Good afternoon. My name is Kate Siemieniewski
and I work in the Alumni
Wisconsin Alumni Association. Today I'd like to welcome you to
Global Hot Spots, a lecture series that takes you behind the
headlines with UW experts.
partnership between the Wisconsin Alumni Association and
the University of Wisconsin Department of International
Studies.
Quality of Healthcare in Today's lecture, Improving the
Lori DiPrete Brown, the Associate Director for Education
and Engagement at the newly established Global Health
Institute.
UW staff and alumni. Joining Lori today is a team of
Katherine Konkle, and Sweta We have RShrestha.ko Ayele,
Please join me in welcoming our guest speakers.
[APPLAUSE]
Good morning, everyone, and thank you for
coming out to learn about our efforts in Ethiopia.
I have a lot to be thankful to
be hearing about that when I Wisconsin Alumni for, and you'll
associates who are actually my talk about some of our staff and
alumna, but it just occurred to me now as I was coming out thatW
the reason I am most grateful to
produced a very important person, my husband, and I
literally owe them all the joys of my life.
So that's just kind of an aside.
Institute is as Associate MDirector for Education andh
Engagement, and by engagement we
students, faculty, often alumni as well, in really making change
for global health and well-being.
So this involves education, it
what we're going to describe involves service learning, and
really bringing some of the most today is a program where we're
from the health sciences to talpartner with a hospital inple
Ethiopia to make change.
in that. We're also engaging out students
approach where we're joined to So we see it as a kind of nested
mutual benefits. learning, and there's a lot of
Ethiopian colleagues when we're here, they're also engaging with
our students to make change for global health and well-being.
So it's something that is very
you'll hear that from the whole excitingteam I think. of, and
The Global Health Institute mission and vision is really,
these are the big ideas we're working with.
So we're wanting to really be about discovery and advancement,
discovery and change. We're looking at determinants
and root causes of health challenges and trying to
establish lasting solutions.
empowerment and sustainability And you'll see the emphasis on
partnership with the Ethiopian and how we're working in this
The three tenets of our program involve enhancing environmental
sustainability, improving the human condition, and carrying
that out with a focus on ethics and governance.
And the thing that I like about this project is even though it
starts with emergency services, which seems pretty narrow and
medical, it really does extend
areas, even the governance. And when you empower people by
showing them that change is possible, that has a spillover
impact into other parts of the
what we describe here. program, and you'll see that in
have guided us, but what's So these are the big ideas that
Ethiopia is that while we're a really kind of wonderful about
conceptual frameworks for all nethis, there's a wonderfulhe
partnership in Ethiopia lead by Dr. Girma Tefera, who many of
you may know for different
He's an established clinician in reasons.
community, but also has wanted the Madison area, leader in our
his own home country of to work to Ethiopia.n systems in
So he has really spearheaded
become a very fertile and emergent place for these ideas
to take root. Also, Dr. Cindy Haq, who was the
founding director of the Center for Global Health, which was
building block toward our institute, is engaged there in
family medicine.
leadership from our deans and from our new Global Health
Institute director Dr. Jonathan Patz.
The Ethiopia partnership is sound, and it's sound for a
number of reasons.
We did not bring the agenda. One is it meets critical needs.
setting. The agenda emerged from the
methodologies that you might It also combines scientific
UW with this concept of a havetwinning model where ourg at
hospital is partnering with their hospital and working
together for change.
can sometimes get expressed in So a lot of the us and them that
really is overcome by that international collaboration
together. rSo it's not just our facultyo
that go there.
for building relationships. WeSo when I was asked to go dog,
this QI training in Ethiopia, I had already worked with the
fellows here. I had eight friends in the
country waiting for me to arrive.
I knew people by name.
I worked with development agencies for many years before
joining UW. We also did great work, but this
model of having it be embedded
and Wisconsin style inrelationships really made itps
great.
to partnership, again that Then UW Madison, this commitment
very helpful. What I brought to it was the QI
methods and approaches. I've been involved in quality
improvement, which is a great change strategy that has so many
applications besides health, and
place within this context. that was something that we could
later about how this is just I'm also going to be telling you
wonderful opportunities, way expanding in terms of some
because when we use the twinning more than we expected, partly
fully. model people engage so much more
volunteering and just getting so We have people from our side
that other new projects are excited abemerging.nvironment
You'll be really delighted when I show you what our students and
colleagues are doing. And then I just want to say the
UW alumni have been big contributors to, not just this
partnership, but really our institute.
