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Kassie AM, Eakin E, Abate BB, Endalamaw A, Zewdie A, Wolka E, Assefa Y. The use of positive deviance approach to improve health service delivery and quality of care: a scoping review. BMC Health Serv Res 2024; 24:438. [PMID: 38589897 PMCID: PMC11003118 DOI: 10.1186/s12913-024-10850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Quality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs. METHODS Articles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats. RESULTS A total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections. CONCLUSION The scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.
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Affiliation(s)
- Ayelign Mengesha Kassie
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Biruk Beletew Abate
- School of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care, Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Schade AT, Sabawo M, Jaffry Z, Nyamulani N, Mpanga CC, Ngoie LB, Metcalfe AJ, Lalloo DG, Harrison WJ, Leather A, MacPherson P. Improving the management of open tibia fractures, Malawi. Bull World Health Organ 2024; 102:255-264. [PMID: 38562195 PMCID: PMC10976873 DOI: 10.2471/blt.23.290755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To assess the impact of an open fracture intervention bundle on clinical management and patient outcomes of adults in Malawi with open tibia fractures. Methods We conducted a before-and-after implementation study in Malawi in 2021 and 2022 to assess the impact of an open fracture intervention bundle, including a national education course for clinical officers and management guidelines for open fractures. We recruited 287 patients with open tibia fractures. The primary outcome was a before-and-after comparison of the self-reported short musculoskeletal function assessment score, a measure of patient function. Secondary outcomes included clinical management; and clinician knowledge and implementation evaluation outcomes of 57 health-care providers attending the course. We also constructed multilevel regression models to investigate associations between clinical knowledge, patient function, and implementation evaluation before and after the intervention. Findings The median patient function score at 1 year was 6.8 (interquartile range, IQR: 1.5 to 14.5) before intervention and 8.4 (IQR: 3.8 to 23.2) after intervention. Compared with baseline scores, we found clinicians' open fracture knowledge scores improved 1 year after the intervention was implemented (mean posterior difference: 1.6, 95% highest density interval: 0.9 to 2.4). However, we found no difference in most aspects of clinicians' open fracture management practice. Conclusion Despite possible improvement in clinician knowledge and positive evaluation of the intervention implementation, our study showed that there was no overall improvement in clinical management, and weak evidence of worsening patient function 1 year after injury, after implementation of the open fracture intervention bundle.
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Affiliation(s)
- Alexander Thomas Schade
- Public Health Department, Malawi-Liverpool-Wellcome Trust, Queen Elizabeth Central Hospital, P.O. Box 30096, Blantyre, Malawi
| | - Maureen Sabawo
- Department of Health Systems and Policy, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Zahra Jaffry
- Trauma and Orthopaedic Department, Bart’s Health NHS Trust, London, England
| | - Nohakhelha Nyamulani
- Trauma and Orthopaedic Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | | | - Leonard Banza Ngoie
- Trauma and Orthopaedic Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | | | - Andrew Leather
- King's Global Health Partnerships, King’s College London, London, England
| | - Peter MacPherson
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Hayirli TC, Meara JG, Abahuje E, Alayande B, Augustin S, Barash D, Boatin AA, Kalolo A, Kengia J, Kingpriest P, Kissima I, Lugazia ER, Mpirimbanyi C, Ngonzi J, Njai A, Smith VL, Kapologwe N, Alidina S. A practical tool for managing change: cross-sectional psychometric assessment of the safe surgery organizational readiness tool. Int J Surg 2024; 110:733-739. [PMID: 38051926 PMCID: PMC10871570 DOI: 10.1097/js9.0000000000000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Strengthening health systems through planned safety and quality improvement initiatives is an imperative to achieve more equitable, resilient, and effective care. And yet, years of organizational behavior research demonstrate that change initiatives often fall short because managers fail to account for organizational readiness for change. This finding remains true especially among surgical safety and quality improvement initiatives in low-income countries and middle-income countries. In this study, our aim was to psychometrically assess the construct validity and internal consistency of the Safe Surgery Organizational Readiness Tool (SSORT), a short survey tool designed to provide change leaders with insight into facility infrastructure that supports learning and readiness to undertake change. MATERIALS AND METHODS To demonstrate generalizability and achieve a large sample size ( n =1706) to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), a collaboration between seven surgical and anesthesia safety and quality improvement initiatives was formed. Collected survey data from health care workers were