Can a system intervention employing team-based case review help improve quality and safety of paediatric hospital care in Kenya? (360G-Wellcome-207522_Z_17_Z)

In Kenya 6% of children admitted to hospital die, a figure many times higher than developed countries. Severe illness and co-morbidity underlie many deaths and require a coordinated response from health-worker teams to deliver multiple interventions safely across admission periods of several days. This can expose many team and system weaknesses that need to be addressed to improve outcomes. I will build on prior work in Kenya to: Comprehensively describe quality and safety concerns, avoidable mortality, their relationship with case severity and case complexity and the changing epidemiology of care in multiple Kenyan county hospitals Co-design the tools and procedures that enable multi-site, team-based case review (TCR) to diagnose and tackle inpatient quality and safety concerns locally and at scale Test if intervention can reduce the frequency of modifiable factors that undermine quality and safety of hospital care and reduce potentially avoidable mortality Undertake empirical work to refine a theory of change supporting a detailed process evaluation and critical exploration of mechanisms of intervention effect spanning individual providers, teams, organisations and institutions This work will be a major contribution to the field of quality and safety in Africa and help develop scalable improvement interventions.