Applying the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework to Safe Surgery 2020 Implementation in Tanzania's Lake Zone
| Autor: | Ladislaus Buberwa, Noor Zanial, Cheri Reynolds, Meck P. Nyanda, William Mnyonyela, David Barash, Steve Kisakye, Augustino Hellar, Ntuli A. Kapologwe, Adelina Mazhiqi, Sarah Maongezi, John G. Meara, Shehnaz Alidina, Bwire Chirangi, Florian Tinuga |
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| Rok vydání: | 2021 |
| Předmět: |
Quality management
Process management media_common.quotation_subject Psychological intervention 030230 surgery Tanzania Health Services Accessibility 03 medical and health sciences Patient safety 0302 clinical medicine Documentation Postoperative Complications Health facility Medicine Humans Longitudinal Studies Qualitative Research media_common Retrospective Studies Patient Care Team Surgeons Surgical team Teamwork Evidence-Based Medicine business.industry Health Plan Implementation Sustainable Development Quality Improvement Leadership 030220 oncology & carcinogenesis Surgical Procedures Operative Surgery Patient Safety business Qualitative research |
| Zdroj: | Journal of the American College of Surgeons. 233(2) |
| ISSN: | 1879-1190 |
| Popis: | Background Access to safe, high-quality surgical care in sub-Saharan Africa is a critical gap. Interventions to improve surgical quality have been developed, but research on their implementation is still at a nascent stage. We retrospectively applied the Exploration, Preparation, Implementation, Sustainment Framework to characterize the implementation of Safe Surgery 2020, a multicomponent intervention to improve surgical quality. Methods We used a longitudinal, qualitative research design to examine Safe Surgery 2020 in 10 health facilities in Tanzania’s Lake Zone. We used documentation analysis with confirmatory key informant interviews (n=6) to describe the Exploration and Preparation phases. We conducted interviews with health facility leaders and surgical team members at 1, 6, and 12 months (n=101) post-initiation to characterize the Implementation phase. Data were analyzed using the constant comparison method. Results In the Exploration phase, research, expert consultation, and scoping activities revealed the need for a multicomponent intervention to improve surgical quality. In the Preparation phase, onsite visits identified priorities and barriers to implementation in order to adapt the intervention components and curriculum. In the Active Implementation phase, four themes related to the inner organizational context – vision for safe surgery, existing surgical practices, leadership support, and resilience – and three themes related to the intervention – innovation-value fit, holistic approach, and buy-in – facilitated or hindered implementation. Interviewees perceived improvements in teamwork and communication and intra- and inter-facility learning, and their needs to deliver safe surgery evolved over the implementation period. Conclusion Examining implementation through the Exploration, Preparation, Implementation and Sustainment phases offers insights into the implementation of interventions to improve surgical quality and promote sustainability. |
| Databáze: | OpenAIRE |
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