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Meet the team: Kingston Maternity - Together is Better


  • Kingston Hospital: Susana Pereira (Consultant), Alexandra Ridout (Registrar), Jonathan Grellier (Head of Improvement)
  • Sierra Leone: Welbodie Partnership

What is the challenge or opportunity you are focusing on?

If burnout in healthcare were described in public health terms, it would be labelled an epidemic. A 2015 study found over 50% of physicians report symptoms of burnout, and an alarming 6.4% had contemplated suicide in the preceding year.

Clinicians tell us they are exhausted, frustrated, and experiencing overwhelming stress. People are feeling overburdened and overregulated. They spend more time looking at computers than their patients’ faces. With increasing demands on time, resources and energy, it’s not surprising that this has become a property of the system we work in. It affects quality, safety and healthcare system performance.

Aaron Antonovsky said that health is more than the absence of disease. To quote the institute of health improvement, “joy in work is more than the absence of burnout.”

“In healthcare, joy is not just humane, it’s instrumental…You cannot give what you do not have…The gifts of hope, confidence, and safety that health care should offer patients and families can only come from a workforce that feels hopeful, confident and safe. Joy in work is an essential resource for the enterprise of healing”.

How can we motivate and create “Joy in work”? We believe that leaders have an obligation to help demoralized staff members reconnect with their original sense of purpose, compassion, and caring. To recapture why we went into medicine in the first place. To see that we are making a difference in the lives of the people we serve. To promote camaraderie and teamwork.

We believe joy is a resource for excellence.

The proposal

Our aim is to form a link between Kingston Maternity Unit and the Welbodi Partnership (a UK registered charity: 112517), to support Maternity Care in Freetown, Sierra Leone. We believe this Health Partnership would build the capacity of individuals, institutions and systems to improve health outcomes for mothers and babies in Sierra Leone as well as revitalising a sense of purpose and encourage “joy at work” for the staff of Kingston Hospital. 

We hope to embed an enhanced system of training and mentorship alongside local partners at the Princess Christian Maternity Hospital (PCMH), located in Freetown, Sierra Leone. The single tertiary facility providing specialist maternity and gynaecology care for the country, this partnership will catalyse improvements in healthcare delivery both home and abroad. This partnership will be built on a quality improvement model, as well as training though the PROMPT model of multi-disciplinary practical obstetric emergency training. Our aim is to identify avenues for growth and development between and across these two health systems. 

This partnership would be undertaken with the support of Welbodi Partnership in Sierra Leone. Since 2008 they have worked in partnership with hospital management, health facility staff and the Ministry of Health and Sanitation (MoHS) in the host country. Their participatory, stakeholder-driven approach, fostering local ownership and innovative solutions within a resource-constrained environment is aligned with our own, and will be essential to the long-term success of this project.

The benefit we hope top achieve

We expect to drive positive change in the health and wellbeing of UK staff. There is a wealth of literature identifying the benefits of overseas experience for NHS staff. Alongside developing leadership and problem-solving skills, we have witnessed first-hand team members returning to their work place with renewed motivation and vigour in their roles at home, as a direct result of their experiences in Sierra Leone.

Sierra Leone has one of the most fragile health systems in the world, reporting the worst maternal mortality rates globally. Estimated at 1165 per 100,000 (six times the global average), death during pregnancy and childbirth account for a third of all deaths in women of reproductive age. Maternal death reviews and surveillance reports indicated that the majority of these women die in a health facility (82%). 50% of all deaths are attributable to causes that are easy to identify through basic surveillance, and readily treatable. Low-skills amongst health workers was identified as a key factor contributing to hospital deaths (Sierra Leone Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy (2017 to 2021 MoHS).

This opportunity for shared learning has potential for significant impact on morbidity and mortality figures, as well as personal development within the UK workforce. This project supports our belief that joy and generosity come together. Actively nurturing the compassion and dedication of healthcare staff will lead to more effective and empathetic care, both home and abroad.

Benefits for the Q Community

The methods of aim setting, tests of change, and measurement that are used for clinical and operational process improvement will now be applied to a new setting (low-income) and with a new, additional goal (shared joy at work). This work will help develop the small body of international literature around quality improvement in developing nations. We will disseminate both our clinical and individual learning stories through a variety of mediums, including social media, story telling and through PROMPT teaching at the Institutional, National and International level. Our learning will be shared far beyond the individuals that benefitted from the opportunity to attend.


  1. Guest

    What a sensible win-win for the NHS and the children of Sierra Leone! I love this idea and as well as the mental health benefits will be interested to see what improvements the NHS staff feel it brings to their clinical skills from learning to operate in a less well resourced environment.

