Barriers in implementing quality improvement initiatives amongst health care workers at a regional hospital, eSwatini

Abstract

The quality and safety of healthcare depend on the capacity of healthcare professionals to continuously implement quality improvement (QI) processes in service delivery. However, QI initiatives often fail to be fully integrated into daily practice due to barriers that hinder effective implementation. This sought to identify and describe factors influencing the uptake and implementation of quality standards among healthcare workers, with the goal of informing strategies to close the gap between expected and actual performance. A descriptive cross-sectional study was conducted at Raleigh Fitkin Memorial Hospital (RFMH), a regional hospital in Manzini, eSwatini guided by the Theoretical Domains Framework (TDF). A stratified systematic sampling method with proportional allocation was used to select 134 healthcare workers across medical, nursing, and allied cadres. Data were collected through a validated self-administered questionnaire distributed both electronically and in hard copy. The instrument contained structured Likert-scale items and open-ended questions assessing individual, organisational, and contextual barriers to QI implementation. Data were analysed using excel to generate descriptive statistics, supported by qualitative thematic insights from open-ended responses. From the findings, it was revealed that although most participants understood QI concepts and recognised their importance, practical application remained imperfect. For example, 77.8% of respondents reported clarity of roles, and the belief in QI’s value was strong, with 90.4% acknowledging its positive impact. Moreover, organisational endorsement of QI was relatively high (83.7%), but financial limitations (21.5%) and moderate self-efficacy (60%) hindered effective implementation. Major barriers included insufficient resources, weak day-to-day management support, inadequate training, low confidence in QI delivery, and limited peer collaboration. Staff thus believed QI enhances patient outcomes but felt constrained by poor organisational systems and perceived lack of active management engagement. The study concludes that, for these barriers to be addressed, it requires a stronger leadership engagement, adequate resourcing, continuous in-service training, and the integration of QI activities into routine hospital operations. Strengthening mentorship, communication, and feedback mechanisms is also essential for sustaining QI practices.