How Kabarole Hospital in western Uganda saved mothers’ lives through team-based problem-solving

Globally, the maternal mortality ratio (MMR) has declined in recent years, with 99% of maternal deaths occurring in developing countries. Most (75%) maternal deaths are due to severe bleeding, infections, pre-eclampsia and eclampsia, complications of obstructed and prolonged labour, and unsafe abortions.1 In 2013 in Uganda, the MMR was 360 per 100 000 live births compared with 210 per 100 000 live births globally.2 3 Kabarole Hospital, a private, not-for-profit general hospital in Kabarole District, was among the high-volume facilities prioritised by the United States Agency for International Development Applying Science to Strengthen and Improve Systems Project for a maternal, neonatal and child health (MNCH) quality improvement (QI) initiative in four districts of Western Uganda. The aim of the initiative was to contribute to a reduction of maternal and newborn mortality and morbidity by 50% in four districts of western Uganda including Kabarole Hospital. In May 2013, maternity staff at Kabarole Hospital were trained in QI methods applied to maternal and newborn care. In June 2013, a QI team of 10 members was formed, composed of the head of nursing (responsible for resource allocation), the medical officer assigned to the MNCH Department (provided technical oversight), the head of the MNCH Department (leader of the MNCH QI team), five midwives (provided MNCH services), the records officer (conducted data analysis and reporting), the laboratory technician (conducted laboratory investigations) and the storekeeper responsible for ordering allocation of drugs and supplies. This team started analysing their processes of care using data summarised from the maternity and antenatal registers and client charts onto a weekly summary sheet developed by the improvement team. The summary sheet contained variables such as number of clients seen per week, number of clients with obstetric complications, management of these complications and the outcome of each obstetric complication. The team recognised …