Nepal: Management of Services

A QI method also relevant to patient safety is morbidity and mortality conferences (M&M). Ideally, M&Ms should encourage system-level improvement and create space for staff discussion of safety improvement. M&Ms were implemented in a remote district hospital in Nepal that previously had no systematic method for quality improvement.1 M&Ms occurred weekly during staff meetings to ensure wide participation, and discussion focused on: clinical operations, supply chains, equipment, personnel, outreach, societal, and structural. Following the M&Ms, the hospital administrator and executive director were responsible for the implementation of proposed interventions. Some examples of interventions pursued as a result of M&Ms reviewing complicated deliveries included a task shifting workshop on emergency, point-of-care investigations to improve efficiency during high patient flow and a training in partograph use during labor. Despite these successful interventions, there were a few challenges that surfaced from the evaluation. These included difficulties implementing M&Ms on the planned weekly basis and lack of contribution from junior staff. Even considering these barriers, M&Ms may be an effective QI method in limited resource settings and can identify intervention points to improve patient safety.


  1. Schwarz D, Schwarz R, Gauchan B, Andrews J, Sharma R, Karelas G, et al. Implementing a systems-oriented morbidity and mortality conference in remote rural Nepal for quality improvement. BMJ Qual Saf. 2011;20(12):1082–8.