What Does a Medical Practice In Kenya Have in Common With a Medical Practice in the US?

ProcessAt NCE last year, I got an opportunity to meet  Dr. Sidney Nesbitt. Dr. Nesbitt a pediatrician in Nairobi, Kenya and is very interested in practice management things like work flow improvements, hiring the right staff and working on making his clinic a better place for both him, his staff and his patients.

I recently heard from Dr. Nesbitt. He shared with me that a group of MIT grad students conducted an assessment of his office in Nairobi in an effort to make improvements in several areas of his practice e.g. workflow, checkin, collections, triage of the practice.

In the fall of 2009, a team of four MIT students applied to work with Muthaiga Pediatrics. The clinic’s head had set their goal: to make the most of Muthaiga Pediatrics’ existing resources so as to “provide a much higher level of medical care in a modern highly organized environment [and eventually to] transform the busy single pediatric practice into a growing clinic chain with a strong brand.”

You would think (I certainly did) that a practice in Kenya has little similarities to a practice in the US. However, when you see the teams objective, and what they set out to discover, I was surprised to see that these objectives are not really that different any practice here in the United States.

The students created a work plan that illustrated 3-key areas where they would focus:

  1. Benchmarking against world class pediatrics clinics
  2. Exploring clinic culture and personal issues
  3. Investigating addition of specialties to clinic

After reading the report I was impressed with two things.

First, I was impressed with how meticulous and well planned the students approached the project. From the way the broke down the key issues, to how the planned their research, to how they decided to make the suggestions was brilliantly executed, in my view. This was all evident in their documentation and supporting documents.

I couldn’t help to think, “why can’t a group of MIT students to come to my office and do the same?” I  later told Dr. Nesbitt how jealous I was. The work they did would put more than half of the practice managers consultants to shame.

The next thing that impressed me was the resources they published in their report and provided to Dr. Nesbitt’s as a type of blueprint or hand-book to execute the MIT students recommendations.

Here is what I’m talking about:

  • Project work plan described the goals for the project and breaks down responsibilities and final deliverables to be completed
  • Interim report was delivered by the MIT team to Muthaiga senior management upon their arrival onsite and outlines their research for the project to date
  • Project plan showed a timeline of activities to be undertaken onsite
  • Job descriptions, daily checklists, and reception tracking timesheet helped the team and the staff precisely define and focus on the tasks designated for each staff member and find bottlenecks in patient flow at reception
  • Tracking model and flow charts were used to record and organize the time patients spent waiting and being seen at each of a series of hospital stations during their visits, as well as the decisions the staff members were required to make at each step
  • Patient survey was administered to patients (by choice and with anonymity) to elicit preferences for areas such as appointment scheduling, and the availability of credit and acceptance of insurance
  • Employee survey was used to collect anonymous feedback on staff perceptions of how well the clinic was operating
  • A two-part final presentation given at the end of the MIT team’s onsite work

I encourage you to head over to the Global Health at MIT blog to read the report. There, you will read all about the project and find all the links to the resources listed above.

Improving Operational Efficiency in a Small Practice: Muthaiga Pediatrics 


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