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Alidina S, Hayirli TC, Amiri A, Barash D, Chwa C, Hellar A, Kengia JT, Kissima I, Mayengo CD, Meara JG, Mwita WC, Staffa SJ, Tibyehabwa L, Wurdeman T, Kapologwe NA. Organizational learning in surgery in Tanzania's health system: a descriptive cross-sectional study. Int J Qual Health Care 2024; 36:mzae048. [PMID: 38814661 DOI: 10.1093/intqhc/mzae048] [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: 01/29/2024] [Revised: 05/05/2024] [Accepted: 05/30/2024] [Indexed: 05/31/2024] Open
Abstract
Organizational learning is critical for delivering safe, high-quality surgical care, especially in low- and middle-income countries (LMICs) where perioperative outcomes remain poor. While current investments in LMICs prioritize physical infrastructure, equipment, and staffing, investments in organizational learning are equally important to support innovation, creativity, and continuous improvement of surgical quality. This study aims to assess the extent to which health facilities in Tanzania's Lake Zone perform as learning organizations from the perspectives of surgical providers. The insights gained from this study can motivate future quality improvement initiatives and investments to improve surgical outcomes. We conducted a cross-sectional analysis using data from an adapted survey to explore the key components of organizational learning, including a supportive learning environment, effective learning processes, and encouraging leadership. Our sample included surgical team members and leaders at 20 facilities (health centers, district hospitals, and regional hospitals). We calculated the average of the responses at individual facilities. Responses that were 5+ on a 7-point scale or 4+ on a 5-point scale were considered positive. We examined the variation in responses by facility characteristics using a one-way ANOVA or Student's t-test. We used univariate and multiple regression to assess relationships between facility characteristics and perceptions of organizational learning. Ninety-eight surgical providers and leaders participated in the survey. The mean facility positive response rate was 95.1% (SD 6.1%). Time for reflection was the least favorable domain with a score of 62.5% (SD 35.8%). There was variation by facility characteristics including differences in time for reflection when comparing by level of care (P = .02) and location (P = .01), and differences in trying new approaches (P = .008), capacity building (P = .008), and information transfer (P = .01) when comparing public versus faith-based facilities. In multivariable analysis, suburban centers had less time for reflection than urban facilities (adjusted difference = -0.48; 95% CI: -0.95, -0.01; P = .046). Surgical team members reported more positive responses compared to surgical team leaders. We found a high overall positive response rate in characterizing organizational learning in surgery in 20 health facilities in Tanzania's Lake Zone. Our findings identify areas for improvement and provide a baseline for assessing the effectiveness of change initiatives. Future research should focus on validating the adapted survey and exploring the impact of strong learning environments on surgical outcomes in LMICs. Organizational learning is crucial in surgery and further research, funding, and policy work should be dedicated to improving learning cultures in health facilities.
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Affiliation(s)
- Shehnaz Alidina
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
| | - Tuna Cem Hayirli
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
| | - Adam Amiri
- W.P. Carey School of Business, Arizona State University, 1151 S Forest Ave Tempe, AZ 85281 USA
| | - David Barash
- GE Foundation, 41 Farnsworth St, Boston, MA 02210 USA
| | - Cindy Chwa
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
| | | | - James T Kengia
- Department of Health, Social Welfare and Nutrition Services, President's Office Regional Administration and Local Government, P.O. Box 1923, Dodoma 00255, Tanzania
| | | | | | - John G Meara
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, 300 Longwood Avenue Boston, MA 02115, USA
| | - Winfrida C Mwita
- Kilimanjaro Clinical Research Institute, P. O. Box 2236, Moshi 25116, Tanzania
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, P. O. Box 2240, Moshi 25116, Tanzania
| | - Steven J Staffa
- Department of Anesthesiology and Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | - Leopold Tibyehabwa
- Programs, Pathfinder International, P.O.BOX 77991, Dar es Salaam, Tanzania
| | - Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
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Fu Y, Wu T, Zhu J, Chen Y, Yang M. Improving operating room efficiency through evidence-based medical management. Minerva Gastroenterol (Torino) 2024; 70:261-263. [PMID: 37310374 DOI: 10.23736/s2724-5985.23.03468-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Yu Fu
- Medical Department, Wuxi 9th People's Hospital, Wuxi, China
