Emergency medicine in Zanzibar: the effect of system changes in the emergency department

Background: Mnazi Mmoja Hospital is a tertiary hospital in Zanzibar serving a population of 1.2 million. The emergency department was overcrowded and understaffed and the hospital management initiated a quality improvement project. The aim of this article is to describe the approach, methods and main results of this quality improvement process. Methods: The Plan-Do-Study-Act (PDSA) method was used in a five-circle process. In addition, a consensus-based approach was performed to identify areas of improvement. Results: Over a period of 6 months, regular staff meetings were implemented, a registration system was developed and implemented, the numbers of patients with simple problems were reduced, a simple triage tool was developed and implemented and an emergency room was established. Conclusions: Change and improvement in health care are achievable despite limited financial resources if a comprehensive, robust and simple system is used. Involvement of all stakeholders from the start, identification and use of change agents, regular feedback and a focus on human resources rather than equipment have been key factors for the success of this project.