The vast majority of 170 million Nigerians have no access to affordable and quality assured health care. The government provided medical facilities are mostly over-stretched and most Nigerians pay out of pocket for basic health care. The Shell Petroleum Development Company of Nigeria Limited embraced the concept of Public Private Partnership as a strategic approach to Corporate Social Responsibility in the health sector. In 2010, SPDC in collaboration with the Rivers State government upgraded the Obio health center to a cottage hospital and worked with the local community to catalyse the Obio Community Health Insurance Scheme. The partners in the CHIS agreed an annual premium of N7,200 [about$36] per participant for access to essential primary and secondary health care, with special focus on maternal and child health.
As the insurance package covers more than 95% of community health care needs, patients seen daily increased from 20 to 147 per day. Patients spent long hours on visits leading to dissatisfaction. In 2012, Lean methodology was deployed to address this problem. The outpatient transit time starts from the time the patient reports to the reception, goes through the medical records, vital signs, consultations, laboratory investigation (if necessary), and pharmacy, till discharge.
With the use of Lean tools such as value stream mapping, lack of standardisation of key activities at transit points was found to be causing proportionate delay in patients waiting time. 5S exercise was carried out, Standard Operating Procedures and visual measures were developed and deployed with onsite trainings.
These led to 78% reduction in transit time, hospital handling more patient flow per day and improved customer satisfaction.
Lessons learnt include using leadership Gemba visits and inculcating Lean thinking among hospital staff to improve operational efficiency and bring about a culture change.