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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

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Agyeman-Duah, Josephine Nana Afrakoma, Theurer, Antje, Munthali, Charles, Alide, Noor, Neuhann, Florian·2014·BMC Health Services Research

DOI 10.1186/1472-6963-14-1PMC PMC3880175

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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.

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Figure 1 Patient flow pattern at the medical department, June 2010.CC BY · PubMed Central

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Authors: Agyeman-Duah, J. N. A., Theurer, A., Munthali, C., Alide, N., & Neuhann, F.
Affiliations: Kamuzu Central Hospital (MW)
Heidelberg University (DE)
Corresponding author: Agyeman-Duah, Josephine Nana Afrakoma
ORCID: Agyeman-Duah, Josephine Nana Afrakoma
Neuhann, Florian
Venue: BMC Health Services Research
Publisher: Springer Science and Business Media LLC
Published: 2014-01-02
Volume: 14
Issue: 1
Pages: 1-1
ISSN: 1472-6963 (ISSN-L)
DOI: 10.1186/1472-6963-14-1
PMC: PMC3880175
OpenAlex: W2121395472
Cited by: 345
References: 31
Citations by year: 2026: 13 · 2025: 17 · 2024: 21 · 2023: 21 · 2022: 26 · 2021: 48 · 2020: 37 · 2019: 33 · 2018: 37 · 2017: 46 · 2016: 29 · 2015: 15 · 2014: 2
FWCI: 56.06
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: BMC Health Services Research (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Greater South Information System
Funders: Universität Heidelberg
Katholischer Akademischer Ausländer-Dienst
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Keywords: healthcare quality improvement, resource-limited settings, barriers to quality improvement, human resource shortage, employee attitudes, medical equipment shortage, internal communication, quality culture, teaching hospitals, Kamuzu Central Hospital, Malawi
MeSH terms: Attitude of Health Personnel, Developing Countries, Hospital Administration, Hospitals, Hospitals, Teaching, Humans, Interviews as Topic, Malawi, Personnel, Hospital, Quality of Health Care, Quality Improvement

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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

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