Strengthening patient safety in a Cambodian hospital through structured weekly reporting: a low-cost quality improvement initiative.

Abstract

Persistent patient safety issues in low-resource hospitals are often underreported, delaying corrective actions and increasing preventable harm. This project aimed to implement a low-cost, structured weekly reporting system to improve patient safety processes and outcomes across departments at a tertiary hospital in Phnom Penh, Cambodia. A one-page Departmental Wise Checklist was introduced in the emergency room/intensive care unit (ER), obstetrics and gynaecology, outpatient department and paediatrics. Weekly reviews, feedback loops and departmental champions supported consistent reporting and follow-through. Implementation emphasised planning, stakeholder engagement, iterative refinement through Plan-Do-Study-Act (PDSA) cycles and integration into routine workflows. Challenges including resistance to extra work, inconsistent submissions and escalation fatigue were addressed through simplified checklists, coaching and departmental champions, while oversight from the hospital quality improvement committee ensured accountability. After 3 months, process measures showed substantial change: formally adopted Standard Operating Procedures (SOP) increased from 0 to 10, Basic Life Support-trained ER staff rose from 38% to 98%, incidents of expired blood products fell from 2 per month to none and reporting compliance averaged 92%. Concurrently, patient-level outcomes demonstrated change: monthly cases of neonatal hypothermia decreased from 6 to 2 and ER adverse events dropped from 4 to 1. These findings suggest that structured weekly reporting, combined with iterative feedback and active departmental engagement, may be associated with strengthening patient safety and accountability in low-resource settings. Long-term sustainability of these improvements is likely to depend on embedding the process into routine quality assurance activities, ongoing staff training and continued leadership oversight. However, sustainability beyond the 12-week intervention period has not yet been empirically assessed. The approach may provide a practical model for consideration and adaptation in similar low- and middle-income country hospitals, subject to local context and resources.