Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop.

Abstract

Background: Malawi has made progress in improving access to maternity care services, shifting the focus to quality of care as an essential determinant of maternal health outcomes. However, no effective mechanisms exist to use patients' experiences of care at health facilities to inform and improve the quality of maternal healthcare.

Objective: To use maternal sepsis patient journeys in a workshop with maternal health stakeholders to identify and prioritise barriers in care and recommend interventions to improve maternal healthcare quality in Malawi.

Methods: In February 2024, in Blantyre, Malawi, using a modified nominal group technique, 28 stakeholders reviewed the patient journeys of three women hospitalised at Queen Elizabeth Central Hospital, who had sepsis after childbirth. Patient journeys narrate events experienced within a healthcare system in the patient's words. In a multiframework approach (Four Delays, Respectful Maternity Care, and WHO Quality of Care), stakeholders identified and prioritised barriers to care and recommended interventions to improve the quality of maternal healthcare. Content analysis of the workshop data linked barriers with stakeholders' suggested interventions.

Results: Nineteen barriers identified included various delays in receiving care, mistreatment by healthcare providers, and suboptimal quality of care. Stakeholders found patient journeys valuable and insightful for identifying gaps in the quality of care and promoting sepsis awareness among healthcare workers and the public.

Conclusions: Patient journeys are a novel tool for capturing the experience of care in Malawi. They have the potential to guide strategic improvements in maternal healthcare quality and ultimately reduce maternal morbidity and mortality.