of patient-centered care. Although I was not expecting my IHI learnings to play a large influence in my summer internship in rural Rwanda, I've been quite surprised at how useful and applicable it has been.

This summer, I've been working in Rwanda with Access Project, an NGO that supports health centers in applying business and management skills to increase access to life-saving drugs and critical health services in their communities. For the past month, I've been working in a rural health center in the village of Ruhunda. I have been supporting the Titulaire, the nurse in charge of the health center, to improve efficiency and safety in several areas around the health center. I spent the first couple of weeks establishing strong, positive relationships with the staff while I observed their services. Afterwards, I begain a discussion with the Titulaire on what he, the staff, and the community believed to be the main obstacles in the provision of care at the center.

The main recommendation that I suggested focused on decreasing wait-time and improving patient flow at the health center. There were several reasons for this. First, the Titulaire mentioned that long wait time is a main complaint brought up in community discussions. In addition, my own observations at the Center confirmed that there was basically no system in place to deal with patient flow, or a process in place to ensure patients are seen on a "first come, first served" basis. The chaotic situation was what my friend Karen calls a "low hanging fruit," or an easy opportunity to make a significant and quick impact. Also, the health center is very understaffed, and this project could potentially produce much improvement with little or no additional burden on the already strained staff. And finally, and most importantly, this project improves patient safety, as there will now be a system to deal with illnesses and emergencies in a timely and efficient manner. To emphasize the severity of the situation that I observed, I was told by staff members that there are times when patients even decide to leave the health center instead of subjecting themselves to the long wait for care. This is a huge patient safety issue!

After conducting a baseline analysis for a few days, I discussed with the Titualaire my recommendations on how to improve on the current situation: I developed a simple numbering system to ensure that patients are seen on a first come, first served basis. The system also includes easily understood symbols to guide patients to the correct waiting areas, which is critical for communities with a significant illiterate population. I provided a simple template and trained him on how to create the staff task list on a weekly basis, instead of on a daily basis. This would allow the medical staff to be notified of their tasks in advance, and therefore provide them with enough preparation time in order to start seeing patients at exactly 8:00 am, when the health center opens. And finally, I discussed with the staff the results of my baseline analysis and the new system I devised with the support of the Titulaire, and asked for their input on potential problems. After a couple tweaks here and there, I'm excited to say that I've successfully implemented the new system and that I'm in the process of collecting data on how patient wait times have improved.

I feel extremely lucky to be working with Access Project, and organization that has given me the freedom to pursue this project and has encouraged and supported my work throughout my stay in Rwanda. My Access Project colleagues have provided invaluable support in helping me develop my ideas and also train the staff meembers during the practice "run through" of the new system. And because of my work in Ruhunda, I've been asked to travel to Gashora, where Access Project is building a model health center, in order to work with HR and patient flow issues. I'm so excited about this opportunity!

With that said, you may be asking how IHI has come into play during this time. IHI has provided me with the framework on how to successfully address an issue: the Model for Improvement. Being involved with the IHI Open School Chapter this past year and completing the IHI Open School online courses has also helped me develop an eye for recognizing opportunities for improvement and has trained me to be constantly aware of issues dealing with health care quality and safety. With this experience under my belt, I'm looking forward to rejoining my fellow IHI Open School colleagues in the fall, and having some great discussions about how they've been working towards improving patient safety and care this summer.