Reference no: EM133315918

Case Study: One of the best stories I've heard about QI in a low income country was in the book Switch by Chip and Dan Heath. They told about Jerry Sternin, who in 1990 was working for Save the Children, the International group that helps children in need. The Vietnam government had invited Save the Children to fight malnutrition. When Sternin arrived, many people there had no faith in the process. They gave him 6 months to make a difference. Problems were immense - sanitation was poor, poverty was nearly universal and clean water was not readily available, and rural people were uneducated related to nutrition. With almost no money to spend, he knew he couldn't change all these big problems in six months. Instead, he traveled to rural villages and met with groups of local mothers (in Lean language, we would call that going to the Gimba). The mothers divided into teams and went out to weigh and measure every child in the village.
What they found is that there were some very, very poor kids who were bigger and healthier than the typical child. Sternin went to see what the mothers of those children were doing. They called them "bright spots". They did have to eliminate any bright spots who weren't "typical". For example, a boy might have an uncle in the government who would send extra money. That would not be something you could replicate.
They also had to understand what was "normal". How did Vietnam typically feed their children? They talked to dozens of people and found that community norms were clear. Kids ate twice a day along with the rest of their families. They ate food that was appropriate for kids - soft, pure foods like the highest-quality rice.
Then they went to the homes of the "bright spots", alert for any deviations. What they observed is that bright-spot moms were feeding their kids four meals a day (using the same amount of food as other moms but spreading it across four servings rather than two). The larger twice-a-day meals eaten by most families turned out to be a mistake for children, because their malnourished stomachs couldn't process that much food at one time.
The style of eating was also different. Most parents believed their kids understood their own needs and would feed themselves appropriately from the communal bowl. But the healthy kids were fed more actively - hand-fed by parents if needed. They were even encouraged to eat when they were sick, which was not the norm. The most interesting difference was the type of food being eaten. The bright-spot mothers were collecting tiny shrimp and crabs from the rice paddies and mixing them in with their kids' rice. Shrimp and crab were eaten by adults but were considered inappropriate for kids. The mothers also tossed in sweet-potato greens, which were considered a "low class" food. What these differences did was something precious: adding sorely needed protein and vitamins to the children's diet.
As an outsider, Sternin didn't know about these practices but now knowing this, he set out a plan to change their behavior. The community designed a program in which fifty malnourished families, in groups of ten, would meet at a hut each day and prepare food. The families were required to bring shrimp, crabs, and sweet potato greens. The mothers washed their hands with soap and cooked the meal together. Cooking together created a social pressure to "go along". The solution came from the bright spots and the process to change came from the community (not from the outsider). Six months after Sternin came to the Vietnamese village, 65% of the kids were better nourished and stayed that way. Later, when researchers from Emory University came to Vietnam, they found kids that were not yet born when Sternin was there were as healthy as those that were, meaning the changes stuck.
The program spread to other villages and eventually reached 2.2 million Vietnamese people in 265 villages. Sternin and crew did not have to have all the answers, they found the bright spots and spread the word.

Question 1. Describe lessons learned to gain the improvement overtime.

Question 2. How could those lessons be applied as an improvement tool for other quality projects?