201 The business model of quality improvement and drivers of success of a private tertiary hospital in Lagos, Nigeria

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Background Over the years, Subol Hospital in Lagos, Nigeria, significantly improved its quality of care as measured with SafeCare standards. This study explores the business model and practices underlying this success and the potential implications for the hospital business and finances, to provide lessons for similar healthcare providers in Africa.Methods We conducted a mixed methods study with data collected in 2019. First, we extracted from hospital records quantitative data related to finances, service delivery, and human resources. Additionally, we performed semi-structured interviews with 30 individuals in and around the hospital at the executive management, clinical, administrative, patient and community levels in August 2019. Quantitative data were analyzed using descriptive statistics while qualitative data were analyzed thematically.Results Over the period of study, the hospital recorded improvements in quality standards, driven by deliberate and sustained investments in QI. Supported by a clear organisational structure and technology, Subol Hospital operates a business model – including no bank loans policy and regular capital reserve and investment scheme – which guarantees financial buoyancy for investments in QI initiatives. The quality improvement was accompanied by a reduction in annual deaths in the hospital, increased revenues, and empanelment in 40 health maintenance organizations, and 60% of the patients were insured. Clients identified high-quality diagnostics and treatment services, and the professionalism the staff members as a key reason for patronising Subol Hospital.Conclusion Subol Hospital demonstrated a consistent and substantial improvement in QI scores and patient outcomes, paralleled by growth in the clientele base and revenues. This case indicates that beyond direct health benefits to clients, organisations could earn economic rewards from investments in QI.

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