Respondent group | Strengths/existing quality model | Weaknesses/challenges hindering quality improvement in healthcare delivery | Areas for improvement |
---|---|---|---|
1. Affiliate respondents (n = 5) | - Existence of treatment protocols | - Staffing- related issues: shortage, underperformance and poor attitude | - Procure essential resources for patient care |
 | - Quality control and assurance measures are in place | - Scarcity of resources | - Use resources efficiently |
 | - Improved patient care practicies | - Patient care | - Enhance team work with supporting departments |
 | (Additional file 1: Appendix 1, Section 1.1) | - Lack of some patients taking responsibility for their own care | (Additional file 1: Appendix 1, Section 1.3) |
 |  | (Additional file 1: Appendix 1, Section 1.2) |  |
2. Patient respondents (n = 4) | In-patients described their overall satisfaction of the care they receive as | - Poor amenities and services in the department | - Strengthen staff attitude and performance |
 | • 'very good’ (1 view) | - Weak adherence to treatment protocol | - Involve patients in their treatment and management |
 | • 'good’ (2 views) | - Patients not involved in their own care | - Improve amenities in the department |
 | • 'poor’ (1 view) | (Additional file 1: Appendix 1, Section 2.2) | (Additional file 1: Appendix 1, Section 2.3) |
 | (Additional file 1: Appendix 1, Section 2.1) |  |  |
3. Staff respondents (n = 4) | - Staff attitude and performance is good | - Workload | - Provide supervision and training |
 | - Existence of treatment protocols | - Poor patient care | - Encourage patient-centred care |
 | - Availability of some logistics like the computer for e-learning | - Lack of adherence to treatment protocol by some staff | - Ensure accountability of and by staff |
 | (Additional file 1: Appendix 1, Section 3.1) | - Staff-related issues: inadequate training and supportive supervision, low incentives for work | - Encourage effective communication among staff |
 |  | (Additional file 1: Appendix 1, Section 3.2) |  |
4. Management respondents | 1. Effort to maintain quality | • The medical department is perceived to be the weakest department in KCH for quality of health care delivery(Additional file 1: Appendix 1, Section 4.1) | 1. Civil society should be involved in sensitizing patients and holding health staffs accountable to patients |
4.1 Current state of quality of healthcare | (Additional file 1: Appendix 1, Section 4.1) | • Inadequate human resource |  |
 |  | • Lack of some essential diagnostic tools |  |
 |  | • Limitation in the use of the few available diagnostic tools |  |
4.2 Patient care and patient focus | 1. Patients appreciate staffs when satisfied with service given | 1. Patients complaint about wrong prescription or delayed treatment | Â |
 |  | 2. Weak patient involvement in their treatment plan |  |
 |  | 3. Self referrals and weak patient referral system among referring facilities |  |
4.3 Treatment protocols | • Treatment protocols are available and accessible to all staffs | 1. Non-compliance due to personal preferences among prescribers; ignorance on the relevance of protocol use; lack of drugs to prescribe |  |
 | • There is a planned review of the current protocols |  |  |
4.4 Change management | 1. Emergency cases are attended to in the MSS ward before transferring to intensive care | 3. No defined human resource plan to cater for staff who leave | Â |
 | 2. Team system for focused patient care and ward rounds |  |  |
4.5 Management-related issues |  | • Shortage of staff |  |
 |  | • Lack of training and proper orientation for staff |  |
 |  | • Poor staff attitude (Additional file 1: Appendix 1, Section 4.5.1) |  |
 |  | • Weak accountability by staff (Additional file 1: Appendix 1, Section 4.5.2) |  |
 |  | • Weak leadership structures |  |
 |  | (Additional file 1: Appendix 1, Section 4.5.3) |  |
 |  | • KCH as a tertiary hospital wastes resources by attending to many primary level cases |  |
 |  | (Additional file 1: Appendix 1, Section 4.5.4) |  |
 |  | • Disintegrated data management system in the hospital |  |
 |  | • No strategic plan for the hospital (Additional file 1: Appendix 1, Section 4.5.5) |  |