I joined the institute eight
through a generous alumni gift years ago, and it as actually
our work, and now we have a very that we were able to even begin
institutional support and solid instifunding.h a lot of
So, anyway, besides that human
had alumni helping us out over resources that you'll see, we've
Here's Ethiopia, for those of you who need a refresher on
where it is, in east Africa.
rural and 15% urban. 80 million people and it's 85%
this Black Lion Hospital is And twhere we're working.where
And the Black Lion Hospital is a
most serious cases will go. puSo it's a last stop for ahe
referral, and it is where most
Because it's a burgeoning urban of center, they see a lot of go.
traffic accidents there, in particular, and Black Lion is
where they're seen. So when we think of our model
for GHI of looking at root
can we prevent accidents by doing some interventions at the
hot spots, if I can use that
occurring. word, where the accidents are
trying to improve But ouemergency care.s with
And the need for emergency
room, familiar to all of us, medicine, this is the waiting
an outdoor space. we'And this was taken by Pete is
Rankin, one of the emergency
who has been very, very, medicine nurses from UW Hospital
program. contributed so much to this
emergency room. AnI did not see it like thise
because by the time I got there,
already made, and I was guided a lot of the interventions were
had implemented changes in by a very proud colleague who
like a very different place than infection control to what looked
And also the pediatric ward that this initial photo.
redone. So the need for emergencyn
medicine, they used a systems approach which included learning
about pre-hospital and
communication, incorporating ambulatory care, triage systems,
quality improvement which is evidence-based practice, and QI,
Here we have the background on what we'll talk about today.
The Black Lion Hospital and the Addis Ababa University with UW
Madison Hospital and University Medical School, and another
great aspect of this program is the people to people connection.
This is a diaspora Ethiopian
which brings a lot of talent group that partners with us
of their country for a number of from people who've been outside
back and be involved in years and,training.ant to give
So that's a really powerful combination.
Twinning partnership, just
volunteerism. bMany, many of the work you'lle
hear about people volunteering. And broad-based institutional
relationships, the mutuality of it and really a
relationship-based approach.
important it was until I went to I didn't really understand how
twinning relationship made the field and saw how that
There are some of our fellows ththat you'll be hearing morely.
about.
they were here in the peak of the tulip bloom a few years ago,
and we broke out of class and went to visit the tulips in my
neighborhood because I just thought they can't go home
without seeing that.
components, and these five Quality improvement has five
Developing standards. thingThere's a lot to that.ful.
It's not just about having
adapting things that they make international standards but
we're working with them on. Here's the evidence base, butt
how do you take this to your
They would have an easy time local setting.
with the resources that we have. staffing our emergency services
kind of raw medical wisdom and Their situation involves so much
improvising that we really need to sometimes adapt standards.
Then monitoring, introducing the
acting on indicators. iAnd then process improvement,d
which is what we'll be talking
We did a lot of training on how to work in a team to improve
processes.
some kind of structure and Organizing for changing, having
And then a culture of change, which it sounds so simple.
When we say that we can do it mentality or yes we can or
anything you want to say, but it
people think they can do it isn't the together.ywhere that
Some of these settings are
When we worked in the hospital, Roman and I were working with a
great team, and they were so
that they didn't have sheets in commithe emergency room. aware
And so it's really hard to go and expect people to do quality
improvement work when the highest trained surgeon in the
country has to focus on hand
But they do it because they want washing and sheets.
what's needed. to make change and they know
packs of sheets and brought them So we actually packed up 200
appreciated. in our excess baggage, which was
you'll see used. These are some of the tools that
these systematic problem-solving We're teaching teams to use
them understand what's really tohappening and what's goings
wrong.
ways of organizing data. These are some other kinds of
seen in your work but they're Arelatively novel in terms of
using them as management tools
make a huge difference. This is where I kind of get sort
of spiritually engaged with the quality because on the one hand
you can do quality improvement, which I did for many years, to
the point, honestly, where I got
It's different people, different tired of it.
