FEATURE – Thanks to Lean, EHA Clinics improved safety, efficiency, and patient experience. Now they’re hoping their results will inspire a growing movement to transform healthcare across Nigeria.

Words: Aisha Amira Saidu, Fatima Abubakar and Chizorom Daniella Ukwa

Three years ago, we found ourselves at a crossroads. At EHA Clinics, we’ve always had big ambitions: to close the gap between individuals and high-quality care in our country, whether that’s in a clinic, at home, or out in the community. We’ve always taken quality and patient safety seriously. But we also knew that good intentions and solid systems weren’t enough in a sector that, like healthcare, never stands still. To keep improving, we knew we needed more than motivation – we needed a framework to constantly push ourselves.

That’s how our lean journey began.

It was this foundation of continuous improvement that later helped us achieve accreditation from Joint Commission International (JCI), a major milestone in our commitment to excellence. But more on that later.

LAYING THE GROUNDWORK: WHY LEAN, AND WHY NOW?

We officially made the decision in 2021. We wanted to go beyond “good enough” and build a culture where excellence wasn’t a milestone but a mindset. Our leadership team knew Lean could offer us a structured, proven path toward that.

But we were also aware that introducing it to healthcare, especially in Nigeria, would require a significant shift. Our CEO at the time, Adam Thompson, played a huge role in getting this initiative off the ground. He challenged us constantly: if we proposed a 95% target, he’d typically ask, “What about the 5% left behind?” That mindset – the refusal to accept “almost” – eventually became part of our DNA.

STARTING SMALL, THINKING BIG: TRAINING AND LEADERSHIP ENGAGEMENT

Critically, we began by investing in our people. Some of our first lean champions were drawn from across departments and enrolled in a training organized by Catalysis. We held lean book clubs, got serious about continuous learning, and ensured that members of our continuous improvement office received Black Belt certification.

But we didn’t stop there. We rolled out White Belt training – our Lean Playbook – to every single staff member and made it part of onboarding for new hires. Our six-month internal Leadership Development Institute began incorporating Yellow Belt certification too. It was clear: this wasn’t a one-off project. This was who we were becoming.

Leadership didn’t sit on the sidelines either. Our gemba walks brought executives and managers directly to the front-line. Over time, we formalized these walks, creating routines and clear protocols that helped us spot waste, engage teams, and build trust.

THE MILESTONES

Looking back, our lean journey has unfolded in waves:

• 2021: Foundations first

We focused on A3 Thinking and small but meaningful improvements, like space

optimization using 5S in our acute care rooms. We also kicked off QI projects aimed at strengthening our insurance claims process – small wins that gave us momentum.

• ‍2022: Kaizen and patient flow

This was a breakthrough year for us. We hosted our first kaizen event focused on patient wait times. The collaboration between teams was electric. The changes were simple but effective – adjusted workflows, clearer roles, better signage – making a real difference in the care we provided.

• ‍2023: Deepening our practice

We revamped our incident management process to be non-punitive and proactive. Our message was clear: safety is everyone’s job, and mistakes are opportunities to learn. We also launched lean maturity assessments, embedded Lean into our OKRs, and introduced tiered daily huddles that connected the front line to leadership.

• ‍2024: Sustaining and scaling

By now, Lean wasn’t just a “thing we were doing” – it was part of how we thought and worked. We introduced quarterly recognition for incident management champions, encouraged every team to lead at least one QI project, and reassessed our lean maturity (see below). We also kept refining our ability to leverage the A3 methodology and building systems that sustain change.

LESSONS WE LEARNED (THE HARD WAY)

It hasn’t been perfect. One of our misses was skipping a baseline lean maturity assessment right at the start, which made it tough to measure our progress in the beginning. We’ve also struggled with staff turnover – showing that bringing new hires into our lean culture takes time and intention.

But every challenge gave us a chance to adjust, to listen more closely, and to double down on what matters: people. That’s been the biggest shift – building a workplace where everyone, from our front desk to our lab scientists, sees themselves as a problem solver.

CULTURE SHIFT: FROM COMPLIANCE TO COMMITMENT

One of the most powerful changes has been in how our teams see safety and quality. Our incident management system is no longer about blame. It’s about learning. When someone reports an issue now, they’re also expected to suggest a preventive action. That’s huge.

We’ve seen a noticeable mindset shift. People want to lead QI projects. They want to make their processes better. They feel proud of their contributions. When you walk through our clinics, you feel it – there’s more energy, more ownership, and more purpose.

Here’s what a few of our team members have said:

“The Lean adoption process has progressed very well. There is an improved understanding and application of the principles.” – C-Suite, 2022

“It’s been only a week, but I’ve already learned so much. I’m excited to become the best version of myself.” – Community Health Worker, 2022

“Patient safety is a top goal here. When errors occur, root cause analysis is done immediately.” – Laboratory Scientist, 2023

“There’s a real focus on safety and error reporting – it’s a vital part of our quality care.” – Nurse, 2024

WHAT WE’VE ACHIEVED (SO FAR)

It’s one thing to talk about Lean; it’s another to show results. Here are a few we’re especially proud of:

• Lean Maturity Score: our most recent assessment came in at 4.3, a strong indicator that lean principles are deeply embedded at EHA Clinics.
• Shorter wait times: our 2022 kaizen event led to major gains in patient flow.
• Budget and efficiency: we’ve seen savings and productivity gains by eliminating waste in clinical and administrative processes.
• Better patient experience: our satisfaction scores are up. Patients are noticing the difference.
• Stronger safety culture: incident reports have become richer, more constructive, and more solution-focused.

LEAN IN NIGERIA: STILL EARLY, BUT GROWING

Right now, Lean isn’t widely adopted in the Nigerian healthcare system. There are only a few organizations visibly practicing it, which limits collaboration and shared learning.

We want to change that.

At EHA Clinics, we see ourselves not just as implementers of Lean, but as advocates. We’re actively looking to partner with others – those who are already on their lean journey and those who are just curious. The more we learn together, the faster we can raise the standard of care for everyone.

LOOKING AHEAD: THE JOURNEY CONTINUES

Lean isn’t a project with an end date. It’s a mindset and a daily commitment. For us at EHA Clinics, this journey has been transformational – but we’re not done. We’ll keep asking hard questions, listening to front-line voices, and improving how we deliver care. Because in the end, it’s not about being perfect. It’s about getting better, every single day.

_THE AUTHORS