Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?

Autor:	Alidina S; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA Shehnaz_Alidina@hms.harvard.edu., Chatterjee P; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.; Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA., Zanial N; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Alreja SS; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Balira R; Department of Epidemiology, National Institute for Medical Research Mwanza Research Centre, Mwanza, Tanzania., Barash D; GE Foundation, Boston, Massachusetts, USA., Ernest E; Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania., Giiti GC; Depatment of Surgery, Bugando Consultant and Referral Hospital, Mwanza, Tanzania., Maina E; Dalberg Implement, Dalberg Group, Nairobi, Kenya., Mazhiqi A; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Mushi R; Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania., Reynolds C; Department of Global Health, Assist International, Ripon, California, USA., Sydlowski M; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Tinuga F; Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania., Maongezi S; Department of Adult Non-Communicable Diseases, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania., Meara JG; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA.; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Kapologwe NA; Department of Health, Social Welfare and Nutrition Service, President's Office - Regional Administration and Local Government, Dodoma, Tanzania., Barringer E; Dalberg Advisors, Dalberg Group, New York, New York, USA., Cainer M; Department of Global Health, Assist International, Ripon, California, USA., Citron I; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., DiMeo A; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Fitzgerald L; Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA., Ghandour H; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Gruendl M; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Hellar A; Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania., Jumbam DT; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Katoto A; Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania., Kelly L; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Kisakye S; Dalberg Implement, Dalberg Group, Dar es Salaam, Tanzania., Kuchukhidze S; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Lama TN; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Menon G; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Mshana S; Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania., Reynolds C; Department of Global Health, Assist International, Ripon, California, USA., Segirinya H; Department of Global Health, Assist International, Dar es Salaam, Tanzania., Simba D; Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania., Smith V; Department of Global Health, Assist International, Ripon, California, USA., Staffa SJ; Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA., Strader C; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Tibyehabwa L; Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania., Troxel A; Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA., Varallo J; Safe Surgery 2020 Project, Jhpiego, Baltimore, Maryland, USA., Wurdeman T; Program in Global Surgery and Social Change, Harvard Medical School Department of Global Health and Social Medicine, Boston, Massachusetts, USA., Zurakowski D; Departments of Anesthesiology and Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ quality & safety [BMJ Qual Saf] 2021 Dec; Vol. 30 (12), pp. 937-949. Date of Electronic Publication: 2021 Feb 05.
DOI:	10.1136/bmjqs-2020-011795
Abstrakt:	Background: Evidence on heterogeneity in outcomes of surgical quality interventions in low-income and middle-income countries is limited. We explored factors driving performance in the Safe Surgery 2020 intervention in Tanzania's Lake Zone to distil implementation lessons for low-resource settings. Methods: We identified higher (n=3) and lower (n=3) performers from quantitative data on improvement from 14 safety and teamwork and communication indicators at 0 and 12 months from 10 intervention facilities, using a positive deviance framework. From 72 key informant interviews with surgical providers across facilities at 1, 6 and 12 months, we used a grounded theory approach to identify practices of higher and lower performers. Results: Performance experiences of higher and lower performers differed on the following themes: (1) preintervention context, (2) engagement with Safe Surgery 2020 interventions, (3) teamwork and communication orientation, (4) collective learning orientation, (5) role of leadership, and (6) perceived impact of Safe Surgery 2020 and beyond. Higher performers had a culture of teamwork which helped them capitalise on Safe Surgery 2020 to improve surgical ecosystems holistically on safety practices, teamwork and communication. Lower performers prioritised overhauling safety practices and began considering organisational cultural changes much later. Thus, while also improving, lower performers prioritised different goals and trailed higher performers on the change continuum. Conclusion: Future interventions should be tailored to facility context and invest in strengthening teamwork, communication and collective learning and facilitate leadership engagement to build a receptive climate for successful implementation of safe surgery interventions. Competing Interests: Competing interests: SA, SSA, EB, MC, PC, IC, ADM, EE, LF, GCG, MG, AH, DTJ, AK, LK, StK, SaK, TNL, EM, SM, AM, GM, ChaR, CheR, HS, DS, VS, CS, MS, LT, AT, JV, TW and NZ had financial support from GE Foundation for the submitted work. EE, AH, GCG, AK, LF, SM, DS, LT, AT and JV declare financial support from ELMA Philanthropies. DB is employed by GE Foundation, which funded this work. NAK reports that he is the Director of Health, Social Welfare and Nutrition Services at PO-RALG in Tanzania. SM reports that she is the Acting Assistant Director NCDs, at the Ministry of Health, Community Development, Gender, Elderly and Children in Tanzania. Both institutions are party to the MoU under which the Safe Surgery 2020 intervention (the subject of the study/assessment) is implemented. (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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