Introduction: For decades, many low and mid income countries (LMIC) have invested significant effort to improve access to and quality of health care, with less attention paid to the non-clinical, administrative hospital management. Accordingly, a practical personnel filing system was designed and implemented to improve file management efficiency. Methods: Setting: The quality improvement project took place in a rural hospital in Rwanda. Design: A pre-and post-intervention study design to assess the effect of the intervention between January 2015 and February 2016. File auditing and time study were conducted. Intervention: A custom-made computer database to manage documents in a personnel file, standardized follow up process and policy were created and implemented. Measures: The pre-and post-intervention completeness of all personnel file and the average time to identify the missing items in a personnel file were measured to evaluate the effect of the project. Results: The completion rate of personnel files increased from 83% pre-intervention to 96% post-intervention. The average time to identify missing items significantly reduced from 6 minutes 30 seconds pre-intervention to 49.6 seconds (p < .001).Conclusions: This project demonstrates that quality improvement principles can help address administrative issues in a resourcechallenged setting. By utilizing available resources to implement an intervention that focused on creating an easy and efficient process, the personnel file completion rate has increased considerably and the time needed to identify missing items significantly decreased. The hospital should apply the same strategic problem solving methodology to conduct other quality improvement projects.

Purpose Post-cesarean wound infection (PCWI) is a common post-operative complication that can negatively affect patients and health systems. Poor hand hygiene practice of health care professionals is a common cause of PCWI. This case study aims to describe how strategic problem solving was used to introduce an alcohol-based hand rub in a district hospital in Rwanda to improve hand hygiene compliance among health care workers and reduce PCWI. Design/methodology/approach Pre- and post-intervention study design was used to address the poor hand hygiene compliance in the maternity unit. The hospital availed an alcohol-based hand rub and the team provided training on the importance of hand hygiene. A chart audit was conducted to assess the PCWI, and an observational study was used to assess hand hygiene compliance. Findings The intervention successfully increased hand hygiene compliance of health care workers from 38.2 to 89.7 per cent, p < 0.001, and was associated with reduced hospital-acquired infection rates from 6.2 to 2.5 per cent, p = 0.083. Practical implications This case study describes the implementation process of a quality improvement project using the eight steps of strategic problem solving to introduce an alcohol-based hand rub in a district hospital in Rwanda. The intervention improved hand hygiene compliance among health care workers and reduced PCWI using available resources and effective leadership skills. Originality/value The results will inform hospitals with similar settings of steps to create an environment that enables hand hygiene practice, and in turn reduces PCWI, using available resources and strategic problem solving.

In developing countries, intravenous (IV) catheter related infections (CRI) rate is generally high. Neonates are more susceptible to develop CRI. We examined the impact of a quality improvement project on IV CRI rates in the neonatal intensive care unit (NICU) of a district hospital in Rwanda. A pre-and post-intervention study was conducted from 2014 to 2016 to evaluate the IV CRI rate and nurses' IV management technique. A written test was administered to evaluate their knowledge on the matter. The intervention had three components: First implementing an IV management policy. Secondly, training staff on the policy and finally, managers provided support and supervision during the change. We measured five indicators: (1) the IV CRI rate; (2) the percentage of nurses who tested ≥ 80% on IV management knowledge; (3) the percentage of IV devices changed following the World Health Organization (WHO) guideline; (4) IV management technique; and (5) the hospital length of stay (LOS). The IV CRI rate reduced from 32.1% to 14.5% (p < .001). The hospital LOS reduced from 15.31 to 7.43 days (p < .001). The compliance of changing IV following WHO guideline increased from 0% to 99% (p < .001); proper IV management technique use increased from 43% to 96% (p < .001); the mean rank of staff on IV management knowledge score significantly increased from 3.5 to 9.5 (p = .004). This project demonstrates that a quality improvement project can help address the IV CRI at very low cost in a resource-challenged setting.

Purpose The purpose of this paper is to describe the quality improvement project to increase the medical record documentation completion rate in a district hospital in Rwanda. Despite the importance of medical records to support high quality and efficient care, incomplete documentation is common in many hospitals. Design/methodology/approach The pre- and post-intervention record completion rate in the maternity unit was assessed. Intervention included assigned nurse to specific patients, developed guideline, provided trainings and supervisions. Findings The documentation completion rate significantly increased from 25 per cent pre-intervention to 67 per cent post-intervention, p < 0.001. The completeness of seven out of the ten elements of medical records also significantly increased. Practical implications The quality improvement project created a cost-effective intervention that successfully improved the documentation completion rate. Ongoing monitoring should be continued to learn sustainability. Originality/value The results are useful for hospitals with similar settings to improve completion of nursing documentation and increase nursing accountability on patient care.