Sorry if this sounds like a rather dry topic – in fact it isn’t at all. I’m writing about this because it is so interesting (to me, at least.)


One of the things that is unusual about this hospital is its particular focus on quality improvement – the process of looking at what you do, and seeing if it is working, reviewing it, making changes, looking again. It really is part of the institutional culture. This is quite unusual for any organisation, and strikingly so for a remote, rural health care organisation. Every department is expected to audit its activity monthly, and submit the data for collective scrutiny once a month. The hospital has an overall five year strategic plan and within this, each department has an annual work-plan.


Today was the day when the audits and workplan for the second quarter were reviewed. For the last few days, we have been gathering our audits together in my department (the adult in patient ward) and reviewing them as a team. Each nurse is assigned an area of work to audit ;- questions such as; Do we screen patients for HIV within 24 hours of admission? Do new patients receive an orientation when they arrive on the ward? Do we screen people for unmet contraceptive need? Is our antibiotic prescribing rational? What is the rate of post operative wound infection? and so on. In a way that I am beginning to get used to, there were an awful lot of loose ends to tie up,  and reassurances that things would all be OK, and then some last minute fixes for everything to be ready on the day. There’s been excel spread-sheeting, and graph making and data transfer in a frenzy.

checking our data before the meeting 

Our team had a meeting with the hospital’s executive director to go through our audits and our performance. We were really rigorously scrutinised. Questions like ‘’ you said your target was about proportions, why are you giving us a percentage?’’ ‘’ Are you clear about your numerator?’’ It was a really detailed and exacting process. And it makes a difference, because the outcome was a really useful discussion of how we can build on what we do to make changes and improve services. For example, now that we screen all our patients about their contraceptive choices, what can we do to encourage people to take up long acting contraceptive methods? Another audit shows that we don’t prescribe antibiotics according to guidelines because we don’t have guidelines for certain conditions – we could write them. It is stuff like this that really can bring about change and can be really inspiring.

The path between the hospital and home

In other news, somewhere in the day, there was a ward full of patients to review, and it was Miss A’s birthday today, so we ended the day with presents and ……chocolate cake.

Too late for a photo of the cake… only crumbs left!


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