Quality improvement: District level facilities inspire Jinja regional hospital
Picture a situation where your younger siblings appear smarter and more hardworking than you in many ways. And everyone in the family and close family friends know about this. Matters are not helped each time family and friends meet. Issues of children’s progress never escape such gatherings. Such moments are full of unease and anguish for the elder sibling.
Akin to that situation is what Jinja Regional Referral Hospital has hitherto found itself in over the last about 18 months since the facility and three of its five referring district level general hospitals started monitoring five quality improvement indicators aimed at improving maternal and newborn outcomes during and around the time of birth.
“It always troubled me that each time results from the monitoring were presented we were the last across all indicators. I wondered what they [other hospitals] were doing that we were not doing. I almost went to visit them to get answers,” said Jinja Hospital Midwife Dorothy Akurut (Below 2nd from left).
Quality Improvement (QI) is one of the interventions under the Preterm Birth Initiative (PTBi) study which is being implemented in a network of hospitals in eastern Uganda including Jinja Regional Hospital, Iganga and Kamuli General hospitals, as well as St Francis Buluba Mission hospital. The control facilities due to take on the QI package later this year are Kamuli Mission and Bugiri hospitals.
According to PTBi Uganda’s Quality Improvement Specialist Rogers Mandu who keeps an eye on QI developments in the hospitals, at the 3rd QI Learning Session in November 2017 the Jinja Hospital team resolved to implement a couple change ideas including improved handovers with proper patient files at the end of shifts, colour coding of patient files that need emergency intervention for Cesarean section and antenatal corticosteroids administration, and opening up a maternity WhatsApp staff communication platform, among others.
“Other change ideas included improved time keeping during reporting for duty by the midwives, equitable duty allocation to individuals, and spot checks by the in charge on duty for proper documentation,” adds Mr Mandu.
And four months down the road, there are winds of change blowing and there is a revolution at Jinja Regional Referral Hospital, if results presented mid-March at the 4th QI Learning Session are anything to go by.
As at the end of January, the proportion of admissions with a documented gestational age derived from the last menstrual period or ultrasound scan stood at 96.7 percent from 66.7 percent in November 2017. Similarly, facility deliveries with a partograph initiated shot to 91.6 percent from a lowly 35 percent in November 2017. The hospital has also started seeing a reduction in newborn deaths, fresh stillbirths and preterm mortality.
“What we did was to step back and start questioning ourselves why we were always trailing others. I initially started joining the teams during handover, empowering team members to own up and make decisions but we also have a hand from our PTBi resident Obstetrician [Dr Angella Namala]. However, involving nurses, midwives and interns in decision making has been so fundamental,” explained Senior Midwife Annet Kenyonyozi (standing below 1st L-R), the Maternity In-charge at the hospital.
According to the hospital’s Director Dr Edward Nkurunziza (Front row 2nd L-R), the facility has recently adopted an “open organisation system” where everybody has access to and they can share information through new media tools, something he says has improved staff attitude and service delivery.
“We created a hospital WhatsApp group including everyone right from the Askaris (guards) to the hospital director. And everyone is free to share work related information. For example, if one unit is facing some challenge may be of not accessing a service from another department, for instance you need blood, but the lab is not open, this can be shared on the platform. Trust me, the person who is responsible for that will have to get concerned and they will act. Staff can now share information and can interact with the management. So, this has broken bureaucratic barriers.”
Weighing in on the discussion, Preterm Birth Initiative (PTBi) East Africa’s QI Consultant Dr Nana Twum-Danso (below speaking to the Jinja maternity team) reiterated that leadership is critical to implementing change ideas under quality improvement. She said: “We may discuss all the technical aspects of QI, present the data and do beautiful graphics but if we do not have leadership and management then we are wasting our time. On that note I would like to thank the director for the open organisational leadership that has been adopted.”
Talking of improved patient care or patience centred care, Nana further argued that leadership ought to appreciate the need to motivate the health workers who are taking care of the patients. “Often times when employees talk of motivation many are quick to conclude that all they want is money but simple things like having where staff can easily meet and chat over tea during shift handovers can boost performance. We can’t improve patient outcomes without improving the work environment of our staff.” ##
Article & Image Credits: Kakaire Ayub Kirunda.