Implementing robust and sustainable quality improvement practices in facilities can help identify opportunities for strengthening systems and improving patient safety. There are a number of different methods and tools for quality improvement, some of which are discussed in Facility Organization and Management. The Mentoring and Enhanced Supervision for Healthcare and Quality Improvement (MESH-QI) is one such program that was first implemented in rural health centers in Rwanda as a collaboration between Partners in Health and the Rwandan Ministry of Health.1 In 2013, MESH-QI was adapted for use in district hospitals where QI efforts were required by the Rwanda Health Sector Strategic Plan but did not engage all staff. QI trainings focused on General introductions to QI concepts, problem Identification and QI tools, QI methodology, and intervention design and implementation. During quarterly meetings, teams were able to discuss the progress they had made and discuss challenges they faced to encourage motivation and sustainability. While such QI programs are not specific to patient safety, they create frameworks for continuously identifying challenges or warning signs for patient safety and actively designing, implementing, and monitoring interventions. The MESH-QI Implementation guide is available online.


  1. Ingabire W, Reine PM, Hedt-Gauthier BL, Hirschhorn LR, Kirk CM, Nahimana E, et al. Roadmap to an effective quality improvement and patient safety program implementation in a rural hospital setting. Healthcare [Internet]. 2015;3(4):277–82. Available from: