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Country Approach: Kenya
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Decreasing Long Waiting Times Through CQI

A group of people wearing white coats stand for a picture.The Babadogo Health Centre in Nairobi, Kenya, had struggled to meet patient needs. Packed to capacity every day, the facility was stretched to carry out its healthcare mission and continuous quality improvement (CQI) activities.

Patients and staff alike were frustrated. Patients frequently complained and left after long wait times before seeing a clinician. Healthcare workers appeared overwhelmed and often left well after closing hours.

The CQI team recognized the need for change and sought to implement several interventions with the ultimate objectives of reducing client waiting time and the number of clients seen in a day.

Similar to many other CQI projects, the staff started with a root cause analysis to assess the client flow and identify gaps. They found multiple issues affecting both clients and staff.

Client-Centered Gaps
  • With the long wait times, many patients ended up leaving before being seen. A majority of them couldn’t take extended periods of time off of work.
  • Some clients reported waiting up to six hours in the facility. A survey of clients found that 88% were not happy with the waiting time.
Staff-Centered Gaps
  • The facility rarely staffed the triage desk, so there was no person or system to manage new patients. This led to chaotic settings where clients weren’t attended to on a first come, first served basis.
  • The burden of many tasks originally fell on the clinicians. Beyond seeing clients, clinicians were also responsible for lab requests, adherence counseling, and booking future appointments.

Interventions

After taking stock of the situation, the CQI team devised several change packages to alleviate the situation. First, the Babadogo introduced an early morning clinic to cater to people working during regular hours.

Next, the staff redefined roles and responsibilities to create a more efficient workflow and maximize staff resources. The numerous responsibilities that previously fell on clinicians were now transferred to a preclinical preparation desk and a triage desk. Additionally, peer educators started to work at the reception desk to help direct arriving clients.

After implementing these changes, the facility waiting time drastically reduced from a maximum of six hours down to 30 minutes to one hour.

“Services have really improved, said one Babadogo client. “Now we can recommend people from the community to come here; before, we would not.”

Babadogo is also thinking about the future and sustaining these improvements. To do so, new staff are taken through the entire patient flow in the facility. Job descriptions and expectations have also changed for certain positions, such as peer educators. The clinic has also set up a suggestion box to solicit client feedback.