The entrepreneurship bug

So i caught the entrepreneurship bug!

It was the start of May 2014, I'd over the preceding weeks had a family member in Abuja, Nigeria who had some health issues. The travails we experienced in attempting to get quality care was distressing. Particularly as finances were not the limiting factor but rather systemic issues that conspired to provide mediocre care.

As  i pondered on this problem i suddenly got the bright spark of an idea that would improve the quality of the health system. The idea filled me with such excitement that i wanted to quit my job right away and jump on a plane to get started on my idea.

Unfortunately reality soon set in, I  had bills to pay, a family to raise etc. I was convinced however that i was on to something. In my mind's eye i had this vision of the wonderful change my innovation could bring. The next logical thing for me to do was to put it down in writing, my business plan was born! I spent hours and days without sleep working on it. I've subsequently gone on to find out the traditional business plan has fallen out of favour particular in tech ventures - my bright idea is a tech venture that aims to improves the quality of healthcare.

So while i had the momentum i bought a domain and webhosting on the 11th of may. Money had been spent i was committed!

Now this may not apply for others but for me, writing down a business plan was useful as it helped solidify my thoughts and forced me to do more research and gain more knowledge. The more work i did the more of a knowledge gap i realised i had. Next step thus was to hit my local library. I browsed the business and IT sections and picked up 2 books - 'the lean startup' by Eric ries and 'how to start a tech business' by Alex cowan. I went on to find out that the former book was a huge bible for tech startups.

...And so my study began.

Key performance indicators

Browsing the intranet of my hospital, I came across the quarterly hospital health target report.

The report consisted of parameters the ministry of health requires all hospitals to report. These parameters are in areas the ministry feel are important goals - so called 'health priorities'-  that are to be met in order to fulfill the need of the population accessing healthcare.

This is not a new phenomenon, the idea of key performance indicators (KPIs) is wide spread in business and is used to judge performance as well as highlight areas for improvement.

It is also a useful goal setting strategy that helps keep the goal always in focus. While it can be detrimental in that focus may start to shift to numbers than perhaps what the numbers are trying to achieve, it is felt to be generally a good thing that most organizations and governments imbibe.

A look at the KPIs for this particular health ministry, summarized in a webpage that houses the results reveal targets in:

- Shorter stays in emergency department - 95 percent of patients will be admitted, discharged, or transferred from an emergency department within six hours.

- Improved access to elective surgery - volume to increase by 4000 discharges per year

- Increased immunization - 90 percent of 8 month olds will have their primary course of immunization on time

- Shorter waits for cancer treatment - all patients ready for treatment wait less than 4 weeks

- Better help for smokers to quit - 95 percent of hospitalized patients who smoke and are seen by a health practitioner in public hospitals and 90 percent of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking.

- More heart and diabetes checks - 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.

The data from different regions are collated and a quarterly reported published. One is then able to compare data across different areas and times for the whole country. The public are aware of it and have certain expectations when they access health care. Staff also have defined targets to work towards in their everyday roles

Over time it is easy to see where one needs to appropriately target interventions or employ different management strategies to ensure improvement. 

These indicators are obviously well thought out, with specific numeric targets. It shows homework has been done and the government has chosen priority areas to invest time and effort to improve the well being of the population. It is also safe to conclude that systems exist to gather this information.

Seeing this, i did a google search for any similarity in the Nigerian health system. To my surprise i came across a national health plan. The plan was laudable in that it was quite a detailed document that had reasonably specific targets and KPIs. The more i read the more obvious it became to me that quite a lot of work had been put into it. But as often is the case with Nigeria, many a great reports are left to rot on government shelves while the status quo carries on.

Where the plan was further let down was the lack of data. Several indicators couldn't be measured as the data just wasn't available. Furthermore the number of KPIs were large, this in my opinion defeats the purpose.

What is needed is something like the much maligned 7 point plan of former president Yar'adua (God rest his soul).

7 indicators with achievable goals, monitored quarterly, easily measurable and impactful in the day to day health of the average individual. This should then be easily accessible to the general public who can compare, contrast and put pressure on the right people when needs be to make sure things get done.

Of course more systems for data collection needs to be put in place to facilitate this and people and healthcare workers need to be educated and carried along. All in all it's not that difficult, all that's needed is the will and we know that when there's a will there's a way!