divided into pilot, exploration, and confirmation samples. The pilot sample was used to assess feasibility. The exploration sample was used to conduct EFA, while the confirmation sample was used to conduct CFA. Factor internal consistency was assessed using Cronbach's alpha coefficient. RESULTS Results of the EFA retained 9 of the 16 proposed factors associated with readiness to change. CFA results of the identified 9 factor model, measured by 28 survey items, demonstrated excellent fit to data. These factors (appropriateness, resistance to change, team efficacy, team learning orientation, team valence, communication about change, learning environment, vision for sustainability, and facility capacity) were also found to be internally consistent. CONCLUSION Our findings suggest that communication, team learning, and supportive environment are components of change readiness that can be reliably measured prior to implementation of projects that promote surgical safety and quality improvement in low-income countries and middle-income countries. Future research can link performance on identified factors to outcomes that matter most to patients.
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Affiliation(s)
- Tuna C. Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School
- Department of Plastic and Oral Surgery, Boston Children’s Hospital
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Egide Abahuje
- Massachusetts General Hospital, Institute of Health Professions
- Northwestern University, Chicago, Illinois
- University of Rwanda, College of Medicine and Health Sciences, Kigali
| | - Barnabas Alayande
- Program in Global Surgery and Social Change, Harvard Medical School
- Department of Population and Health, Harvard TH Chan School of Public Health, Boston
- Center for Equity in Global Surgery, University of Global Health Equity, Buttaro
- Faith Alive Foundation, Jos, Nigeria
| | | | | | - Adeline A. Boatin
- Program in Global Surgery and Social Change, Harvard Medical School
- Harvard Medical School
- Department of OB/GYN, Massachusetts General Hospital
| | - Albino Kalolo
- Department of Public Health, St Francis University college of Health and Allied Sciences, Morogoro
- Implementation Research Division, Center for Reforms, Innovation, Health Policies and Implementation Research (CERIHI)
| | - James Kengia
- Directorate of Health, Social Welfare & Nutrition Services, President’s Office - Regional Administration and Local Government (PO-RALG), Dodoma
| | - Paul Kingpriest
- Northwestern University, Chicago, Illinois
- Surgical Equity and Research Centre
| | | | - Edwin R. Lugazia
- Anesthesiology Department-Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Joseph Ngonzi
- Obstetrics/Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Abdoulie Njai
- University of Missouri-Columbia School of Medicine, Missouri, USA
| | | | - Ntuli Kapologwe
- Directorate of Health, Social Welfare & Nutrition Services, President’s Office - Regional Administration and Local Government (PO-RALG), Dodoma
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School
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Bete DY, Sibhatu MK, Godebo MG, Abdulahi IJ, Liyew TW, Minas SM, Bryce E, Ashengo TA, Varallo J. Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project. BMJ Open Qual 2023; 12:e002406. [PMID: 37940334 PMCID: PMC10632882 DOI: 10.1136/bmjoq-2023-002406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND In 2009, the WHO introduced the surgical safety checklist (SSC) as one of the interventions for improving patient safety. The systematic use of structured checklists during surgery has been shown to reduce perioperative morbidity and mortality. However, SSC utilisation has been challenging in low-income and middle-income countries, including Ethiopia. Jhpiego Ethiopia implemented a quality improvement project (QIP) aimed to increase SSC utilisation. METHODOLOGY A model for improvement was used to design and implement a collaborative QIP to improve SSC utilisation at 23 public health facilities (13 primary health care facilities, 4 general hospitals and 6 tertiary hospitals) in Ethiopia from October 2020 to September 2021. SSC utilisation was defined as when a patient chart had SSC attached and each part of the checklist was completed. Training of surgical staff on safe surgery packages, monthly clinical mentorship and cluster-based learning platforms were implemented during the study period. We analysed bimonthly chart audit reports from each facility to assess the proportion of surgeries where the SSC was used. Shewhart charts were used to conduct a time-series analysis. Additionally, the Z-test for two sample proportions was used to determine if there is a statistically significant change from the baseline measure with a p<0.05. RESULT In the postintervention period, the overall SSC utilisation improved by 39.9 absolute percentage points to 90.3% (p<0.0001) compared with the baseline value of 50.4% early in 2020. A time-series analysis using Shewhart charts showed a shift in the mean performance and signals of special cause variation. The largest improvement was observed in primary health care facilities in which the SSC utilisation improved from 50.8% to 97.9% (p<0.0001). CONCLUSION This study demonstrates that onsite clinical capacity building, mentorship and collaborative cluster-based learning platforms can improve SSC utilisation across all levels of facilities performing surgery.