But then you start to see that problems, same method.
improvement, you get incremental in our own setting, quality
You go from 90 to 95 compliance, change.
But in these low resource settings, you're talking about
dramatic change of systems where
and suddenly it's possible. So this is really a tool for not
only improved health outcomes but, even in terms of the
potential for advocacy for
for improved governance, once ryou show people that they cand
work together to make changes within their systems, it can
just mushroom.
practical tool for change. And that really is a very
about doing this training. And that's why I get so excited
aren't looking that good in this Here's a couple of graphs which
But one of them on the left shows the change in infection
control compliance. At the beginning you'll see it
was around 30, and we got it up to about 80s there.
This is hard to do in the low resource setting in Africa, and
it's really to the credit of our
accomplished it. amazing colleagues that they
increases in compliance with the The one on the right shows
going to tell you a lot more triage practices, and Roman is
Again, these are two very, they went from having a triage system
that almost didn't work.
setting where every, really, So you've got a low resource
help someone how really needs eveit, but that sorting isn't to
happening maybe 10% of the time.
of the time. And now it's happening like 95%
the largest urban hospital, it So when you think about that at
effect in the sense that people start to have more faith in the
whole health system when
work. And Roman worked with the team.
It's a laborious process to make
you about it. I'm just flashing, I'm doing the
easy part, flashing up the big
So, that said, I'm going to now turn it over to Roman and Kate
and Sweta.
really enjoyed working with. These are people who I have
alumni. They graduated both within the
last five years, both their undergrad and their MPHs here.
Another reason why I'm so proud of our institute and our growth
is because we can hire our own
really exciting to see them go graduates, and it's really,
come for an advisory meeting to be colleagues that I can really
rely on for doing some great
I'm going to invite them each to fieldwork.
themselves, and Roman will be telling you about the fellows
program and her work on the triage.
Kate will be telling you about
methodology. the process improvement
Institute, does this kind of She's with the Population Health
brought that expertise to training Ethiopia.Wisconsin,
And then Sweta has been involved
We were invited to do a national with me more recently.
this, and Sweta helped me with training because they liked
more about what that national scalineffort looked like.ll talk
So, with that, I will pass the
Hi, everyone. Thank you, Lori, for that
introduction. My name is Ramon Aydiko Ayele.
I am a public health disease
researcher for the Wisconsin investigator/assistant
I have done my undergraduate Immunization Program right now.
women's studies here at UW, and degree graduated in 2008.der and
And also continued on doing my
graduated just this past May. I started working as an intern
in the quality improvement
And she took me in and mentored me and taught me everything I
need to know about quality
part of the trainers and the improvement, and then I became
improvement. advisers for quality
student and continued working throughout my graduate program,e
and it has been one of the most significant works that I have
done so far.
exciting in itself and quality Partly because, just the work is
also having that connection with improvement is exciting, but
can just imagine. my hIt's really wonderful. you
I'll just go into, today I will be talking about the Ethiopia
emergency department fellows
trainings consist of and how training and what those
As Lori said earlier, the partnership is taking a systems
approach to address the entire
There are three main objectives that the partnership is trying
to address, and these are providing leadership training
for individuals who would serve as the core leaders in the
emergency department at Black Lion Hospital.
So it as part of this leadership
improvement training was program that the quality
And also, the second kind of developed.
emergency medicine trainers, objective is developing local
the emergency department and which ensured that all staff in
have emergency medicine thrknowledge and skills andld
awareness.
expanding local workforce and And the services.ective is
For example, in 2010 emergency
opened where any kind of medicine training center was
quality improvement, it could be training related to, it could be
the partnerships and the clinical trainings that a lot of
training center. exchangeships happen in that
can say this is our training So they have a place that they
So the quality improvement center and build up on that.
four exchange trips that training we focus on, there were
There were four groups of fellows who traveled from
Ethiopia for four to six weeks
We had eight nurses and nine here in Madison.
different kinds of training in physicians so far, and they had
leadership training, and one of the training was in quality
improvement.
from pediatric and adult These physicians are selected
with equal gender participation econsideration and also withts
different backgrounds.
clinical work goes from Tintensive care unit nurses ton
surgery to obstetrics and gynecologists and a variety of
fields so that when they come here they can be trained in
emergency medicine with the skill set they had previously.
