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Individual staff efforts to respond to maternal emergencies were undermined by a lack of consistency in availability of resources and support. The ways in which policies were applied exacerbated inequities in care. Staff improvised as a means of managing with limited material or human resources and knowledge. Social hierarchies and punitive cultures challenged adequacy of communication with women, documentation of care given and supportive environments for quality improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Quality care for pre-eclampsia requires organisational change to create a safe space for learning and improvement, alongside efforts to offer patient-centred care and ensure providers are equipped with knowledge, resources and support to adhere to evidence-based practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061500","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T10:45:19Z","timestamp":1681728319000},"page":"e061500","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Understanding challenges as they impact on hospital-level care for pre-eclampsia in rural Ethiopia: a qualitative study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7851-7171","authenticated-orcid":false,"given":"Tanya","family":"Robbins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Shennan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Sandall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigist","family":"Eshetu Guangul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahel","family":"Demissew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Abdella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Mayston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7937-3226","authenticated-orcid":false,"given":"Charlotte","family":"Hanlon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,4,17]]},"reference":[{"key":"2023050303461633000_13.4.e061500.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"2023050303461633000_13.4.e061500.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2013.05.005"},{"key":"2023050303461633000_13.4.e061500.3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/1471-0528.12629","article-title":"Pre-Eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the world Health Organization multicountry survey on maternal and newborn health","volume":"121 Suppl 1","author":"Abalos","year":"2014","journal-title":"BJOG"},{"key":"2023050303461633000_13.4.e061500.4","doi-asserted-by":"publisher","DOI":"10.4314\/ejhs.v24i0.3S"},{"key":"2023050303461633000_13.4.e061500.5","doi-asserted-by":"crossref","unstructured":"Mersha AG , Abegaz TM , Seid MA . 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