| | - Tie Wu
- Medical Department, Wuxi 9th People's Hospital, Wuxi, China
| | - Jiandong Zhu
- Medical Department, Wuxi 9th People's Hospital, Wuxi, China
| | - Yue Chen
- Department of Gynecology and Obstetrics, Wuxi 9th People's Hospital, Wuxi, China
| | - Miao Yang
- Medical Department, Wuxi 9th People's Hospital, Wuxi, China -
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Horgan S, Hegarty J, Drennan J, Keane D, Saab MM. The effect of interventions on the incidence of surgical site infections in acute care settings: A systematic review. J Tissue Viability 2024; 33:75-88. [PMID: 37977894 DOI: 10.1016/j.jtv.2023.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
AIM Surgical site infections (SSIs) are common healthcare associated infections with serious consequences for patients and healthcare organisations. It is critical that healthcare professionals implement prevention strategies to reduce the incidence of such infections. Prevention strategies are key to reducing the incidence of SSIs. The aim of this systematic review is to describe the effect of interventions conducted in acute care settings on the incidence of SSIs (primary outcome), length of stay, intensive care unit admission, and mortality rate (secondary outcomes). MATERIALS AND METHODS This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. A search was undertaken in Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2017 and March 2022. Studies that focused on interventions within acute hospital settings in patients undergoing elective surgery with the aim of reducing the incidences of SSIs were included. Due to heterogeneity results were synthesised narratively. RESULTS In total, 23 studies were included. Findings show that interventions that are effective in reducing the incidences of SSIs have multiple components including care bundles, stakeholder engagement, targeted surveillance and education. Few studies were identified that evaluated the effect of SSI prevention interventions on length of stay and mortality, and none assessed intensive care admission rates. CONCLUSIONS The included interventions varied widely, which made it difficult to draw definitive conclusions regarding specific interventions that reduce SSI. Multicomponent interventions and care bundles showed promise in reducing the occurrence of SSIs. Further studies should focus on standardised evidence-based interventions and compliance using randomised controlled designs.
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Affiliation(s)
- Sinéad Horgan
- South/South West Hospitals Group, Department of Nursing and Midwifery, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
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Kassa M, Madzimbamuto F, Kediegite G, Tuyishime E. Regional anaesthesia practice in public hospitals in Botswana: A cross-sectional study. PLoS One 2023; 18:e0295932. [PMID: 38113237 PMCID: PMC10729981 DOI: 10.1371/journal.pone.0295932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Little is known about the regional anesthesia practice in low resources settings (LRS). The aim of this study was to describe the regional anesthesia capacity, characteristics of regional anesthesia practice, and challenges and solutions of practicing safe regional anesthesia in public hospitals in Botswana. METHODS This was a cross-sectional survey of anesthesia providers working in public hospitals in Botswana. A purposive sampling method of public hospitals was used to achieve representation of different hospital levels across Botswana. Paper-based questionnaires were sent to anesthesia providers from selected hospitals. Descriptive statistics were used for analysis. RESULTS Questionnaires were distributed to 47 selected anesthesia providers from selected hospitals; 38 (80.9%) were returned. Most participants were nurse anesthetists and medical officers (57.8%). All hospitals perform spinal anesthesia; however, other regional techniques were performed by a small number of participants in one referral hospital. Most hospitals had adequate regional anesthesia drugs and sedation medications, however, most hospitals (except one referral hospital) lacked ultrasound machine and the regional anesthesia kit. The common challenges reported were lack of knowledge and skills, lack of equipment and supplies, and lack of hospital engagement and support. Some solutions were proposed such as regional anesthesia training and engaging the hospital management to get resources. CONCLUSIONS The results of this study suggest that spinal anesthesia is the most common regional anesthesia technique performed by anesthesia providers working in public hospitals in Botswana followed by few upper limb blocks. However, most public hospitals lack enough training capacity, equipment, and supplies for regional anesthesia. More engagement of the hospital management, investment in regional anesthesia resources, and training are needed in order to improve the regional anesthesia capacity and provide safe surgery and anesthesia in Botswana.