So the specific training that the quality improvement training
that they received would be discussed, the methodology would
be discussed by Kate, but I just
the trainings that we have done wouldso far, specific ones.me of
While they are in Madison they
taught by Lori and I. And they receive certificate of
completion at the end of each training.
And they also receive mentorship
improvement projects that they on independent quality
Hospital where they implement would tthose programs.ck Lion
So far we had 15 quality
and I'll talk in depth about one improvement projects develop,
different genres of quality oimprovement projects that weree
undertaken. But there was quality
improvement training within the hospital where, in fall of 2010,
Lori and myself traveled there
improvement training for 50 senior staff from different
departments at the hospital, and
was to alleviate demand of beds tby the emergency departmentng
through active inpatient bed
turnover by discharging patients management and improve bed
And this was a huge issue because even though it was an
emergency department where
and leave right away, it was a patients are supposed to come in
in the emergency department for situatimore than 30 days.stayed
And another patient would come
bed, and everyone in the and there was just not enough
frustrated so they communicated this frustration with other
departments through this quality
designed and are implemented improvement training and
alleviate and coordinate those different methods as to how to
department is receiving. burdens that the emergency
goals, but they also And each department set its own
the emergency departments so communicated those goals with
This past fall, Lori, Kate, and Sweta traveled to Addis Ababa
with the aim of doing another quality improvement training
mostly for new leaders who were not part of the previous batch
that we trained in fall 2010. So they developed different aim
statements with these trainees
prevention efforts in the pediatrics emergency department,
increasing emergency medication availability, and also increased
quality service at the hospital.
things that these trainings came So there are a lot of different
There was also an assessment of previous quality improvement
project that the fellows
and also monitored to figure out implemented that were assessed
the next step and so on. what's going on next and what's
improvement project that I was So this is the quality
I did my thesis for my MPH highly involved in.
So the main project was taken by program in this area.
our emergency department, only a physician named -- who said in
are triaged, and we don't know about 10%-20% of our patients
hospitals and what kinds of patients are seen, and we don'tr
know the demand so I would like to do this quality improvement
project.
from Lori and myself, she Sdesigned and implemented thatce
program at Black Lion Hospital. And she did this through
redesigning the triage form because it was lengthy, and due
to crowding at the hospital, it was very difficult to fill this
form in.
nurses on the benefits of Rtriaging, and also talking toge
different stakeholders regarding
challenges were. the benefits and what the
was very difficult to find at Forthe hospital sometimes.per
They didn't have enough printed material so just simple things
like that.
things were available and were So she made sure that those
year, and that the nurses and inclthey physicians and thenext
residents knew the importance of
crowding at the hospital as well triaging to decrease the
So after the implementation, as respond well.
75% within the first three patient triaging increased to
Currently, 100% of the patients are triaged, and it wasn't easy
to get to that point but there
evaluation and follow-up and was a lot of monitoring and
did from the hospital and then supportive supervision that she
distance. And she said further evaluation
is needed because sometimes I noticed that some of the forms
the name is filled but the
written, so I would like to study how the completion rate is
going.
to look at how complete the forms are and talk to the nurses
about these issues. And the goal was to improve the
quality of triage from
50% to increase it up to 75%. cAnd we saw a dramatic increase
where on average now there about
complete, which is a great 94% of the time the forms are
there was only 10% completion progress forate.riage where
This is after a year and a half of implementing the program, so
it shows that the program is
sustainable improvement and the nurses took ownership and
consider it as one of their tasks now.
I'll pass my mic to Kate so she can discuss about the
methodologies that we used.
Hi, everyone. Oh, I feel kind of tall which
doesn't often happen. So I am Kate Konkle.
