A Year in Review: September Update
As Chisale, the Medical Ward charge nurse left my office, I look at the paper we have drafted together, and I realize what a year this has been. The Secretary of Health and Population is coming in two days to follow up on accreditation and quality improvement in Nkhoma Mission Hospital, so I worked together with Medical Ward leadership to list our projects and outcomes. Each meeting and improvement measure didn’t seem like much at the time, and sometimes it felt like we slid back for every improvement we made. But now I hold in my had a paper with seventy lines of items – seventy! – which list improvements we have initiated, implemented, and sustained in the department over the last year.
First were the changes in clinician and nursing notes. We must have had twenty different versions of these notes as we tried new formats and received feedback. Some of the changes were little – pre-set spaces for writing patient pain levels, improvements in condition, and consent to treatment. Other interventions were bigger, like separating out the space for the problem list (what we see wrong with the patient) from the diagnosis (what is causing the problem, what we can treat). The charts that the Medical Ward team designed last year are now being used in wards throughout the hospital, and we are continuing to revise our versions. The new chart formats are already helping us improve at least ten items necessary for accreditation, not to mention helping the staff identify patient problems and improve outcomes for patients.
And the charts were just the beginning. We identified improvements in infection prevention, emergency care, information sharing, analysis of adverse events, protocols, training, patient education, outpatient chronic disease management, and (most recently thanks to COVID) isolation room capacity. Seeing every project listed one by one really hit me with the cumulative impact from this last year. The nurses reminded me of projects I forgot or thought were abandoned but in actuality continued to make a difference. I wondered how many of these intentional improvements had contributed to the reduced mortality rates on the ward that we have been observing over the last year. I worked with Chisale to prepare a power point presentation of some of the more interesting projects and improvements, just in case he is called upon to showcase improvement projects for the upcoming Ministry visit. It was such a blessing to see how a year of projects lead to impactful, lasting change.
In addition to my work in the hospital and Greg’s work teaching in Bible colleges, this next year we plan to be more involved in community-based training initiatives to benefit pastors and their communities. Greg is looking into pairing agricultural trainings with theological education to help pastors lead their communities towards wellness. I plan to come alongside with screenings and public health and diet teachings, based on priorities and interests of the churches. We’re looking forward to how these programs might extend our impact outside the walls of hospitals and colleges.
Thank you for your continued encouragement and support, Greg and Christina