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Affiliation(s)
| | | | | | | | | | | | - Emily Bryce
- Jhpiego Corporation, Baltimore, Maryland, USA
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Smith SM, Eadara A, Parkash V. Addressing quality and safety in anatomic pathology in low- and middle-income countries. Front Med (Lausanne) 2022; 9:1060179. [PMID: 36619634 PMCID: PMC9817141 DOI: 10.3389/fmed.2022.1060179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022] Open
Abstract
The World Health Organization (WHO) has created a sustainable development goal of reducing preventable mortality from cancer in low- and middle-income countries (LMICs) by 30% by 2030. Central to achieving this goal is the creation and maintenance of quality anatomic pathology services (APS). Within the last decade, quality assurance programs and patient safety measures have become a major focus of research for upper middle- and high-income countries (UMHICs), which has led to marked documented improvement in the quality of services provided by laboratories, as well as a decrease in patient safety events. We propose that as APS are developed in LMICs, the lessons learned by UMHICs are necessary to incorporate to produce quality and safe services toward obtaining the aforementioned goal. Furthermore, data suggests that Quality Improvement work requires change at the macrosystems and microsystems levels to achieve these goals. Here, we propose five "microsystems" strategies for professional organizations, healthcare institutions in LMICs and UMHICs that would accelerate quality improvement programs/systems implementation in APS in LMICs.
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Affiliation(s)
- Stephen M. Smith
- Department of Laboratory Medicine & Pathobiology, University Health Network, Toronto, ON, Canada
| | | | - Vinita Parkash
- Department of Pathology, Yale School of Medicine, Yale University, New Haven, CT, United States,*Correspondence: Vinita Parkash,
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Quality Improvement Models and Methods for Maternal Health in Lower-Resource Settings. Obstet Gynecol Clin North Am 2022; 49:823-839. [DOI: 10.1016/j.ogc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alidina S, Sydlowski MM, Ahearn O, Andualem BG, Barash D, Bari S, Barringer E, Bekele A, Beyene AD, Burssa DG, Derbew M, Drown L, Gulilat D, Gultie TK, Hayirli TC, Meara JG, Staffa SJ, Workineh SE, Zanial N, Zeleke ZB, Mengistu AE, Ashengo TA. Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned. BMC MEDICAL EDUCATION 2022; 22:653. [PMID: 36045356 PMCID: PMC9434847 DOI: 10.1186/s12909-022-03691-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND A well-qualified workforce is critical to effective functioning of health systems and populations; however, skill gaps present a challenge in low-resource settings. While an emerging body of evidence suggests that mentorship can improve quality, access, and systems in African health settings by building the capacity of health providers, less is known about its implementation in surgery. We studied a novel surgical mentorship intervention as part of a safe surgery intervention (Safe Surgery 2020) in five rural Ethiopian facilities to understand factors affecting implementation of surgical mentorship in resource-constrained settings. METHODS We designed a convergent mixed-methods study to understand the experiences of mentees, mentors, hospital leaders, and external stakeholders with the mentorship intervention. Quantitative data was collected through a survey (n = 25) and qualitative data through in-depth interviews (n = 26) in 2018 to gather information on (1) intervention characteristics including areas of mentorship, mentee-mentor relationships, and mentor characteristics, (2) organizational context including facilitators and barriers to implementation, (3) perceived impact, and (4) respondent characteristics. We analyzed the quantitative and qualitative data using frequency analysis and the constant comparison method, respectively; we integrated findings to identify themes. RESULTS All mentees (100%) experienced the intervention as positive. Participants perceived impact as: safer and more frequent surgical procedures, collegial bonds between mentees and mentors, empowerment among mentees, and a culture of continuous learning. Over 70% of all mentees reported their confidence and job satisfaction increased. Supportive intervention characteristics included a systems focus, psychologically safe mentee-mentor relationships, and mentor characteristics including generosity with time and knowledge, understanding of local context, and interpersonal skills. Supportive organizational context included a receptive implementation climate. Intervention challenges included insufficient clinical training, inadequate mentor support, and inadequate dose. Organizational context challenges included resource constraints and a lack of common understanding of the intervention. CONCLUSION We offer lessons for intervention designers, policy makers, and practitioners about optimizing surgical mentorship interventions in resource-constrained settings. We attribute the intervention's success to its holistic approach, a receptive climate, and effective mentee-mentor relationships. These qualities, along with policy support and adapting the intervention through user feedback are important for successful implementation.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA.