I am a program manager and
University of Wisconsin Population Health Institute, and
I also a QI consultant with the Institute for Wisconsin's Health
Inc, which is another public
and have done quality improvement training primarily
with local health departments and also the state Division of
Public Health all over
So I was really excited about the opportunity to take that
skill set and take it to Addis
training there. So, I am going to talk a little
bit more about the methodology
week that we were in Addis. aSo the brief overview is wer
didn't want to just go in and do
primary presenters, so we did do a training with us being the
workshop, but we also did a nested train the trainer, and we
really wanted to build capacity for this training to continue
after we were gone and that there was capacity in country
and at these different
continue. And then we also had a closing
symposium, and I will talk about
more specifically. each of these areas a little bit
goal was really to build QI Sskills and knowledge, again,r
really giving people the tools
knowledge of how to do quality and the understanding and
that process improvement that impLori talked about before.lly
How do they really get to the root of problems and work as a
team together to make these improvements to really improve
health outcomes in their
And then we also wanted cparticipants to leave with a.
tangible started project so that
something hypothetical or just they weren't working on
they were really applying these tools as they were learning them
to something that they had
that was important to them that ithey really wanted to addressue
and fix and that they could take
their group and have something that then back to the rest of
little bit momentum and a little started, hopefully building a
quality improvement and what it could really do for these issues
that they were looking at in the
were from. different departments that they
those specific projects that And Sweta will talk more about
So it was really exciting to they worked on.
they were struggling with and being able to help them and give
them some systematic tools to apply.
So the workshop consisted of, we
the quality improvement that provided that broad overview of
the quality triangle and the Lori showed you the triangle,
improvement and what that includes, but then really spent
a lot of time focusing on the tools and the skills needed to
do that process improvement and bringing a team together and
really digging deeper into the
We also took some time to have a problem.
recognizing that these were the lindividuals that were going to
go back and lead the QI efforts in their different departments
and that wanted to talk about what does that look like and how
do you get comfortable as a leader and are there different
ways to lead and what are the qualities of a good leader,
where did people feel like what qualities they individually
possessed as a leader and what
So we really wanted to make sure they wanted to work on.
didn't just send them back that we touched on that and
this might be a different role without really thinking about
They might not be a supervisor for them.
this was an opportunity for them in their department but that
and really use this as an topportunity to do that, buty
that's not always comfortable for people that aren't used to
that. So we really wanted to make sure
that we included that in our
And then we finally gave them a lot of teamwork time.
Again, we wanted them to go back
We wanted them to also come together as a team and figure
out what those dynamics look
up and who could be a good like and who was going to step
give them time to start a leader, but project.e wanted to
And they were going to present
so there was a lot of pressure this at the symposium at the end
something as they were doing on them to come up with
We provided as much support as this work throughout the week.
We also realized with the language barrier, Amharic is the
language that they were speaking
they sat with us they wanted to speak English and that kind of
inhibited sometimes the natural dialog.
So we often would just let them do their work and check in from
time to time and answer questions.
You'll see pictures as we go. This is a fish bone diagram
which is a root cause analysis
little bit. But lots of crazy pictures of
funny diagrams and process maps but some really good, hard work
that went on during that week.
see both their enthusiasm and Anthe effort that they wereto
putting into really making some significant changes in the work
that they were doing. So now I'm going to walk
through.
training and what we really Tasked them to focus on and atur
the end present on. And so we start with an aim
statement really asking them
does success look like when what dyou're finished?, what
What do you want to change? What do you want it to look like
when you're done with this
involved? QI is really about involving all
of the people who play a role in
It's not just the leaders, it's not just the higher-ups, it's
the people that are doing the work.
So thinking about who needs to
should you include and ask be part of this team and who
Sometimes that means janitorial staff, sometimes it means the
clerical staff. It's not just doctors.
There's lots of people that are involved in a lot of these
things. The cause and effect analysis is
really starting to dig deeper into the root of the problem and
figure out what's really going
problem that they're seeing. on, what's really driving the
sort of symptom level and we A lot of times we focus at that
deeper. So we did fish bone diagrams,
and you'll see some pictures of those in there.
Some of them actually drew
everything as well. We had lots of fun artists in
our group.
look at the process. And then we asked them to take a
Again, this is about process So what's currently happening
You have to know what the process looks like before you
can figure out where it's going wrong and how to make some
improvements. And then we talked about
indicators. Measuring is a huge part of
quality improvement.
start and you don't know where If you don't know where you
made an improvement or not. We talk about it's really easy
to change things, it's hard to
We can do things improve things.
we're doing them better. differently, it doesn't mean
whether or not we're doing them better or if we're just doing
them in a different way.
action. So once they kind of did all of
this work, they figured out what
do, some strategies we could are some things that we could
to improve the health outcome, take to make these improvements,
our group more efficient or to to improve this process, to make
And we asked them to put it all have bein a timeline.tcomes.
