Paradigm shift in strategy and performance: Healthcare resilience

By Vincent Chagara

Over the past few years, Health Systems worldwide have faced tremendous and unprecedented changes and shifts in healthcare service delivery.

The paradigm shift has been occasioned by several factors that include rising demand for healthcare services; advancements in medical technology and innovation; increased competition among healthcare service providers; increased consumer knowledge on their rights and changes in health policy towards universal healthcare.

These factors have revolutionized healthcare service delivery from a provider-centered healthcare delivery structure to a patient-centered structure that regards the patients’ expectations and needs as its highest priority.

In addition, the factors have changed the tools, methods to deliver medical technology and health information, cultural awareness, and values toward healthcare services.

The paradigm shift in healthcare has enabled the creation of an ‘ambient care’ environment that is not only responsive and proactive but it has also facilitated easy participation of individuals in their healthcare management.

Additionally, the shift has enhanced communication between professional healthcare providers and patients and their relatives.

A close analysis of the health care system unravels the various causes of the paradigm shift in healthcare service delivery; the implication of the shift on the healthcare service payers and providers as well as the expected actions by organizations to leverage the opportunities presented.

Technological innovations have brought immense transformation in the way healthcare providers work, have shifted care from calendarbased to needs-based, and from being episodic and reactive to proactive and continuous.

Further, the widespread use of Information, Communication, and Technology (ICT) in managing and sharing health care data has significantly contributed to changing the shape of the health care service delivery.

These advancements in information and communication technology (ICT) coupled with the dire need to make healthcare accessible in remote regions have paved the way for technological application in the healthcare arena and the birth of digital health that includes mHealth, health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine. mHealth offers a means for healthcare professionals to keep their patients updated via reminders, alerts, and health-related information. It has opened up a new vista in healthcare by digitally connecting clinicians to clinicians, patients to clinicians, and patients to other patients.

The upsurge of the internet and the adoption of its usage has been instrumental in bringing a paradigmatic shift in healthcare service delivery. This has led to the rise of Electronic Health (eHealth) which has contributed to improvement in healthcare service delivery by enhancing accessibility, convenience, and affordability.

Hospitals are also leveraging other technological innovations by automating many of the operations to enhance efficiencies and improve service delivery. These include automation of processes through business process re-engineering, HMIS. Enterprise Resource planning, PACS, LIMS, Queue management among others.

The use of Electronic Medical Records (EMR) which can store the health and medical information of a patient in digital form has widely been adopted. This has improved the communication between the health care team as it delivers readable and organized information to medical practitioners thus reducing the risk of medical errors.

The emergence of Health portals aimed at bridging the communication gap between the patient and providers has greatly shifted the way healthcare services are delivered. These portals are personal healthcare-related websites that provide a platform for patients to communicate with their healthcare team through teleconsultations.

Additionally, they permit access to lab test results, schedule appointments with the doctors, and refill prescriptions. The adoption of the platforms has had immense benefits that include enhanced medication adherence, improved self-care practices, improved patient satisfaction, and functional status.

The interest and focus of health service payers and policymakers have made a colossal paradigm shift from disease therapy to disease prevention and health promotion. Further to this, and taking cognizance of the dynamics of inpatient management and knowledge on their rights, emphasis, and attention have been shifted to new dimensions of patientcentredness, patient satisfaction, and patient experience by epidemiologists and healthcare service providers.

This can be witnessed by the adoption and implementation of the patient-centered care dimensions through the provision of care that

PHOTO | ENGAGEDLY A depiction of growth due to performance

is respectful of, and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

A ROADMAP TO SUCCESS

The Hospital has made deliberate moves towards ensuring that it keeps abreast with the paradigm shift witnessed in healthcare service delivery as Mr. Job Makanga, the Acting Director, Corporate Services KNH emphatically notes “The Hospital has to keep abreast with the current changes in healthcare service delivery and leverage on the opportunities thus presented to offer the widely demanded healthcare services specialized quality healthcare services that meet and exceed patient expectations while positioning the Hospital at sustainable competitive edge and ensuring the Hospital remains agile to the paradigm shifts through innovative ways.”

According to the Manager, Strategy and Performance Management, Mr. Vincent Chagara, “the Hospital has developed the corporate strategic plan which guides on the direction the Hospital will take in the next five years to deliver value to her stakeholders. The environment within which the Hospital operates is highly dynamic and complex thus necessitating frequent and timely interventions, innovations, and strategies in a bid to remain agile”.

To enhance service delivery and streamline processes, the Hospital has conducted Business Process Re-Engineering (BPR) and is automating the processes through the installation of the Enterprise Resource Planning (ERP).

“Undoubtedly, the Hospitals’ journey to achieving quality specialized healthcare for Kenyans is laid with numerous hurdles, even so, not all is lost. The KNH strategic plan has identified objectives, initiatives and targets aimed at ensuring the Hospital aligns its operations with the dynamics in the sector and remains sustainable,” reiterated Mr. Makanga.

The Hospital has initiated various quality and performance improvement initiatives aimed at ensuring that the Hospital provides the highest standard of care to its customers.

“These include quality improvement teams, feedback on performance, target setting for medical specialists (KNH3-KNH5), cascading of performance targets from tier 1 the corporate to tier 3 through the performance appraisal system, performance contracts, performance reviews, continuous monitoring & evaluation, research & innovations, and peer reviews,” stated Mr. Chagara.

To further, continuously track progress, Mr. S. Wainaina, the Planning, Monitoring, and Evaluation Chief Manager, indicated that the hospital has institutionalized M&E in her operations to aid in tracking the progress of implementation, develop a consolidated source of information and close the gap on the increasing appetite for data and spur evidencebased decision making.

The Hospital has developed a road map to guide towards the achievement of its objectives while taking cognizance of the paradigm shifts in Healthcare. roadmap for the FY 2021-2022

To remain sustainable, KNH is executing its blue ocean strategy geared towards enhancing operational excellence, business growth as well as excellence in clinical outcomes. Blue ocean strategy is the simultaneous pursuit of differentiation and low cost to open up a new market space and create new demand. It is about creating and capturing uncontested market space, thereby making the competition irrelevant.

Below is the Diagram by Henry Karuti, Senior Strategy & performance officer.

BUSINESS PROCESS REENGENERING

Review 8 strategies and develop 4 strategies Monitor Implementation of strategic plan

Implement performance improvement and culture change initiatives VISION STRATEGIC DESTINATION MISSION STRATEGIC OBJECTIVES

Cascade departmental targets to individuals conduct mid and end-year performance appraisal

Conduct PC Evaluation and provide Feedback

Develop board PC, 84 department Pcs

Conduct perfomance reviews