| | - Meaghan M Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Olivia Ahearn
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Bizuayehu G Andualem
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | - Sehrish Bari
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | | | - Abebe Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andualem D Beyene
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Miliard Derbew
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Laura Drown
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Dereje Gulilat
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Tuna C Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Steven J Staffa
- Department of Anesthesiology and Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, MB, Boston, USA
| | - Zebenay B Zeleke
- Amhara Regional Health Bureau, Federal Ministry of Health, Addis Ababa, Ethiopia
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Martin GP, Armstrong N. Speaking up in resource-constrained settings: how to secure safe surgical care in the moment and in the future? BMJ Qual Saf 2022; 31:631-633. [PMID: 35292564 DOI: 10.1136/bmjqs-2021-014624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/24/2022]
Affiliation(s)
| | - Natalie Armstrong
- Department of Health Sciences, University of Leicester, Leicester, UK
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Alidina S, Tibyehabwa L, Alreja SS, Barash D, Bien-Aime D, Cainer M, Charles K, Ernest E, Eyembe J, Fitzgerald L, Giiti GC, Hellar A, Hussein Y, Kahindo F, Kenemo B, Kihunrwa A, Kisakye S, Kissima I, Meara JG, Reynolds C, Staffa SJ, Sydlowski M, Varallo J, Zanial N, Kapologwe NA, Mayengo CD. A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment. HUMAN RESOURCES FOR HEALTH 2021; 19:115. [PMID: 34551758 PMCID: PMC8458007 DOI: 10.1186/s12960-021-00652-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/01/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND Safe, high-quality surgical care in many African countries is a critical need. Challenges include availability of surgical providers, improving quality of care, and building workforce capacity. Despite growing evidence that mentoring is effective in African healthcare settings, less is known about its role in surgery. We examined a multimodal approach to mentorship as part of a safe surgery intervention (Safe Surgery 2020) to improve surgical quality. Our goal was to distill lessons for policy makers, intervention designers, and practitioners on key elements of a successful surgical mentorship program. METHODS We used a convergent, mixed-methods design to examine the experiences of mentees, mentors, and facility leaders with mentorship at 10 health facilities in Tanzania's Lake Zone. A multidisciplinary team of mentors worked with surgical providers over 17 months using in-person mentorship, telementoring, and WhatsApp. We conducted surveys, in-depth interviews, and focus groups to capture data in four categories: (1) satisfaction with mentorship; (2) perceived impact; (3) elements of a successful mentoring program; and (4) challenges to implementing mentorship. We analyzed quantitative data using frequency analysis and qualitative data using the constant comparison method. Recurrent and unifying concepts were identified through merging the qualitative and quantitative data. RESULTS Overall, 96% of mentees experienced the intervention as positive, 88% were satisfied, and 100% supported continuing the intervention in the future. Mentees, mentors, and facility leaders perceived improvements in surgical practice, the surgical ecosystem, and in reducing postsurgical infections. Several themes related to the intervention's success emerged: (1) the intervention's design, including its multimodality, side-by-side mentorship, and standardization of practices; (2) the mentee-mentor relationship, including a friendly, safe, non-hierarchical, team relationship, as well as mentors' understanding of the local context; and (3) mentorship characteristics, including non-judgmental feedback, experience, and accessibility. Challenges included resistance to change, shortage of providers, mentorship dose, and logistics. CONCLUSIONS Our study suggests a multimodal mentorship approach is promising in building the capacity of surgical providers. By distilling the experiences of the mentees, mentors, and facility leaders, our lessons provide a foundation for future efforts to establish effective surgical mentorship programs that build provider capacity and ultimately improve surgical quality.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Sakshie Sanjay Alreja