So you want to make sure that you have a succinct time frame
in which this is going to happen
ongoing, never ending project. so that you don't just have this
of work to do in three days, So, as you can see, that's a lot
it in about two and a half. So we asked a lot of them, and
they showed up, and they did an amazing job, and it was really
exciting and really energizing
this work with them. and exhausting, I think, to do
nested this train the trainer. Along with that, though, we
in and build more skill and Acapacity in the participants,go
but we wanted to make sure that there were some people who were
getting that leadership opportunity and could continue
this training even when we were finished.
So the goal really was to build the internal capacity and
leadership for quality
trainings to continue. improvement work for these
facilitators who had either been We had a wonderful group of
or had prior quality improvement part of the training here at UW
great job coaching the teams, really giving their experience
and expertise in helping them through, and then also helping
us lead some of the sessions, doing examples or co-leading
some of these sessions so that
experience. That was a really fun group to
work with, and we did a preview and review every day with them
so that they really got an
know what was going on. oI think that's the next slide.d
Yes.
walk-through so that they knew So we did a pre-workshop
themselves into and they knew what the workshop was going to
look like, and they were
questions. prepared for that and could ask
and coaches and talked with them We asked them to be presenters
would look like, and then, what that meant and what that
reviews. again, these daily previews and
have questions about today, are there concerns, and then ended
the day with what went well,
a great QI tool. what could we do better which is
Friday which was an opportunity for the group to really show off
the hard work that they had done, and we invited members
from the Black Lion CEO, which
talking. that's a picture of her there
of this. She was a really great supporter
from the Ministry of Health were So she came, some individuals
American Health Alliance. We had a lot of good people that
were there and interested to
with this project. hear about what was going on
of the groups that had already There were some people that some
Berhan, which was one of the done QI projects were from Debre
from Black Lion got to present hospitals that attended, and
ongoing or had already taken their projects that were already
And then we asked our workshop place and been completed.
that they had done. partiAnd they just blew our work
expectations away.
We asked them to do this five by They were really phenomenal.
Five slides, five minutes to five model.
asked them to do, and they did present all of that work we had
And I think we were all blown away by both the amount work
they had done, the amount of
into their projects and really really good thought they had put
going to go because I think they excited to see where they were
really put together some amazing had a really good start and just
So Sweta, now, is going to tell you more about some of the work
that they did.
I do feel tall. Thank you so much for allowing
us to be here today.
did my undergraduate degree here My name is Sweta Shrestha, and I
in public health here too, and I neurobiology and did my master's
lot of great advisers. found public health thanks to a
work that I'm doing right now at And it's great to be able to
I serve as an adviser to the the institute.
certificates in global health, undergraduate and graduate
undergrads and tell them all my wisdom and everything that I
have in the couple short years
So I was really lucky to get the I've been working.
with Lori. opportunity to go to Ethiopia
Uganda and in Nepal before. I And I was part of the QIin
training that went the summer before here in Madison.
So I'm just going to briefly
I know Ramon talked about one, talk about the projects.
give you an idea of the range of but I just wanted to kind of
and then talk a little bit more about the QI training that we
did this past fall/winter, fall.
November. And then just talk about the
projects that we did with them. So, the project started out, the
training started out focusing on
then moved to pediatric emergency medicine, and then
with our group it was much
So some of the projects that broader than that.
increase triage quality system, reduce decision making intervals
in trauma care, and effective and efficient patient registry
system. And a lot of this are things
that we take for granted here in
pretty well, but working with the fellows here and there, you
can really help them focus on what the problem is because we
don't know. Only through working
with the people there who do
really focus on the root causes and actually make a difference.
And the year after, this is where the projects were more
about improving infection prevention and improving quality
of triage in pediatric emergency
So this is when we had a lot of our pediatric fellows here.
