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Quality Improvement in healthcare in low resourced settings – where do you start?

Jenine de Vries, Project Manager of the Centre for Global Burn Injury Policy & Research at Swansea University writes about how a Quality Improvement course for burns nurses in Malawi inspired researchers to produce a free online Practical Guide to Quality Improvement for Burn Care in Low-Resourced Settings.

Quality improvement (QI) in healthcare is crucial in order to improve treatment outcomes and patient experience. Quality improvement projects work to make care safer, more effective and economical, to ensure equity and access to care, and simply to ensure that patients get the best care possible. In low-resource settings and busy health care environments, it is not always easy to focus on these questions. However, providing care without questioning if it can be improved eventually results in poor care so it’s important to overcome these obstacles. 

Patricia, a burns nurse from Malawi who worked with the Centre, successfully completed her own QI project in her hospital. Her project achieved a more than 40% increase in the practice of handwashing for staff at her unit and a 73% increase in availability of hand washing stations, soap and hand sanitiser. She reflected: “I have learned that simple changes can have great impact on service delivery in the health care system”.

Capacity building

The Centre for Global Burn Injury Policy & Research at Swansea University and the charity Interburns work together with several overseas partners in the NIHR Global Health Research Group on Burn Trauma. One of the aims we have is to build capacity among healthcare staff in burn care in low resourced settings for research and quality improvement. Not only do local people know best where the delays occur or improvements are possible within their centre, it also ensures sustainability.

In May 2019 we started a course in Implementation & Improvement Science for nurses in low income settings. The course was held in Malawi and there were eight burn nurses from Ethiopia and Malawi participating in this pilot course. The course offered a combination of formal training in research and quality improvement skills, and hands-on support and feedback during the participants’ own quality improvement projects in the months after. 

New practical guide to QI

Each nurse completed a successful project in their own burns unit. For example, two of the nurses, Olive and Ziphilly, worked on improving documentation of patients’ vital signs and fluid monitoring. They managed with training, small adaptations to the documentation forms and checks on appropriate equipment to increase the rate of correct and complete recording from 50 to 78% in a few months. Another nurse, Ephrem, worked on increasing the privacy of patients during dressing changes by implementing the use of screens in the room. 

The result of the course was not only a range of successful improvements in the hospitals in Malawi and Ethiopia but also a cohort of knowledgeable nurses who can share their skills with colleagues.

We felt so inspired by all the fantastic QI projects that these nurses had completed, that we decided to create a free Practical Guide to Quality Improvement for Burn Care in Low-Resourced Settings. This Practical Guide summarises the eight key steps of Quality Improvement to guide nurses and other health care workers through their own projects. It is not a formal, academic training course, but very much a practical step-by-step guide. For each of the eight steps we show some real-life examples from the projects carried out by the participants of the course. The result is a very accessible manual, which shows how much you can do in an environment with limited resources. 

Small changes can have great impact

Quality Improvement is definitely not only for those with money to spend. Creativity, cooperation, and above all a motivated project leader can make a huge difference by introducing small changes. It is important, as Patricia’s quote reminds us, to focus on simple steps. No single QI project can reduce patient mortality or revolutionise treatment, but small changes can work towards more efficient, more effective, and fairer care for all patients. 

Our NIHR Global Health Research Group has also designed a more formal online Implementation & Improvement Science course. This course is also freely available online and focused on health care professionals in low resourced settings. It is written for an audience who would prefer a more thorough and theoretical approach. Together with the Practical Guide, we hope this will be an inspiration for health care staff in burns and other medical specialisms to improve the care they provide. If you know of a group, a hospital or a person who could benefit from these free materials, please help them on the route to quality improvement by sharing these resources!

Jenine de Vries, Project Manager of the Centre for Global Burn Injury Policy & Research at Swansea University

Learn more about the project on the Centre’s website

The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.