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | | | - Danta Bien-Aime
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Monica Cainer
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Kevin Charles
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | | | - Laura Fitzgerald
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Geofrey C. Giiti
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Yahaya Hussein
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | | | - Benard Kenemo
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Albert Kihunrwa
- Department of Surgery and Department of Obstetrics and Gynaecology, Bugando Medical Center, Mwanza, Tanzania
| | - Steve Kisakye
- D-Implement, Dalberg Advisors, Dar es Salaam, Tanzania
| | | | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA USA
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Cheri Reynolds
- Assist International, Dar es Salaam, Tanzania and Ripon, CA USA
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Meaghan Sydlowski
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - John Varallo
- Safe Surgery 2020 Project, Jhpiego, Dar es Salaam, Tanzania and Baltimore, MD USA
| | - Noor Zanial
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115 USA
| | - Ntuli A. Kapologwe
- Department of Health, Social Welfare, and Nutrition Service, President’s Office – Regional Administration and Local Government, Dodoma, Tanzania
| | - Caroline Damian Mayengo
- Department of Curative Services, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
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Mammo TN, Weiser TG. Addressing quality in surgical services in sub-Saharan Africa: hospital context and data standardisation matter. BMJ Qual Saf 2021; 30:927-929. [PMID: 34099496 DOI: 10.1136/bmjqs-2021-013259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tihitena Negussie Mammo
- Department of Surgery, Addis Ababa University, Addis Ababa, Oromia, Ethiopia.,Lifebox Foundation, Addis Ababa, Ethiopia
| | - Thomas G Weiser
- Department of Surgery, Stanford University, Stanford, California, USA .,Lifebox Foundation, London, UK
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Hayirli TC, Meara JG, Barash D, Chirangi B, Hellar A, Kenemo B, Kissima I, Maongezi S, Reynolds C, Samky H, Ulisubisya M, Varallo JE, Warinner CB, Alidina S, Kapologwe NA. Development and content validation of the Safe Surgery Organizational Readiness Tool: A quality improvement study. Int J Surg 2021; 89:105944. [PMID: 33862259 DOI: 10.1016/j.ijsu.2021.105944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recent efforts to increase access to safe and high-quality surgical care in low- and middle-income countries have proven successful. However, multiple facilities implementing the same safety and quality improvement interventions may not all achieve successful outcomes. This heterogeneity could be explained, in part, by pre-intervention organizational characteristics and lack of readiness of surgical facilities. In this study, we describe the process of developing and content validating the Safe Surgery Organizational Readiness Tool. MATERIALS AND METHODS The new tool was developed in two stages. First, qualitative results from a Safe Surgery 2020 intervention were combined with findings from a literature review of organizational readiness and change. Second, through iterative discussions and expert review, the Safe Surgery Organizational Readiness Tool was content validated. RESULTS The Safe Surgery Organizational Readiness Tool includes 14 domains and 56 items measuring the readiness of surgical facilities in low- and middle-income countries to implement surgical safety and quality improvement interventions. This multi-dimensional and multi-level tool offers insights into facility members' beliefs and attitudes at the individual, team, and facility levels. A panel review affirmed the content validity of the Safe Surgery Organizational Readiness Tool. CONCLUSION The Safe Surgery Organizational Readiness Tool is a theory- and evidence-based tool that can be used by change agents and facility leaders in low- and middle-income countries to assess the baseline readiness of surgical facilities to implement surgical safety and quality improvement interventions. Next steps include assessing the reliability and validity of the Safe Surgery Organizational Readiness Tool, likely resulting in refinements.
