A Quality Improvement Story From Machakos County In Kenya

Continuous Quality Improvement On Tuberculosis Management At Mutituni Level 4 Hospital In Machakos County – Kenya

Presented by: Boice Kitavi, Clinical Officer

Introducing Boice Kitavi, a dedicated clinical officer hailing from Kenya. He serves as a pillar of healthcare at Mutituni Level 4 Hospital, located in the heart of Mutituni within Machakos County, Kenya. This primary care facility is under the diligent oversight of the Ministry of Health. Primary care, the cornerstone of the healthcare system, plays a pivotal role in safeguarding community well-being.

Boice’s passion revolves around combatting Tuberculosis, affectionately known as TB. He fervently emphasizes, “Tuberculosis is a deadly and infectious disease that affects the lungs though it can affect other parts of the body.”

Within the precincts of this hospital, comprehensive services encompassing TB screening, testing, and treatment have long been extended to all individuals seeking care within its walls. However, Boice astutely recognized significant gaps in the delivery of care at the frontline.

The genesis of their transformative project traces back to the diligent endeavours of their departmental Work Improvement Teams (WITs). Delving into the realms of data analysis, the team performed a retrospective evaluation of records from the year 2022. This marked the inception of their PDSA (Plan-Do-Study-Act) cycle.

Boice further expounds, “In planning for improvement, we initiated our Quality Improvement (QI) journey with a meticulous examination of the current state. Our initial focus was on dissecting the workload associated with TB cases.” This analysis paved the way for a well-thought-out intervention: the allocation of specific clinicians tasked with the equitable distribution of responsibilities pertaining to TB patient care.

The QI team, in their unwavering commitment to progress, honed in on areas with a high prevalence of TB cases. They channelled their efforts into community engagement, placing paramount importance on first-contact counselling. This proactive approach aimed to address social and behavioural changes, with a particular emphasis on countering drug abuse.

Their collective aim was nothing short of ambitious: to reduce the rate of TB-delayed conversion among patients on treatment follow-up, with a target of diminishing it from 24% to below 10%.

Check out Key Facts about Tuberculosis.

Boice Kituvi’s initiatives and interventions at the Level 4 Hospital encompassed the continuous tracking of conversion rates in follow-up treatment, assigning specific clinicians to alleviate the workload for TB patients, targeting areas with a high prevalence for community engagement, prioritizing first-contact counselling, and emphasizing counselling for social behavioural change, particularly concerning drug abuse. The goal was to lower the TB-delayed conversion rates from 24% to less than 10% for patients on treatment follow-up.

For further insights into Boice’s remarkable journey, please view his submission video below:

This QI Story emerged as Position 2 in the Storytelling Contest!

Lessons learned by Kituvi and the team emphasized the vital role of individualized counselling in ensuring TB treatment adherence and underscored the significance of ongoing close monitoring and trend analysis in enhancing the conversion rate, concluding that quality takes precedence over quantity in healthcare interventions.

This is part of the storytelling contest submission for World Patient Safety Month. Read more here.

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