Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi
- PMID: 24382312
- PMCID: PMC3880175
- DOI: 10.1186/1472-6963-14-1
Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi
Abstract
Background: Knowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities.
Methods: A mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher's perspectives by means of document review and participatory observation.
Results: Human resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process.
Conclusions: Establishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.
Figures
Similar articles
-
District health managers' perceptions of supervision in Malawi and Tanzania.Hum Resour Health. 2013 Sep 5;11:43. doi: 10.1186/1478-4491-11-43. Hum Resour Health. 2013. PMID: 24007354 Free PMC article.
-
Barriers to Quality Care in Medical Imaging at a Teaching Hospital in Ghana: Staff Perspective.J Med Imaging Radiat Sci. 2020 Sep;51(3):425-435. doi: 10.1016/j.jmir.2020.05.002. Epub 2020 Jun 11. J Med Imaging Radiat Sci. 2020. PMID: 32536512
-
The future of Cochrane Neonatal.Early Hum Dev. 2020 Nov;150:105191. doi: 10.1016/j.earlhumdev.2020.105191. Epub 2020 Sep 12. Early Hum Dev. 2020. PMID: 33036834
-
Health professionals' experience of teamwork education in acute hospital settings: a systematic review of qualitative literature.JBI Database System Rev Implement Rep. 2016 Apr;14(4):96-137. doi: 10.11124/JBISRIR-2016-1843. JBI Database System Rev Implement Rep. 2016. PMID: 27532314 Review.
-
Providing oxygen to children in hospitals: a realist review.Bull World Health Organ. 2017 Apr 1;95(4):288-302. doi: 10.2471/BLT.16.186676. Epub 2017 Feb 21. Bull World Health Organ. 2017. PMID: 28479624 Free PMC article. Review.
Cited by
-
Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals.Front Oncol. 2023 May 3;13:1122355. doi: 10.3389/fonc.2023.1122355. eCollection 2023. Front Oncol. 2023. PMID: 37207162 Free PMC article.
-
Avoidable hospitalization after family physician and rural health insurance: interrupted time series and regression analyses, Tehran province, Iran.Prim Health Care Res Dev. 2022 Feb 24;23:e7. doi: 10.1017/S1463423618000300. Prim Health Care Res Dev. 2022. PMID: 35197145 Free PMC article.
-
Effectiveness of virtual training for medical officers and community health officers in the critical care management of COVID-19 patients in the intensive care unit.Indian J Anaesth. 2021 Oct;65(Suppl 4):S168-S173. doi: 10.4103/ija.ija_704_21. Epub 2021 Oct 28. Indian J Anaesth. 2021. PMID: 34908569 Free PMC article.
-
Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi.BMC Health Serv Res. 2020 Dec 14;20(1):1142. doi: 10.1186/s12913-020-06002-x. BMC Health Serv Res. 2020. PMID: 33317520 Free PMC article.
-
Breast and cervical cancer screening services in Malawi: a systematic review.BMC Cancer. 2020 Nov 12;20(1):1101. doi: 10.1186/s12885-020-07610-w. BMC Cancer. 2020. PMID: 33183270 Free PMC article.
References
-
- Franco L, Sustaining quality of healthcare: institutionalization of quality assurance. Bethesda, MD: Quality Assurance Project; 2006. p. 15. Retrieved August, 2002.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous