Using Value Stream Mapping to improve quality of care in low-resource facility settings.

QUALITY PROBLEM OR ISSUE: Jacaranda Health (JH) is a Kenya-based organization that attempts to provide affordable, high-quality maternal and newborn healthcare through a chain of private health facilities in Nairobi. INITIAL ASSESSMENT: JH needed to adopted quality improvement as an organization-wide strategy to optimize effectiveness and efficiency. CHOICE OF SOLUTION: Value Stream Mapping, a Lean Management tool, was used to engage staff in prioritizing opportunities to improve clinical outcomes and patient-centered quality of care. IMPLEMENTATION: Implementation was accomplished through a five-step process: (i) leadership engagement and commitment; (ii) staff training; (iii) team formation; (iv) process walkthrough; and (v) construction and validation. EVALUATION: The Value Stream Map allowed the organization to come together and develop an end-to-end view of the process of care at JH and to select improvement opportunities for the entire system. LESSONS LEARNED: The Value Stream Map is a simple visual tool that allows organizations to engage staff at all levels to gain commitment around quality improvement efforts.