June 24, 2015

“To be amongst the best…”

Drew Weil, 2015 GHLI U.K. Fellow
You don’t have to go far to find a British citizen that is proud to receive health care through the National Health Service. It is one of the country’s sparkling achievements and a system that people from every social class and demographic endear. 
My fascination for how the U.K. can care for literally every member of their society so well was what drove me to this GHLI fellowship working for the 12 weeks with the East & North Hertfordshire NHS Trust. And subsequently, I wanted to understand what can we learn and apply to improve our own U.S. healthcare system. 
My work here is largely focused on improving the care and services provided for frail and elderly people. I believe that the way a country and health system cares for their most vulnerable populations is a good test of its conviction to humanity and civility. In this Trust, there are many stakeholders eager to work towards and progress forward with this aim. 
However, with a more diverse stakeholder group, also comes opportunities for redundancies and inefficient work processes. I am able to work with each of these groups – which include community health care providers, social service leaders, NHS commissioners, hospital administrators, physicians, government representatives, and others – to find a common approach to improving care and healing that is provided. I’m excited and feel a sense of accomplishment when I can apply concepts I’ve learned in my Health Care Management coursework and past work experiences. Whether it is interpreting data, discussing the economics of the NHS, or watching the hospital operations in real-time, it is an amazing feeling to see the pieces begin to come together.
Although the weather is typically grey and overcast, the people have been warm and cheerful. It is an inspiring group of people to work with, and it makes it very easy to wake up, be motivated and want to contribute-to and improve their community! “Cheers!” 

June 10, 2015

Never Again or Never Give Up? The Reality for Global Health Workers

By Rex Wong, Director, GHLI, Health Management and Leadership

Rex Wong, Director, GHLI, Health Management and Leadership
Being a manager of global health programs in Africa for more than a decade, I receive many inquiries from young, energetic, people who want to join the world of global health. Apparently I am “living their dreams.” I see equally as many people who were just as passionate only to realize that this work may actually be just that … a dream.  

New groups continuously come to this country ready to make a difference. While they enter with good intentions, reality often leads to frustration and, within a year, I see many of them pack their bags and leave vowing “never again.”  

Global health can be deceivingly glamorous and brutally demoralizing. During one of my first presentations recommending strategic plans and ideas to the Ethiopian government and hospitals, the stunned faces and you-are-out-of-your-mind looks told me it was not going to be easy. I tried regardless. This year, as I spoke to master in hospital administration students in Ethiopia, the responses I received could not be more different. Not only have the students heard of the systems we’ve taught all these years, many have even implemented them. As a global health worker, I could not have asked for better reward.  

Sometimes it’s hard to believe we make any progress, not to mention impact. But I don’t fail to see the improvements we have made - a toilet in the hospital being fixed or a cashier being relocated to a more convenient place for patients. Every now and then, I receive unexpected appreciation from a staff or a patient and that would make it all worth it. We cannot give them more salary or promotions, but we offer glimpses of better future.  

Nobody ever said it would be easy or that change would be drastic. Many of us may not stay in a country long enough to see the results, but know all efforts are valuable and we are making a difference. 

June 2, 2015

Why We Do What We Do: Halima Mohammed

Halima Mohammed
As a child, I watched people with acute and chronic illnesses coming to the health station located hundreds of meters from our home. My father was a health assistant in charge of a rural government clinic and spent most of the days working in the clinic. He was sometimes called for emergency services during the night and had to travel to remote rural villages when epidemics occurred. My exposure and interest in public health was a part of my life as long as I can remember.

After completing my high school education, I enrolled in the Addis Ababa Centralized School of Nursing. I was assigned to the rural health center Arsi, Robe where I started my professional career as a qualified nurse. There I diagnosed and treated patients, provided maternal and child health services, and vaccinated children at the health center and outreach posts. I was often expected to perform those duties without a supervisor - which challenged me while also giving me the opportunity to make decisions, be confident and broaden my education and experience.

After four years at the rural health center I was transferred to a regional hospital in Arsi, Assela where I worked in several departments and managed a nurses division. I then relocated to Addis Ababa, Ethiopia where I joined the Black Lion Specialized Referral Hospital and served for 15 years in diverse positions. During that time, I also advanced my education and received a B.S. degree in nursing and M.H.A. in Health Care Administration.

I joined the GHLI HEPCAPS Project in November 2013. I appreciate and enjoy the strategic thinking of the program, which aims to strengthen health systems in African countries, mainly through capacity building, training and research. As part of the HEPCAPS team, I work to strengthen primary health care units within the larger health sector in Ethiopia. The time motion study for HEPCAPS and PHCU demonstration project by GHLI are the most rewarding aspects of my work. This project helps us understand how health extension workers in Ethiopia spend their time, and my role includes collecting, monitoring and reviewing this data. The biggest challenge is bringing the people and the stakeholders I work with on board to implement the strategy.

As my work progresses, I hope to continue to improve health systems at the grassroots level and to also develop my skills by working on projects with people from which I can continue to learn and grow.

March 30, 2015

Reducing Hospital Readmission Rates -- What Really Works?

Erika Linnander, GHLI Senior Technical Officer

Unplanned hospital readmissions are estimated to cost more than $17 billion each year for Medicare alone. Across the country, hospital executives, clinicians, policymakers, and researchers search for the best ways to reduce unplanned hospital readmissions. Hospitals are intently focused on this issue, and are joining quality improvement networks and programs to guide their efforts. A dizzying array of tools and best practices are available, but which approaches are in fact tied to reduced readmission rates?

Researchers at Yale’s Global Health Leadership Institute continue to study which strategies work best for providing quality patient care and reducing hospital readmissions. Between 2010 and 2012, they found significant increases in the use of nine frequently recommended strategies among hospitals participating in the State Action on Avoidable Rehospitalization initiative or the Hospital-to-Home Campaign.

The latest evidence appearing in the May 2015 issue of the Journal of Internal Medicine shows that hospitals that incorporated any combination of three or more of these strategies which focused on changes to hospital culture and administration, saw significantly larger reductions in risk-standardized readmission than those hospitals that took up fewer strategies. After adjusting for hospital size and location, hospitals that implemented several strategies reduced their readmissions rates by 0.4 percentage points more than hospitals that implemented fewer strategies. Scaled nationally, this improvement could save the Medicare $400 million annually.

The study findings showed rather than a single recipe, many different combinations of strategies led to similar reductions in readmission rates.

What can health care professionals make of these results? First, there is no silver bullet. None of the nine strategies alone accounted for sizable reductions in readmission rates. Second, the successful hospitals were implementing at least three new strategies to reduce readmissions. Because readmissions have multiple root causes, a bundle of strategies is likely needed. Different hospitals used different means for achieving results. Last, change is hard. Despite their enrollment in major quality improvement initiatives, 70% of the hospitals surveyed had taken up fewer than three strategies during the course of the study.  

March 26, 2015

Leadership Towards the Advancement of Human Rights

Photo Credit: Thi Nhat Le
Zahirah McNatt, GHLI Director, Leadership Education and Practice

As part of the Senior Leadership Program (SLP), I recently worked with delegates from Cambodia, Laos, Myanmar, Philippines, and Viet Nam in Phnom Penh, Cambodia to address strengthening the enabling environments for persons with disabilities. Each team brought with them a national problem - high staff turnover, too few rehabilitation professionals, poor access to physical rehabilitation centers and limited knowledge among people with disabilities about their legal rights.

For this program, all written materials were translated into four languages and we had simultaneous interpretation during lectures and group activities. For five days, we explored problem solving, leadership and management, good governance and the United Nations Convention on the Rights of People with Disabilities (UNCRPD).

The trip was an awe-inspiring opportunity to encourage collaboration among several stakeholders. We had representatives from national disabled people’s organizations, government ministries, parents, teachers and physical rehabilitation facilities. The diversity created dynamic teams and allowed for cross-country dialogue about better integrating disability rights efforts in Southeast Asia.

The SLP created a safe space for discussion on how to operationalize the aspirations of the UNCRPD. Many countries stall once ratifying such agreements and are unable to make the dreams reality. These five nations have the potential to implement practical solutions that increase accessibility and diminish discrimination against people with disabilities.

While there are many difficult stories about children who use wheelchairs being unable to get to school or people with visual impairment being denied the right to vote - I remain hopeful. I am personally motivated by the role models present in the Program itself - women and men with and without disabilities who have chosen to champion the rights of others. I left Phnom Penh struck by the power of our unified voices and further committed to encouraging and demanding justice and equality for all.

March 10, 2015

Why We Do What We Do: Nikole Allen

GHLI program manager Nikole Allen first became interested in global development as a freshman in high school. Nikole realized that, “access to education, health and economic opportunities provided to most Americans is not universal.” She became actively involved in Operation Days’ Work, a USAID-led youth development program.The program empowers students to promote international awareness and support educational initiatives in lower income countries. Nikole’s work with the program focused on funding a grant to refurbish a secondary school in rural Ethiopia. With piqued interest in the global health field, she selected a major in international studies at the Western Oregon University. 

While pursuing her Master’s of Public Health through the Peace Corps Master International program at the University of Washington she was reconnected to Ethiopia, where she worked as a community HIV/AIDS advisor. Later, she joined the Clinton Health Access Initiative’s Ethiopian Hospital Management Initiative and began working with the Ministry of Health to help hospitals interpret key performance methods -- including the measurement of patient and staff satisfaction, the uptake of patient satisfaction best practices and the implementation of the World Health Organization Surgical Safety Checklist.  

Since joining the GHLI team, Nikole has led research and training programs in the United Kingdom, Tanzania and Rwanda. GHLI has provided her with the opportunity to collaborate with a variety of groups in different health systems. She particularly enjoys learning about each group’s challenges and providing them with the guidance and support to generate strategies to address those problems. 

“The GHLI leadership programs are incredibly valuable because they offer country participants the ability to learn outside of their regular environment and reflect on their challenges.”

“I appreciate that GHLI recognizes that health system challenges exist everywhere, so we have domestic projects and partners in high income countries as well,” said Nikole. “I’m looking forward to continuing to explore the intersection of public health and development across the globe.”