'I was struck by how hospitals in Malawi and the UK face similar challenges in making healthcare safer for patients' The chief executive of the Health Foundation and our new regular columnist discusses the global challenges of patient safety and some possible responses

Picture of Stephen Thornton

This summer I visited Malawi in east Africa, combining some business for the Health Foundation with work for a local orphan care charity. In spite of the very different political, economic and geographical environment I was struck by how hospitals in Malawi and the UK face similar challenges in making healthcare safer for patients.

In the hospitals I visited I heard Malawian clinical teams and managers telling me about problems to do with finances, hygiene, waste disposal, equipment, data capture, transport, logistics and staffing - many of the same issues raised by the UK professionals involved in our Safer Patients Initiative.

These were desperately resource-poor settings. Yet even here, pumping more money into the system wouldn't necessarily mean safer hospitals.

The Health Foundation is working with a consortium in Malawi to introduce quality improvement methods that will improve the quality of care for mothers and newborn babies. We are spending£2.7m over three years. But our work is less about providing financial resources and more about developing expertise in both hospitals and in community settings.

The three photos from my trip underline some common findings from both initiatives. In the first photo (To view the picture, click on Picture 1 at the bottom of the story), you see national guidelines pinned to a delivery room wall that have been covered up with memos and staff rotas - in other words, ignored.

The second (To view the picture, click on Picture 2 at the bottom of the story)shows the opposite wall covered with notes, diagrams and charts produced by the clinical team as it monitors and tracks its own data and uses it to make improvements. Such practices are not unique to Malawi. Unless brought alive by active engagement of clinical teams, guidelines and protocols can remain stubbornly irrelevant. In that unit I witnessed first-hand the need for bottom-up quality improvement approaches to meet top-down missives.

The third photo (To view the picture, click on Picture 3 at the bottom of the story)shows us that achievable, measurable and sustainable small steps of change are paramount. The hospital where I took this picture was experiencing problems of women arriving at hospital in labour, yet not getting to the labour ward in time. They decided to employ two volunteer porters, who were given the responsibility of spotting these women as they arrived, taking down their critical administrative details and getting them to the ward within three minutes. After testing different ways of doing this, they managed to find a way to consistently achieve their target - one that was defined by them in a challenging but realistic way to improve the care the women receive.

Underpinning these examples is the importance of strong leadership that challenges frontline teams to focus on and prioritise safety issues, allowing them to find their own innovative solutions to operational problems. The big question, both in Malawi and the UK is: how can we make this the norm? How can we spread these approaches in such a way that they become 'the way we do things round here'?

Stephen Thornton is chief executive of the Health Foundation