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Affiliation(s)
- Tuna C Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Harvard Business School, Boston, USA
| | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA; Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA.
| | | | | | | | | | | | - Sarah Maongezi
- Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | | | - Hendry Samky
- Center for Reform, Innovation, Health Policies and Implementation Research, Dodoma, Tanzania
| | - Mpoki Ulisubisya
- Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | | | | | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Ntuli A Kapologwe
- President's Office - Regional Administration and Local Government Directorate of Health, Social Welfare and Nutrition Services, Dodoma, Tanzania
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Bari S, Incorvia J, Ahearn O, Dara L, Sharma S, Varallo J, Smith V, Cainer M, Samphy C, Rathamony K, Kanora N, Dara V, Meara JG, Koy V, Alidina S. Building safe surgery knowledge and capacity in Cambodia: a mixed-methods evaluation of an innovative training and mentorship intervention. Glob Health Action 2021; 14:1998996. [PMID: 34927579 PMCID: PMC8725702 DOI: 10.1080/16549716.2021.1998996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Working in partnership with the Cambodian Ministry of Health, the Safe Surgery 2020 initiative (SS2020) supports the prioritization of surgery and mobilization of resources to target limited workforce capacity. An evaluation study was conducted to assess the impact of SS2020 on intervention hospitals in Cambodia. OBJECTIVE To understand the impact of the SS2020 program on intervention hospitals in Cambodia by assessing the changes in key surgical performance indicators before and after the intervention, identifying key barriers and facilitators to adoption of learnings, and discovering lessons on the uptake and diffusion of this initiative in Cambodia and other similar contexts. METHODS This study is a convergent mixed-methods evaluation of a one-year multicomponent SS2020 intervention. Surgical observations were conducted in 8 intervention hospitals at baseline and endline to evaluate pre and post adherence to 20 safety, teamwork, and communication items. Fifteen focus groups were conducted in all intervention sites at endline to assess key facilitators and barriers to positive impact. RESULTS There was significant improvement in 19 of 20 indicators assessed during surgical observations. Among the highest performing indicators were safety items; among the lowest were communication items. Participants self-reported improved knowledge and positive behavior change after the intervention. Institutional change and direct patient impact were not widely reported. Most participants had favorable views of the mentorship model and were eager for the program to continue implementation. CONCLUSIONS The results provide evidence that change in surgical ecosystems can be achieved on a short timeline with limited resources. The hub-and-spoke mentorship model can be successful in improving knowledge and changing behavior in surgical safety. Workforce development is important to improving surgical systems, but greater financial and human resources are needed. Ministry support in adopting, leading, and scaling is crucial to the continued success of safe surgery interventions in Cambodia.
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Affiliation(s)
- Sehrish Bari
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Joseph Incorvia
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Olivia Ahearn
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Lem Dara
- Calmette Hospital, Phnom Penh, Cambodia
| | | | | | | | | | | | | | | | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Virya Koy
- Department of Hospital Services, Ministry of Health, Phnom Penh, Cambodia
| | - Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
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