Oh, what a shocker! It turns out that over 90% of the world’s tiny tots with the misfortune of a wonky ticker are born where resources are as scarce as a snowball in the Sahara—those low- to middle-income countries (LMICs). And guess what? The combo of not enough hands on deck, some pretty shoddy equipment, and health systems that are about as functional as a chocolate teapot means the care these kiddos get is, well, not exactly top-notch. This, my friends, leads to outcomes that are as suboptimal as a parachute made of lead.

But wait, there’s a glimmer of hope! Despite these teeny-weeny hurdles, some bright sparks believe we can whip up a quality improvement (QI) framework that could actually make a dent in the mortality rates. Imagine that! In this riveting review, we’re going to snoop around and find out what’s throwing a spanner in the works when it comes to getting these QI shindigs off the ground in LMICs.

And because we’re all about those happy endings, we’ll even throw in a few tales of QI knight-errants who’ve managed to slay the dragon of inefficiency in LMICs. The secret sauce? A pinch of simplicity, a dollop of teamwork, and a leadership that’s as passionate about quality of care as a squirrel is about nuts. So, buckle up, and let’s take a magical mystery tour through the land of “doing better with less” in the world of congenital heart disease. Isn’t modern medicine just the bee’s knees?