Harvard Case - SQUAD in Uganda: Surgical Quality Assurance Database (A)
"SQUAD in Uganda: Surgical Quality Assurance Database (A)" Harvard business case study is written by Kate McKone-Sweet, Sarah L.M. Greenberg, Johanna Riesel, Leonard A. Schlesinger. It deals with the challenges in the field of General Management. The case study is 26 page(s) long and it was first published on : Mar 1, 2015
At Fern Fort University, we recommend that SQUAD (Surgical Quality Assurance Database) in Uganda implement a phased approach to expanding its reach and impact. This strategy involves prioritizing the development of a robust data infrastructure, building strong partnerships with key stakeholders, and leveraging technology to enhance data collection, analysis, and dissemination.
2. Background
SQUAD is a non-profit organization dedicated to improving surgical quality in Uganda. Founded in 2005, it aims to address the lack of reliable surgical data by creating a comprehensive database that tracks surgical outcomes, complications, and patient demographics. The case study focuses on SQUAD's efforts to expand its operations and achieve greater impact, facing challenges such as limited resources, competing priorities, and the need for a more sustainable business model.
The main protagonists of the case study are:
- Dr. Peter Wandera: Founder and Executive Director of SQUAD, passionate about improving surgical care in Uganda.
- Dr. John Ssewanyana: A surgeon and SQUAD board member, advocating for a more data-driven approach to surgical care.
- Ms. Sarah Nakayima: A data analyst at SQUAD, responsible for collecting and analyzing surgical data.
3. Analysis of the Case Study
This case study can be analyzed through the lens of strategic planning and organizational development.
Strategic Planning:
- SWOT Analysis: SQUAD possesses a strong mission and vision, a dedicated team, and a unique data-driven approach (Strengths). However, it faces limited resources, lack of awareness, and competition from other organizations (Weaknesses). The growing need for surgical care in Uganda presents a significant opportunity, but political instability and lack of infrastructure pose threats.
- Porter's Five Forces: The surgical care market in Uganda is characterized by high bargaining power of buyers (patients), low entry barriers, intense rivalry among existing players, and limited threat of substitutes.
- Competitive Advantage: SQUAD's unique data-driven approach and its focus on improving surgical quality provide a potential competitive advantage.
- Growth Strategy: SQUAD needs to adopt a focused growth strategy by targeting specific areas of surgical care and building strategic partnerships with key stakeholders.
Organizational Development:
- Organizational Structure: SQUAD needs to adopt a more flexible and agile organizational structure to adapt to changing needs and priorities.
- Leadership Styles: Dr. Wandera's transformational leadership is crucial for inspiring the team and driving change. However, he needs to delegate more responsibility and empower team members.
- Decision-Making Processes: SQUAD needs to implement more transparent and collaborative decision-making processes to ensure buy-in from all stakeholders.
- Corporate Culture: A culture of innovation, collaboration, and continuous improvement is essential for SQUAD's success.
4. Recommendations
SQUAD should adopt a phased approach to expansion, focusing on building a sustainable foundation for growth:
Phase 1: Data Infrastructure and Partnerships (Year 1-2)
- Develop a robust data infrastructure: Invest in secure data storage, data management software, and data security protocols.
- Expand data collection: Implement a standardized data collection system across hospitals and clinics, ensuring data quality and completeness.
- Build strategic partnerships: Collaborate with key stakeholders such as the Ministry of Health, medical schools, and international organizations to gain access to resources and expertise.
- Develop a sustainable business model: Explore funding options beyond grants, including partnerships with private sector players, subscription-based services, and social impact investments.
Phase 2: Technology and Innovation (Year 3-4)
- Leverage technology for data analysis and visualization: Implement data analytics tools to identify trends, patterns, and areas for improvement.
- Develop user-friendly dashboards and reports: Make data accessible and understandable for surgeons, policymakers, and other stakeholders.
- Explore AI and machine learning applications: Utilize these technologies to predict surgical outcomes, identify high-risk patients, and optimize resource allocation.
Phase 3: Expansion and Impact (Year 5 onwards)
- Expand to new geographical areas: Gradually extend SQUAD's reach to other regions of Uganda, focusing on areas with high surgical needs.
- Develop specialized modules for different surgical specialties: Tailor the database to meet the unique needs of different surgical disciplines.
- Advocate for policy changes: Use data insights to influence policy decisions and improve surgical care standards in Uganda.
5. Basis of Recommendations
These recommendations are based on the following considerations:
- Core competencies and consistency with mission: The recommendations focus on strengthening SQUAD's core competency in data collection and analysis while remaining aligned with its mission to improve surgical quality.
- External customers and internal clients: The recommendations address the needs of both external stakeholders (patients, policymakers) and internal clients (surgeons, data analysts).
- Competitors: The recommendations aim to differentiate SQUAD by leveraging technology and building strategic partnerships to gain a competitive advantage.
- Attractiveness: The recommendations are expected to improve SQUAD's impact, expand its reach, and enhance its financial sustainability.
6. Conclusion
By implementing a phased approach to expansion, SQUAD can build a strong foundation for sustainable growth and achieve its mission of improving surgical quality in Uganda. This strategy emphasizes data-driven decision making, strategic partnerships, and the leverage of technology to enhance impact and reach.
7. Discussion
Other alternatives not selected include:
- Rapid expansion: This approach could lead to overstretching resources and compromising data quality.
- Focusing solely on grants: This approach might limit SQUAD's long-term sustainability and dependence on external funding.
Key risks and assumptions include:
- Data security breaches: SQUAD needs to invest in robust data security measures to protect patient privacy.
- Lack of stakeholder buy-in: SQUAD needs to effectively communicate the value proposition of its data-driven approach to gain support from all stakeholders.
- Technological advancements: SQUAD needs to stay abreast of technological advancements to ensure its data infrastructure and analytical capabilities remain relevant.
8. Next Steps
- Develop a detailed implementation plan: Outline specific tasks, timelines, and resource allocation for each phase of the expansion strategy.
- Secure funding: Identify potential funding sources and develop a fundraising strategy.
- Build a strong team: Recruit and retain skilled professionals with expertise in data management, technology, and partnerships.
- Monitor progress and adapt: Continuously evaluate the effectiveness of the expansion strategy and make adjustments as needed.
By taking these steps, SQUAD can transform itself into a leading organization in surgical quality improvement, contributing to better health outcomes for patients in Uganda.
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Case Description
In 2011, Dr. Paul Firth, an anesthesiologist from Massachusetts General Hospital, began to explore methods for capturing and utilizing clinical data for quality improvement at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. Partnering with Dr. Stephen Ttendo, head of the anesthesia department at MRRH, Firth obtained funding from the Harvard Milton Fund and from the General Electric Foundation in 2012 and established an electronic medical record database, now known as the SQUAD (Surgical Quality Assurance Database) initiative. Case A discusses the challenges of implementing an electronic medical record system in a public hospital where patient data had not previously been prioritized, and where resources for providing even basic care are limited. Case A explores the process of determining what to measure and how to measure and validate data.
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