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Affiliation(s)
- Mamo Kassa
- Department Anesthesia and Critical Care, University of Botswana, Gaborone, Botswana
| | - Farai Madzimbamuto
- Department Anesthesia and Critical Care, University of Botswana, Gaborone, Botswana
| | - Gaone Kediegite
- Department Anesthesia and Critical Care, University of Botswana, Gaborone, Botswana
| | - Eugene Tuyishime
- Department Anesthesia and Critical Care, University of Botswana, Gaborone, Botswana
- Anesthesia, Critical Care, and Emergency Medicine department, University of Rwanda, Kigali, Rwanda
- Anesthesia and Perioperative Medicine department, Western University, London, Canada
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Fitzgerald L, Tibyehabwa L, Varallo J, Ernest E, Patted A, Bertram MM, Alidina S, Mshana S, Katoto A, Simba D, Charles K, Smith V, Cainer M, Hellar A. Mentoring approaches in a safe surgery program in Tanzania: Lessons learned during COVID-19 and recommendations for the future. Surg Open Sci 2023; 14:109-113. [PMID: 37577254 PMCID: PMC10413135 DOI: 10.1016/j.sopen.2023.07.014] [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] [Received: 04/28/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Background COVID-19 has dramatically affected the delivery of health care and technical assistance. This is true in Tanzania, where maternal mortality and surgical infection rates are significantly higher than in high-income countries. This paper describes lessons learned about the optimal application of in-person and virtual mentorship in the Safe Surgery 2020 program to improve the quality of surgical services in Tanzania before and after the COVID-19 pandemic. Methods From January 2018 through December 2020, Safe Surgery 2020 supported 40 health facilities in Tanzania's Lake Zone to improve the quality of surgical care. A blended surgical mentorship model, employing both onsite and virtual mentorship, was central to the program's capacity development approach. With COVID-19, the program pivoted to full virtual mentorship. Through continuous learning and adaptation processes, including a human-centered design workshop, surveys assessing mentors' confidence with different competencies, and focus group discussions with mentors, mentees and safe surgery program staff, the program distilled the optimal use of mentorship models. Results Developing complex surgical skills, addressing contextual considerations, problem-solving, and building trusting relationships were best suited to in-person mentorship, whereas virtual mentorship was most effective in supporting mentees' quality improvement projects, data use, case discussions, and reinforcing clinical practices. Leading successful virtual learning required enhanced facilitation skills and active engagement of health facility leadership. Conclusions In-person and virtual mentorship offer distinct benefits and complement each other when combined. Investing more in-person mentorship at the beginning of programs allows for the establishment of trust that is foundational to effective mentorship.
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Affiliation(s)
| | | | - John Varallo
- Jhpiego, 1615 Thames St, Baltimore, MD, United States
| | - Edwin Ernest
- Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania
| | - Anmol Patted
- Jhpiego, 1615 Thames St, Baltimore, MD, United States
| | | | - Shehnaz Alidina
- Harvard T. H. Chan School of Public Health, Boston, MA, United States1
Current affiliation. - Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States2
Former affiliation.
