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

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


JournalBMJ Quality & Safety
Article typeJournal research article – Clinical research
Publication date – Feb – 2021
Authors – Shehnaz Alidina , Pritha Chatterjee , Noor Zanial, Sakshie Sanjay Alreja, Rebecca Balira, David Barash, Edwin Ernest, Geofrey Charles Giiti, Erastus Maina, Adelina Mazhiqi, Rahma Mushi, Cheri Reynolds, Meaghan Sydlowski, Florian Tinuga, Sarah Maongezi, John G Meara , Ntuli A Kapologwe, Erin Barringer, Monica Cainer, Isabelle Citron, Amanda DiMeo, Laura Fitzgerald, Hiba Ghandour, Magdalena Gruendl, Augustino Hellar, Desmond T Jumbam, Adam Katoto, Lauren Kelly, Steve Kisakye, Salome Kuchukhidze, Tenzing N Lama, Gopal Menon, Stella Mshana, Chase Reynolds, Hannington Segirinya, Dorcas Simba, Victoria Smith, Steven J Staffa , Christopher Strader, Leopold Tibyehabwa, Alena Troxel, John Varallo, Taylor Wurdeman, David Zurakowski
Keywordsholistically, Lower performers, surgery
Open access – Yes
SpecialityHealth policy
World region Global

Language – English
Submitted to the One Surgery Index on February 16, 2021 at 8:30 am
Abstract:

Abstract
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.

OSI Number – 20941

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