When Emergency Medicine becomes an emergency: A five-circle progress to optimize the emergency care at Mnazi Mmoja Hospital
On September 10, 2011, an overcrowded ferry named MV Spice Islander sank off the coast between Unguja and Pemba resulting in more than 187 casualties. A flood of crisis took over the Island as lack of equipment impeded rescue operations, and people on tour boats and makeshift mattress canoes scurried to save their loved ones. On land, survivors flocked to receive what treatment was available at Mnazi Mmoja Hospital, Zanzibar Island’s flagship public hospital and sole tertiary health provider.
At the outpatient department (OPD) in Mnazi Mmoja Hospital (MMH), survivors battled amongst a steady stream of patients for care and resources. Prior to 2012, there was simple no emergency department at MMH—no personnel trained, no space for practice, and no resources allocated for emergency treatments. At the time, emergency patients were directed to join the long lines at the outpatient department, often waiting four or more hours to receive care. Recognizing a severe gap in emergency care, the CEO of MMH reached out to professionals at Haukeland University Hospital (HUH) in Norway for relief aid and much needed reform efforts.
The Plan-Do-Study-Act (PDSA) was established as a multifaceted quality improvement process by HUH to address a lack of emergency care and overall efficacy of clinical processes. Most formative in this effort was the “five-circle process”, a set of action steps to implement staff progress meetings, formally register all OPD patients, develop a triage system to systematically classify emergencies (thereby selectively conserving resources), and establishing a physical emergency department at MMH. The plan sought to recuperate a disconnected clinical staff, and ultimately improve health outcomes through human developments, rather than strictly technological, or financial ones. And it worked—today, the emergency department at MMH openly serves a population of 1.2 million people at all hours of the day.
The PDSA has certainly emerged as a standstill model of success for sustainable development in low-resource areas. This model maneuvers the lack of organizational management—and largely the undercurrent culture of passiveness—by involving stakeholders from the start, pioneering change agents within the present system, and focusing on human developments rather than technological ones. An emphasis on communication has mobilized the clinical staff at MMH to critically analyze a set of interconnected problems, and offer goal-driven, context-rich solutions of their own. Applying these lessons to our own project, a sense of local leadership is much-needed, if not crucial for long-term sustainability. On our front, we need to continue to engage the local team in different ways and maintain a steady stream of information both ways. Although financial fuel and new technologies continue to cure increasingly complex cancers, it is the problems that we have already solved which linger on. The PDSA proves that human development and organizational reform seed the roots for larger change.
References:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501336/
http://www.helse-bergen.no/en/OmOss/Avdelinger/internasjonalt-samarbeid/prosjekt/zanzibar/Sider/akuttmedisin.aspx