Introduction Mzuzu Central Hospital (MZCH) has one orthopaedic surgeon for a population of 4 million. Coupled with its limited resources, this leads to long waits for surgery, which impacts the patient, surgeon, and hospital. Whilst long term solutions will require financial investment, innovation in service provision – such as efficiency, timeliness, effectiveness, equity, and safety – can also help address these challenges.

Methods Three UK orthopaedic surgeons visited MZCH. Processes and systems were observed. Semi-structured interviews discussing service improvement were conducted, responses were thematically analysed, and the staff were then questioned on these themes.

Results Themes focussed exclusively on increasing resources, such as staffing and equipment. There were no responses that considered ways to improve their service by changing the systems within which they work. When questioned on this, staff cited a lack of awareness and training in quality improvement (QI) methodologies.

Conclusions QI methodologies can help implement effective, enduring change. In the UK, these concepts are introduced early, are a mandatory component of clinical activity, and are central to improving the quality of the health service. Introducing this in Malawi could allow service innovation independent of financial constraints. Teams visiting similar environments may wish to promote awareness and training in QI methodologies to aide with local service innovation.