Interview with Imran Osman Yusuf

July 12, 2023
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“Quality and patient safety should be everyone’s business.”

Interview with Imran Osman Yusuf, CEO, Avenue Healthcare, Kenya 

Preventing falls, reducing the spread of hospital-acquired infections, and improving quality of care are crucial for succeeding in a competitive healthcare marketplace, says Imran Osman Yusuf, CEO of Avenue Healthcare in Kenya. In an interview with IFC, Mr. Yusuf attributes Avenue’s success in improving patient care to data-driven decision-making, securing buy-in across the organization, and pursuing progress over perfection. An IFC investment client, Avenue Healthcare recently won IFC’s Business Case for Quality Contest for its innovative fall prevention program at its Parkland Hospital in Nairobi.

Avenue recently implemented a fall prevention program. What sparked this initiative?

What sparked the fall prevention initiative was a drive for quality. As part of a baseline review of quality metrics, the team had observed a very simple thing: we noticed that patients were falling at a rate of 11.1 per 1,000 patient days against a benchmark of 1.5 per 1,000 patient days. Studies have shown that about one-third of patients who fall experience serious injury, including fractures and head trauma. With this in mind, our team embarked on a fall prevention initiative to reduce falls and prevent patient harm.

Can you quickly walk us through the main steps you took to reduce falls?

We started by conducting in-depth interviews with nurses, support staff, and patients and their families on their experiences and observations. We also performed a root cause analysis, which revealed that many factors were contributing to the high rate of falls, including slippery floors, staff competency gaps, and faulty equipment. But operating in a resource constrained environment meant that remodeling entire floors, installing handrails throughout the facility, and guiding each patient as they moved through the facility was out of reach.

So, we began by replacing tiles in high-volume ward washrooms with non-slip tiles and also fixing bedrails. We increased nursing staff levels in general wards from one for nine patients to one for six patients. In critical care units and for patients at higher risk for falls, we implemented a one-to-one nurse-patient ratio. We also trained nurses on fall risk assessment, prevention, and management. Finally, we made it clear to all staff that reports of falls would not be met with punitive action. Encouraging hospital personnel toward a culture of incident reporting has the power to transform an institution.

How long did it take to see a financial return on this investment to improve patient safety? 

We made an initial capital investment of around $300,000 in the fall prevention program and tripled our human resources budget. Within a year, we reduced legal costs associated with falls by more than 95 percent. These cost savings have continued into 2023 as we have had more than eight continuous months without any patient falls. Patient satisfaction is up and Avenue hospitals have been growing more than 15 percent each year since we implemented the program, with a net increase in profitability since 2021, which has more than covered the increased HR costs.

When it comes to making investments in quality improvements, business units may look at the conversion of changes into cost savings, while clinical teams will evaluate patient outcomes. What strategies are most effective for obtaining buy-in across a hospital organization?

Using data and patient stories to demonstrate the impact and benefits of quality improvements are critical in getting the attention of stakeholders. It is also important for quality improvements to align with organizational goals. For example, quality is a key component of Avenue’s new strategic plan and we report results of quality initiatives to the board just like we would with financial results. We also have a board committee dedicated to quality and two senior leadership team members dedicated to quality - a Chief Medical Officer and Chief Nursing Officer. Securing buy-in should start at the top of an organization.

What lessons were learned from the fall prevention program, and how will you apply that knowledge to future investments in higher quality of care? 

The first lesson we learned is to aim for progress over perfection. We didn’t need to completely renovate our hospitals to see fall rates decline. Small fixes often make a big impact.

The second lesson is about using data to communicate and drive initiatives. The effectiveness of the program hinged on data, and we have since only expanded the depth and breadth of information we gather at the hospital to support data-driven decision-making.

The last lesson is on stakeholder engagement. We involved our frontline staff and patients and their families from the get-go, which enabled us to clearly understand the problem around falls and implement the necessary solutions. Engaging with frontline staff and patients has become standard protocol. That practice enables us to focus on what is best for medical staff and their patients and helps us get buy-in from colleagues.

How does access to data shape an institution’s ability to understand patient safety problems and devise solutions?

Data isn’t about understanding how many patients come through a hospital, it’s about understanding what their journeys looked like. For instance, when we started analyzing data at Avenue, we found that too many doctors were sending bloodwork to outside labs for testing. This was clearly a quality issue or else they would have been using the one inside the hospital. We spoke with clinicians and learned that our labs were missing some essential pieces of equipment they needed to diagnose and treat patients. For example, we installed a microbiology data management system that increased sensitivity to bacterial growths that ultimately helped doctors guide treatment.

How can health organizations make sure initiatives to improve quality of care, such as patient safety, are maintained for the long term?

The first thing I would advise is to replace old habits with new tools, policies, and training. Take data collection as an example: Make it as simple as possible and find ways to incorporate it into day-to-day tasks. For instance, first thing in the morning, check to see if there were any incidents and then convert them into incident reports as a matter of routine.

It is also valuable to have someone trained as a frontline worker on the senior leadership team. Our Chief Nursing Officer brought the quality discussion to the forefront and became a champion of improving patient safety. Quality improvement goals are tracked on a monthly basis. We also have regular check-ins with staff to help them if issues come up and to reaffirm our commitment to new policies and changes. Quality and patient safety should be everyone’s business.

What are 3 pieces of advice for other hospital leaders trying to implement similar changes for strengthening quality of care?

My first piece of advice is to view quality improvements as a continuous process, not a singular event. It’s going to take time and it will get messy, but strengthening quality of care is an ongoing opportunity, not a punishment.

Second, I recommend using data to guide decision-making. Healthcare is a complex system and it can be difficult to untangle the different parts and subsystems. Take your time planning quality initiatives and use as much analysis as possible.

Thirdly, start small and stack up minor improvements, which will lead to big, transformational changes.

If I can add a fourth piece of advice, I would say surround yourself with experienced people who are not afraid to challenge you.

This interview has been edited for length and clarity.

Published in July 2023

Imran Osman Yusuf has over 16 years’ experience managing all levels of multiple businesses and projects including budgeting, financial management, and administration. He has vast experience in the healthcare industry, retail industries, and manufacturing.

Imran holds a Master’s in Business Administration  (MBA) from the University of Liverpool and is a Certified Public Accountant (CPA-K) registered as a practicing member with the Institute of Certified Accountants of Kenya (ICPAK).

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