ANALYSIS OF BUSINESS PROBLEMS (ABP) CONCEPTS IN PRACTICE   

The Wards, Clinics and general work environment in OAGH (a public Hospital) was not as clean as it should ideally be. Hospital Hygienists responsible for the task were often not efficient in carrying out their tasks as at when due. This was further worsened by a lack of proper supervision by the Departmental Head in charge.  All this posed a serious health risk to both patients and staff who were all at risk of developing hospital-acquired (nosocomial) infections.

The Management of the hospital took the necessary step of reorganizing the Hygienists and their operations, while also providing well-outlined and communicated standard operating procedures for these cadre of staff. This was then further aided with trainings and role play scenarios and hands-on supervision.

PROBLEMS IDENTIFIED

1. Poor supervision
2. Lack of Standard Operating Procedures (SOPs)
3. Poor wages and general lack of motivation
4. Favoritism and lopsidedness in duty schedules
5. Knowledge gap on the essence of role at work   

ORGANIZATION OBJECTIVES

OAGH’s Vision is to be the choice regional center for excellence in health service delivery in Lagos state. Hospital also has a Mission to deliver prompt, qualitative, equitable and affordable healthcare services in a friendly environment, in line with international best practices.

GENERATE ALTERNATIVE OPTIONS

I had a series of meetings with officers in the Supervising Department (HoD Environment), all Hygienists, Hospital Administrative Manager, the Director of Clinical Services, and Apex Nurse. At each of these meetings, the Hygienists were asked to express their views freely and openly and to provide their perspectives on how there could be improvements in their work leading to the overall improvement in the hospital’s cleanliness. Other perspectives were also provided from Team leads present.

Alternatives Presented and Considered were:

1. Organize continuous trainings on hospital waste collection, handling and proper disposal
2. Reorganize duty schedule to be more objective and evenly spread among all Hygienists
3. Develop Standard Operating Procedures (SOPs) for the Hygienists
4. Change Supervisors – to build staff confidence in new system
5. Incentivize hard work, diligence and efficiency with staff recognition and reward measures

DEVELOP A CRITERIA

1. Develop Standard Operating Procedures (SOPs) on Cleanliness covering the Timeliness, Frequency, Mode, Materials etc.
2. Periodic objective feedback evaluation from Staff and Patients were conducted by the Quality Improvement Team of the Hospital to determine effectiveness, timeliness and quality of work done 
3. Attendance of Trainings was also used as criteria to determine those who got incentives

EVALUATE THE ALTERNATIVES USING ESTABLISHED CRITERIA

1. Continuous Training – this came at some cost to the Hospital, but this cost was far cheaper than the consequences of a filthy hospital environment
2. Reorganize Duty Schedule – this generated some argument and unsettled some of the ‘Senior’ Hygienist staff who felt they should do less work. However, the changes were still made and the prospects of productivity-based incentives helped in making them adjust to the new schedules
3. Change of Supervisors was a bit touchy and initially rocky, but all concerned eventually came to terms with the new development.

MAKE A CHOICE

1. The Choice was made to Change the Duty Schedule for the Hygienists
2. The Choice was made to have new Standard Operating Procedures (SOPs)
3. The Choice was made to change Supervisors
4. The Choice was made to Institute Productivity-based Welfarism to the Hygienist cadre of the hospital

RE-EVALUATE

Re-evaluation of the changes made is an ongoing process. Progress and improvements have been achieved in the hospital’s cleanliness so far, however, there is a need to periodically evaluate how well the process is going to prevent retrogression.

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