In the back of a room at St. Paul’s Hospital Medical College in Addis Ababa, a young doctor stirred with the question.

Did Ethiopia’s new health management project, called the Balanced Scorecard, really change the way that doctors, nurses, and administrators went out about their work? Dr. Lina Mohammed, an emergency department specialist, raised her hand.

"Before the training course, you just came to work every day and then you left. You didn’t get to see the bigger picture," she said. "We weren’t working for a larger goal. We were just putting in the hours."

Dr. Lina Mohammed, emergency department specialist

at St. Paul’s Hospital Medical College in Addis Ababa

Ethiopia is in the beginning stages of instituting a new way of managing its health services, and a group from MLI’s Learning Collaborative Forum today visited St. Paul’s Hospital, which is making plans to be the first hospital in Addis Ababa to institute the Balanced Scorecard initiative. The approach calls for a Ministry and its health facilities to develop a strategic vision, align the day-to-day work with that vision, create performance indicators at different levels of the organization, and then measure later whether the organization has met targets.

The initiative has been strongly pushed by Health Minister Dr. Tedros Adhanom Ghebreyesus, and supported by MLI with funding and technical assistance. So far, trainers have mostly worked with Addis-based government managers, training 125 people in the last year. Ethiopia is not only poised to start expanding the effort to the country’s health facilities, but it also plans to expand the management approach to the entire government, across all sectors.

"It means investing in more critical areas of our work, and in the end that means seeing improved results in health care," said Dr. Lia Tadesse Gebremedhin, CEO at St. Paul’s Hospital. Rahel Gizaw, MLI’s country lead in Ethiopia, who is helping shepherd the Balanced Scorecard project through government channels, said that at first some workers in the Ministry were resistant to the new plan. They feared it could mean their jobs were in jeopardy if they performed badly. "But once it was seen as a strategic management process, which would improve a system’s performance, and that it wouldn’t be used as a punitive tool, people really accepted it," she said.

At St. Paul’s, Dr. Gebremedhin said that she hoped it would improve a range of issues, including cutting down on patients’ waiting time, managing the use of beds more wisely, and increasing patient satisfaction. One earlier survey found that 68 percent of patients said their hospital experience was positive. Now the hospital is aiming for 95 percent satisfaction.

She said she approaches her job differently now because of the training. "We deal with so many different problems here," she said about the hospital, the country’s second largest, which sees roughly 110,000 patients a year. "Days would go by and I would only be dealing with day-to-day problems. It changed my way of thinking. I know now which areas that I really need to be focusing on. I know where I need to spend more time on."

After Balanced Scorecard is rolled out to the hospital’s 17 departments, she said, "I think this is really going to improve the quality of this place."

For more information, Dr. Lia Tadesse Gebremedhin and Rahel Gizaw have authored a MLI case study: Implementing a Balanced Scorecard at St. Paul's Hospital, Addis Ababa, Ethiopia

See a presentation on St. Paul's implementation of the Balanced Scorecard below along with an interview with Hospital CEO Dr. Lia Tadesse Gebremedhin:

 

Live-blog from Ethiopia:

Part 1: MLI Live-blog from Addis Ababa

Part 2: ‘Its Always Good to Think Big’

Part 3: Mali’s Path to Community Health Insurance

Part 4: ‘A New Dawn’ in Health Care in Sierra Leone

Part 5: Want to Bargain? The Nepalis can Help

Part 6: From Mali to Nepal: The Trail of a Negotiator

Part 8: Ethiopia and the Importance of Family Planning

Part 9: Gang of Four: Table Talk with Reproductive Health Directors

Part 10: Ethiopia’s Tedros: Four Steps to Owning Health Programs

Part 11: ‘We Want to be Led”

Part 12: ‘We Became Beggars”

Forum Wrap-up, Part 1: Marty Makinen and Amanda Folsom

Forum Wrap-up, Part 2: Rosann Wisman

Photo credit Dominic Chavez.