RT Journal Article
SR Electronic
T1 Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP bmjqs-2020-011795
DO 10.1136/bmjqs-2020-011795
A1 Shehnaz Alidina
A1 Pritha Chatterjee
A1 Noor Zanial
A1 Sakshie Sanjay Alreja
A1 Rebecca Balira
A1 David Barash
A1 Edwin Ernest
A1 Geofrey Charles Giiti
A1 Erastus Maina
A1 Adelina Mazhiqi
A1 Rahma Mushi
A1 Cheri Reynolds
A1 Meaghan Sydlowski
A1 Florian Tinuga
A1 Sarah Maongezi
A1 John G Meara
A1 Ntuli A Kapologwe
A1 Erin Barringer
A1 Monica Cainer
A1 Isabelle Citron
A1 Amanda DiMeo
A1 Laura Fitzgerald
A1 Hiba Ghandour
A1 Magdalena Gruendl
A1 Augustino Hellar
A1 Desmond T Jumbam
A1 Adam Katoto
A1 Lauren Kelly
A1 Steve Kisakye
A1 Salome Kuchukhidze
A1 Tenzing N Lama
A1 Gopal Menon
A1 Stella Mshana
A1 Chase Reynolds
A1 Hannington Segirinya
A1 Dorcas Simba
A1 Victoria Smith
A1 Steven J Staffa
A1 Christopher Strader
A1 Leopold Tibyehabwa
A1 Alena Troxel
A1 John Varallo
A1 Taylor Wurdeman
A1 David Zurakowski
YR 2021
UL http://qualitysafety.bmj.com/content/early/2021/02/04/bmjqs-2020-011795.abstract
AB 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.