Learning Across Borders: What a Kenyan Eye Hospital Learned When They Visited Nigeria

City Eye Hospital is a social venture that provides quality and affordable eye care to people living in Kenya. Eye Foundation Hospital has been operating in Nigeria for 20 years to fight against preventable blindness. The two hospitals partnered up to participate in the 2017 CHMI Learning Exchange.

At City Eye Hospital, our vision is to become the leading eye care provider in East Africa. Since we opened our doors in June 2015, we have achieved remarkable milestones, including growing our outpatient volume by four-fold, performing over 1,000 cataract surgeries (60% of which were provided at no cost to the patient), and developed a robust outreach program that offers free eye screening and eye care products like eye drops and eye glasses at a discounted price. The outreach program has screened over 21,000 people for eye related conditions in just two years.

However, our accelerated growth has inevitably brought challenges, and we hoped to find a way around them with the help of a peer learning program. We decided to apply for CHMI’s Learning Exchange, and to partner with Eye Foundation Hospital (based in Nigeria) because they have been in the eye care field for more than two decades and are the leading eye care provider in the West Africa region. We were certain that there were invaluable lessons that we could learn from them.

Specifically, we hoped to identify solutions to the following issues through the Learning Exchange:

• Many patients have commended us for the excellent customer service and friendly staff at our facility. How can we maintain a unique customer experience as patient volume grows?
• Our staff size has more than tripled in the past two years, causing human resource management challenges. How do we ensure that our human resource policy is dynamic enough to address the majority of staff needs?
• The hospital systems where we’re working aren’t strong enough to handle such a high growth rate.  How do we develop Standard Operating Procedures (SOPs) to maintain quality of care?
• How do we create staff retention incentives for senior doctors and senior members of management?
• Despite our high growth rate, we aren’t widely known in the country. From our statistics, 80% of new patients are referred by previous happy patients. How do we develop effective marketing strategies to create more awareness of our existence?

What we learned

• A strong mentorship program for doctors can empower them and improve their performance. Our Chief Medical Director now works with doctors in training for six months to build their confidence before they are allowed to start operating on patients on their own. When this mentorship program was implemented, we saw that the doctors at each hospital demonstrated a full command of hospital operations. It was also a motivating factor for young doctors to work in the hospital.
• A staff feedback mechanism in each department allows us to address emerging staff issues promptly and enhance their experience in the hospital.
• Communicating company vision and mission to the rest of the staff consistently enables them to fully buy into the organization, and understand the direction everyone should be moving together to achieve the organization’s goals and objectives. At Eye Foundation Hospital, we saw that the vision and mission statement was clearly displayed in every room and department. Even as visitors we were able to understand and internalize the vision and mission of the company.
• Constant scanning of the market is important to develop strategies responsive to dynamics in the market. Company leadership should meet regularly to develop plans to grow the business and address challenges affecting its growth.
• Documenting and displaying SOPs clearly on the walls of every room provides clear direction to staff when executing their duties. Dedication to these SOPs was evident at Eye Foundation Hospital, where the motto was “what is not written is not a rule.”
• There should be post-operative practices for both providers and patients. Post-operative counselling for patients has been incorporated into City Eye Hospital’s SOPs and fully implemented by the counselling department. We’ve received positive feedback from patients who are very impressed with this change. Weekly post-operative review meetings with surgeons and theatre staff, as well as bi-monthly meetings with doctors have also been implemented after the visit to Eye Foundation Hospital.

Challenges faced during implementation

While the lessons learned above were very fundamental to the successful running of our organization, we recognized that challenges would emerge during implementation. These are some of the specific challenges we faced:

• Kenya and Nigeria have very different cultures, so we couldn’t simply copy and paste the things we learned at Eye Foundation Hospital. Rather, we adapted them to our culture to ensure they were easy for our staff to accept and follow.
• Staff were sometimes reluctant to adapt. We realized that some changes needed to be introduced gradually since there was resistance from staff, especially older members of staff.

Importance of participating in a learning exchange

Despite the challenges that came along with implementing some of the things learned, we consider learning to be very important, especially among fairly young organizations like ours.

• When you get first hand exposure at other facilities, you realize that some of the challenges you face in your organization are not unique to you but are common in the industry. This realization can shift your thinking and change your perspective as a leader, allowing you to seek out new solutions and get support from other leaders in the industry.
• By traveling to Eye Foundation Hospital and seeing things first hand, we were able to seek immediate clarification for any questions or uncertainties we had. We were able to not only observe but even participate in some of the activities. For example, we participated in a brainstorming session with the leadership team which gave us insight on how to conduct such sessions ourselves. We were able to borrow and implement best practices in eye care like post-operative counselling for surgery patients and regular review meetings with surgeons, which has improved quality of care in the hospital.

Take home

Learning should be a daily exercise of any company, and it works best when top management spearheads it. It’s equally important to run an organization with an open mind as this allows you to adapt to new changes which may go long way in improving the running of the organization. I encourage any person considering engaging in a learning activity to go for it. You never know what lies ahead until you venture out to find it. This is what learning does.