Methods Between and Ridge Regional Hospital adopted a

Methods Between 2013 and 2015, Ridge Regional Hospital adopted a quality improvement programme in three stages. In the first stage, two senior staff members were selected to serve as QI (quality improvement) leaders and received 4 days of training in Six Sigma methods. In the second stage, two frontline staff from each of the eight departments in obstetric and neonatology were appointed as clinical champions and received 1 day of training in the running of small improvement projects using Lean principles and the Plan-Do-Study-Act approach. In the third stage, two levels of improvement projects—interdepartmental, led by the QI leaders and departmental, led by the clinical champions—were launched. Findings Within 6 months of the introduction of the quality improvement programme, two systems projects and two departmental projects to address waiting time for emergency caesarean sections and hand hygiene in the neonatal intensive care unit had begun. The two department-level projects addressed the triage of sick mothers and cleaning and organising the neonatal intensive care unit to reduce errors. There was a four-fold caffeic acid in the percentage of mothers needing emergency caesarean surgery with unacceptable waiting times, over 93% accuracy in identification of the sickest mothers, and a 37% increase in hand hygiene compliance. Interpretation The multi-level approach taken for quality improvement programmes has had some success in this referral hospital in Ghana. Improvements cannot be achieved without the engagement of all staff across levels, but selected leaders also need the analytical capability to address complex system problems. Each level reinforces the other. The approach at Ridge Regional Hospital is being scaled-up to four other Ghanaian regional hospitals. Furthermore, a learning network is being created to share improvement solutions across the entire system. To engage front line staff in building these capacities, while also increasing capability to address system problems, a multi-tiered approach is needed. Funding Kybele and PATH. Declaration of interests
Abstract Background Of all deaths from non-communicable diseases (NCDs), 80% occur in low-income and middle-income countries (LMIC), which makes these countries a key focus for prevention and management of chronic disease. Patient-centred education empowers patients to participate in medical decision making and has been shown to improve health outcomes and quality of life for patients with chronic diseases. However, little is known about its effectiveness in LMICs. In this study, we aimed to implement and measure the effect of a patient-centred intervention in people with heart failure in Kampala, Uganda. Methods We recruited patients with heart failure from the outpatient department of Mulago Hospital, Kampala, Uganda. Participants received a 28-page educational booklet, PocketDoktor, which described the pathophysiology, diagnosis, and management of heart failure. The booklets contained interactive prompts for patients to ask questions at each level of discussion and a trained health educator reviewed the booklets with participants. We administered a Likert-scale questionnaire to measure patients\' satisfaction, knowledge of their condition, and confidence in self-management (using the Patient Activation Measure, PAM-13) at baseline, as well as qualitative interviews to assess patient\'s perception of their disease process and quality of care. At 3 months\' follow-up we repeated the quantitative and qualitative surveys. We used paired t tests and Wilcoxon signed rank tests to compare pre-intervention and post-intervention quantitative information. We transcribed qualitative interviews and generated code lists. Findings We interviewed 105 patients between November, 2014, and April, 2015, of whom 95 were included in analysis. The proportion of patients who strongly agreed that they were satisfied with their medical care at Mulago Hospital rose from 16% at baseline to 79% (n=73) after the intervention (p<0·001). Perceived knowledge also increased: from the PAM-13, 76 patients (80%) reported improvements in their understanding of their medical condition (p<0·0001), 76 (80%) had sustained improvement in knowledge of treatment options (p<0·0001), and 78 (83%) had improvement in their knowledge of how to prevent problems with their health (p<0·0001). In interviews, participants reported that materials were easy to read, that they had improved knowledge of disease, and improved communication with physicians.