  2. Guest

    really interesting project . I also have links to people who have looked at improving maternity care in Uganda by looking at men’s attitudes to maternity care. Some ‘Whose Shoes’ #MatExp resources have been used & published & we could consider this approach. Attitudes of men may determine women’s access to care .

    1. Guest

      Flo this is really helpful, thank you. Your tweet put me in touch with two new contributors - and also highlighted how your work re. WhoseShoes has taken off in Uganda, as well as being so important in the UK. Both useful, and incredibly inspiring. "Helping people work together to improve lives" - that is what it is all about after all!

  3. Guest

    Helena Watson 2 years, 11 months ago

    I am keen to support and promote this exciting new project. It will benefit from Welbodi’s local and international network and their proven track record in improving paediatric outcomes in Sierra Leone via quality improvement and training. Motivation seems to be the x-factor behind so many good examples of individual and collective clinical  excellence at home and abroad.  I look forward to understanding more about how this will be implemented and evaluated.

  4. Hi Susana - really excited about this project.  The opportunity to learn about and demonstrate the impact of process improvement in a completely different setting is fascinating.  I think it will also produce some great examples to counter the assumption that 'more resources' is necessarily the answer to some of the problems we face.  I know the likes of IHI and Virginia Mason have done some work in parts of Africa and are seeing similar benefits for both sides.

    1. Guest

      Thank you Jonathan, we are too! We have done some scoping interviews at the hospital in Sierra Leone and I wanted to share a quote with you from one of their senior midwives - "I have worked for Africa for 35 years and the best midwives I have seen are in Sierra Leone. Midwives in PCMH [the tertiary hospital in the capital] are skilled, but they are demotivated."

      The quality improvement framework, "Developing People - Improving Care" is relevant in both settings. We have lots to learn from each other.

  5. Guest

    Rebecca Best 2 years, 11 months ago

    This looks like a great project. Finding ways to improve staff motivation feels particularly important in both settings - I really like the “joy at work” theme.

    1. Guest

      Becky, your local experience in Freetown as part of the Welbodi Partnership, and your relationship with the hospital is going to be invaluable. In fact your fantastic Hospital Triage Quality Improvement project in Sierra Leone was part of the inspiration for our project! Understanding system demand and flow through patient-mapping exercises will certainly establish the direction for our project programme. And collecting, managing and evaluating data throughout the partnership will be a critical part of this journey. Welcome aboard!

  6. Guest

    Caroline Everden 2 years, 11 months ago

    Having volunteered previously under the auspices of a UK-Uganda hospital link, I've seen the benefits it can bring to all involved. There are proven techniques for teaching obstetric skills, which we know can quickly deliver improvements in outcomes, but the ongoing link allows maintenance and development of those skills.

    What a fabulous project this has the potential to be, I hope it gets the support it deserves.

    1. Guest


      We are so excited to learn from your experience, both in medical education but also as a local QI champion. This project will depend upon on bringing together the rich and varied individual skills of our fantastic community! We really believe this project, and our aim of creating a global Q community, is going to be a learning experience for us all, with so many new opportunities for innovation and practical problem solving. Home and abroad. #TogetherIsBetter







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  7. Guest

    Sadiya Hussain 2 years, 11 months ago

    This is an absolutely fantastic venture. Clinicians will benefit immensely from getting involved. The MMR in Sierra Leone is 1360/100,000 live births. To put this in context the MMR in the UK is about 9/100,000. Women are dying everyday from largely preventable causes. The reasons for these are complex and inextricably linked with cultural, social, and economical factors. We have a real opportunity here to get involved, with training, education, empowering women and healthcare professionals to take the reigns and improving the health of women.


    Well done team! This is very exciting!!



    1. Thank-you for your feedback. Please can you click the support button near the top of this page. Thank-you. Gill Wilson

    2. Guest

      Susana Pereira 2 years, 11 months ago

      Thanks Sadiya!

      Sometimes in the UK we forget how far  we went in safety! We tend to take it for granted and forget the importance of what we do.  And the lack of sense of purpose easily ends in burnout! We are working on how to measure impact at Kingston Maternity- one of the ideas today was to use the cultural survey. Another idea was to measure savings! We may become inspired with the so much is done in Sierra Leone with very little!!



  8. Guest

    This looks like a very interesting project.  Have you considered some of the learnings from Ghana's quality improvement project, "Project Fives Alive".  The following link may be helpful:


    1. Thank-you for your feedback. Please can you click the support button near the top of this page. Thank-you. Gill Wilson

    2. Guest

      Susana Pereira 2 years, 11 months ago

      Many thanks for your suggestion! Very interesting and useful! We will be focusing on system improvement and moving as much away as possible from “delivering training”.

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