| | - Stella Mshana
- Safe Surgery 2020 Project, Jhpiego Tanzania, Mara, Tanzania
| | - Adam Katoto
- Safe Surgery 2020 Project, Jhpiego Tanzania, Kagera, Tanzania
| | - Dorcas Simba
- Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania
| | | | | | | | - Augustino Hellar
- Safe Surgery 2020 Project, Jhpiego Tanzania, Dar es Salaam, Tanzania
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An SJ, Davis D, Kayange L, Gallaher J, Charles A. Predictors of mortality for perforated peptic ulcer disease in Malawi. Am J Surg 2023; 225:1081-1085. [PMID: 36481056 PMCID: PMC10209347 DOI: 10.1016/j.amjsurg.2022.11.029] [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: 09/26/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mortality from perforated peptic ulcer disease (PUD) remains high, especially in sub-Saharan Africa. We sought to identify predictors of mortality following surgery for perforated PUD. METHODS We performed a retrospective study of acute care surgeries at Kamuzu Central Hospital (KCH) in Malawi from 2013 to 2022. Patients undergoing omental patch surgeries were included. Bivariate and multivariate analyses were used to model predictors of mortality. RESULTS A total of 248 patients were included. The mean age was 30 ± 15 years. Ninety percent were male. Mortality rate was 22.2%. Predictors of mortality included age (adjusted odds ratio [AOR] 1.06, 95% confidence interval [CI] 1.03-1.09), shock index (AOR 1.86, 95% CI 1.14-3.03), days to operative intervention (AOR 1.44, 95% CI 1.10-1.88), and presence of complications (AOR 9.65, 95% CI 3.79-24.6). CONCLUSIONS Mortality following surgery for perforated PUD remains high in this low-resource environment. In-hospital delay is a significant and modifiable predictor of mortality.
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Affiliation(s)
- Selena J An
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA
| | - Dylane Davis
- School of Medicine, University of North Carolina at Chapel Hill, 1001 Bondurant Hall, CB 9535, Chapel Hill, NC, 27599, USA
| | - Linda Kayange
- Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi
| | - Jared Gallaher
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, 4001 Burnett Womack Building, CB 7050, Chapel Hill, NC, 27599, USA; Department of Surgery, Kamuzu Central Hospital, Private Bag 149, Lilongwe, Malawi.
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Brima N, Morhason-Bello IO, Charles V, Davies J, Leather AJ. Improving quality of surgical and anaesthesia care in sub-Saharan Africa: a systematic review of hospital-based quality improvement interventions. BMJ Open 2022; 12:e062616. [PMID: 36220318 PMCID: PMC9557325 DOI: 10.1136/bmjopen-2022-062616] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To systematically review existing literature on hospital-based quality improvement studies in sub-Saharan Africa that aim to improve surgical and anaesthesia care, capturing clinical, process and implementation outcomes in order to evaluate the impact of the intervention and implementation learning. DESIGN We conducted a systematic literature review and narrative synthesis. SETTING Literature on hospital-based quality improvement studies in sub-Saharan Africa reviewed until 31 December 2021. PARTICIPANTS MEDLINE, EMBASE, Global Health, CINAHL, Web of Science databases and grey literature were searched. INTERVENTION We extracted data on intervention characteristics and how the intervention was delivered and evaluated. PRIMARY AND SECONDARY OUTCOME MEASURES Importantly, we assessed whether clinical, process and implementation outcomes were collected and separately categorised the outcomes under the Institute of Medicine quality domains. Risk of bias was not assessed. RESULTS Of 1573 articles identified, 49 were included from 17/48 sub-Saharan African countries, 16 of which were low-income or lower middle-income countries. Almost two-thirds of the studies took place in East Africa (31/49, 63.2%). The most common intervention focus was reduction of surgical site infection (12/49, 24.5%) and use of a surgical safety checklist (14/49, 28.6%). Use of implementation and quality improvement science methods were rare. Over half the studies measured clinical outcomes (29/49, 59.2%), with the most commonly reported ones being perioperative mortality (13/29, 44.8%) and surgical site infection rate (14/29, 48.3%). Process and implementation outcomes were reported in over two thirds of the studies (34/49, 69.4% and 35, 71.4%, respectively). The most studied quality domain was safety (44/49, 89.8%), with efficiency (4/49, 8.2%) and equitability (2/49, 4.1%) the least studied domains. CONCLUSIONS There are few hospital-based studies that focus on improving the quality of surgical and anaesthesia care in sub-Saharan Africa. Use of implementation and quality improvement methodologies remain low, and some quality domains are neglected. PROSPERO REGISTRATION NUMBER CRD42019125570.
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Affiliation(s)
- Nataliya Brima
- King's Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, King's College London, London, UK
| | - Imran O Morhason-Bello
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine/University College Hospital, University of Ibadan, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
| | | | - Justine Davies
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
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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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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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