And also to increase compliance in the pediatric emergency
department with protocols of
improving it to 75%. hand hygienes and really
reducing orthopedic trauma And in 2011, they focused on
increasing emergency drug and material accessibility in the
pediatric ER, and reducing
patients for radiology workup. length of stay in the emergency
medicine quality improvement A lot of the pediatric emergency
You'll see they were building a new ER for the pediatric
department, and I have a picture
all the work that they have done of that, and it's quite amazing
So, Kate talked a little bit and are continuing doing.
I just wanted to point out that abwhile the previous workshopsd
focused on Black Lion Hospital
pharmacists, this opened it up and the doctors and nurses and
through AIHA and the CDC and the to more of the regional partners
Really, we had people from twinning partnership.
HIV/AIDS control and social Tanzania wworkers.working in
So we had a broader audience for
And one of the groups chose to this workshop.
patients staying more than 24 focuhours in the ER from thet of
currently 41% to 20% within the first three months of
implementation by making
So really streamlining the appropriate and timely decision.
who knew best what were the holdups and what was preventing
them from reaching the 20%. So the quality improvement
workshop we did really gave them
diagram to help them really map out what were the challenges
that we're facing.
groups focused on, this was a Agroup of pharmacists in Addise
Ababa University, is to increase
medicine from 28% to 75% within 12 months through application of
proper drug supply management system.
And this is from the essential
And really trying to get more of drug list from the WHO.
important to have in every ER those drugavailable. WHO deems
And what was great about this team was as they were talking
and debating back and forth,
a couple of the members said, theywell, it's not possible.am,
We will never get all of these
And a few members of the team said, well, this country that we
just visited a few years ago or a few months ago, I think they
had just gone to Zambia, they said they have it, why can't we?
And that is so key because that it's never going to happen here,
we're never going to deal with
everywhere. So to hear them say of course we
can do it, they're doing it and saying it to their own
colleagues was just great for me
And another team that were to see.
from Debre Berhan and that is a rural hospital a few hours away
from Addis Ababa, and they came and really wanted to work on
improving the waiting time. And they wanted to reduce the
outpatient waiting time to one
building one extra window for cashiers and really improving
the communication with
And while they were there, they were a really great group to
work with, they mapped out where
what was going on, trying to the patients were waiting and
hours and hours of wait, and figure out what was causing this
cashier was dealing with and the they figured out that the same
first time paying for their patientsmedication.g for the
So as simple as building another
work out, and this was something window was, hopefully, going to
now. that they're working on right
communication, really making And also improving
time. They know why the other patients
are late. So all of that is being worked
on right now. And another thing I wanted to
point out in this picture is the
right side of the picture, she nurse that you can see in the
presentation on the last day, the symposium, and a lot of
times, even here, I think nurses
that other health professionals ddo, and she was really quiet
through the whole workshop and
on the last day. really starting to get her voice
large group where there were And for her to stand up in this
CDC, from the Ministry of Health, and give a presentatione
in five minutes about what they wanted to do was incredible.
And just what Lori talked about,
quality improvement, it's not tjust about little things about
reducing the time from 20 minutes to 15.
It's about really empowering
do, that quality can happen and peothat they can do it withs I
whatever they have, and the greatest asset that these people
have are themselves and their talent.
And another team that I had the privilege of working with was
from Tanzania, and they were two
really improve the utilization doctors, and they wanted to
built around Tanzania but aren't of the skills lab that had been
So really, through the workshop, being used.
as these skills labs not used. we sat down and talked about why
trying to develop manuals so So they're going to focus on
are actually schools all over the country so you can imagine
the magnitude of this project when it's actually implemented
could have. So that's a project that,
hopefully, we'll have a chance
which I'm excited about. to work on more in the future,
new pediatric triage area. And this is a picture of the
emergency department, and it's They built a new pediatric
light, and the cleanliness. If you walk through the old
pediatric ER, it's a windowless room where all of these kids
are.
here, I just think about our And when I was walking through
here and a lot of times take for children's hospital that we have
Just having this color and this open, bright space for kids to
be when they're sick is so
happy that this is in place so amazing, and I'm really, really
with implementation of all these that they can really go ahead
them the best care possible. other pediatric projects to give
that were there were focused on HIV testing and counseling, ands
they really wanted to make sure that as the services are being
implemented that they were doing
as appropriate as possible. eSo that's another thing thatt
we're following up, and then
go. Lori will Thank you. on as we
I want to make sure we have time for questions, so I'll just
wrap up really briefly with the way these programs are just kind
of exploding into some new
So, in addition to working at the hospital level, we've been
invited to work at the national level with the other twinning
partnerships, there are seven,
And more recently, we just were engaged by the American
International Health Alliance to
on quality. We'll be Zambia in April working
with their partners, and then in
So it's really taking off, and Tanzania in the fall.
joint learning network among we're hoping that we can build a
shared lessons can happen. those countries so that those
just be a catalyst for so much So really one small project can
In the spirit of our global health institute approach, we
have a lot of other things going
because people kind of come engaging with their whole heartt
as well as their UW trained minds, we've been able to
identify a master's thesis
our institute is funding. relFirst one of its kind inhat
Ethiopia. We presented our work at the
16th annual conference on AIDS
10,000 people there, and we got andto have a UW presence.was
We have student projects. Sweta and I lead a freshman
honors class in global health.
Hamlin Fistula Hospital, which They became interested in the
whole other day, but at their iinsistence we visited the a
hospital and we've come up with a project where our students can
make blankets that they hand out
there to get treatment for this highly stigmatizing condition
that is, for the most part, curable.
We are also looking, Roman and
involved in evaluation of programs for AIDS orphans and
vulnerable children in Ethiopia,
policy development and system again usstrengthening.hes for
And we're hoping to have service
We have service learning learning programs.
countries, again topic for programs in a number of
developing one with Save the another day, but we're
So a lot of opportunities for Cprofessionals and students toy.
engage in Ethiopia. Lots of relationships building
on each other, again, hoping to create change and to learn with
these really amazing partners that we have.
We're really, really grateful to
As I said, so much of this you for coming.
alumni support. Even just being our audience and
giving us an opportunity to tell
because it's hard work and it's this stornice to share.ft to us
So thank you very much and look forward to questions for any of
us. We would welcome them.
Thank you.
[APPLAUSE] >> Thank you, everyone.
microphone around now for I'questions.he
Anyone have any questions?
in Ethiopia? >> How many hospitals are there
I don't know the exact number Aof hospitals in Ethiopia.r?
There are none other of this
There are a number of urban hospitals.
There's a system of public
just like here. hEach region would have a major
hospital. So in terms of this level of
care, probably it's at the
We are in conversations with the regional level.
network of hospitals. >> How many beds are there in
this particular hospital? >> No, in the hospitals.
It's an 800-bed hospital. It was designed for, like, 200,
and it's just exploded over the last 20 years.
How are the participants in the training chosen?
Are they self-selected or how do
Again, this is a benefit of the twinning partnership.
The leadership there is very
would be the right people, who engaged in figuring out who
the training and do it. There was some self-selectionf
because, frankly, with all these
settings, people just don't come trainings that occur in these
But there was coordination, particularly the leadership of
the hospital decides who gets trained.
In some of the cases, they
So anybody who was a nurse wanted to train everyone.
active bed management almost supervisor above, like for the
at that level. every department was represented
questions? >> Are there any other
and budgets and all kind of >> How do yothings?e politicians
Well, Ethiopia, at the
fortunate because they have a Minister of Health who really
has a great reputation
and wanting to follow WHO nstrategies for building blockse
for better systems. There's a lot of political,
administrative even, constraints
So some of the things, it is in this situation.
Some of the things that really this incremental change idea.
with the way procurement is done, and it takes eight monthso
to get soap dispensers because
So some of those things are constraints that we work around
because quality improvement isn't a tool for everything, but
one can hope that those systems are going to be concurrently
improving.
opposition to what we're doing. It benefits everybody to improve
emergency services. You can imagine other things
where you might, and again, the network is strong and very well
trained, very enlightened, and
Minister of Health. So we've been fortunate at that
level.
a separate item that we haven't Thad a lot of interaction with.
Okay, well, if there are no more questions, I just want to
congratulate you on the new Global Health Institute.
Thank you.
much for joining us today, and >> And, ladies, thank you very
the future. we hope to Thank you.from you in
[APPLAUSE]