127 lines
4.5 KiB
YAML
127 lines
4.5 KiB
YAML
abstract: 'Background: Access to safe surgical care represents a critical gap in
|
|
|
|
healthcare delivery and development in many low-and middle-income
|
|
|
|
countries, including Ethiopia. Quality improvement (QI) initiatives at
|
|
|
|
hospital level may contribute to closing this gap. Many such quality
|
|
|
|
improvement initiatives are carried out through international health
|
|
|
|
partnerships. Better understanding of how to optimise quality
|
|
|
|
improvement in low-income settings is needed, including through
|
|
|
|
partnership-based approaches. Drawing on a process evaluation of an
|
|
|
|
intervention to improve surgical services in an Ethiopian hospital, this
|
|
|
|
paper offers lessons to help meet this need.
|
|
|
|
Methods: We conducted a qualitative process evaluation of a quality
|
|
|
|
improvement project which aimed to improve access to surgical services
|
|
|
|
in an Ethiopian referral hospital through better management. Data was
|
|
|
|
collected longitudinally and included: 66 in-depth interviews with
|
|
|
|
surgical staff and project team members; observation (135 h) in the
|
|
|
|
surgery department and of project meetings; project-related
|
|
|
|
documentation. Thematic analysis, guided by theoretical constructs,
|
|
|
|
focused on identifying obstacles to implementation.
|
|
|
|
Results: The project largely failed to achieve its goals. Key barriers
|
|
|
|
related to project design, partnership working and the implementation
|
|
|
|
context, and included: confusion over project objectives and project and
|
|
|
|
partner roles and responsibilities; logistical challenges concerning
|
|
|
|
overseas visits; difficulties in communication; gaps between the time
|
|
|
|
and authority team members had and that needed to implement and engage
|
|
|
|
other staff; limited strategies for addressing adaptive-as opposed to
|
|
|
|
technical-challenges; effects of hierarchy and resource scarcity on QI
|
|
|
|
efforts. While many of the obstacles identified are common to diverse
|
|
|
|
settings, our findings highlight ways in which some features of
|
|
|
|
low-income country contexts amplify these common challenges.
|
|
|
|
Conclusion: We identify lessons for optimising the design and planning
|
|
|
|
of quality improvement interventions within such challenging healthcare
|
|
|
|
contexts, with specific reference to international partnership-based
|
|
|
|
approaches. These include: the need for a funded lead-in phase to
|
|
|
|
clarify and agree goals, roles, mutual expectations and communication
|
|
|
|
strategies; explicitly incorporating adaptive, as well as technical,
|
|
|
|
solutions; transparent management of resources and opportunities;
|
|
|
|
leadership which takes account of both formal and informal power
|
|
|
|
structures; and articulating links between project goals and wider
|
|
|
|
organisational interests.'
|
|
affiliation: 'Aveling, EL (Corresponding Author), Univ Cambridge, Inst Publ Hlth,
|
|
Cambridge Ctr Hlth Serv Res, Forvie Site,Robinson Way, Cambridge CB2 0SR, England.
|
|
|
|
Aveling, EL (Corresponding Author), Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy
|
|
\& Management, Boston, MA 02115 USA.
|
|
|
|
Aveling, Emma-Louise, Univ Cambridge, Inst Publ Hlth, Cambridge Ctr Hlth Serv Res,
|
|
Forvie Site,Robinson Way, Cambridge CB2 0SR, England.
|
|
|
|
Aveling, Emma-Louise, Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy \& Management,
|
|
Boston, MA 02115 USA.
|
|
|
|
Zegeye, Desalegn Tegabu, Fed Minist Hlth, POB 1234, Addis Ababa, Ethiopia.
|
|
|
|
Silverman, Michael, Univ Leicester, Dept Infect Inflammat \& Immun, Univ Rd, Leicester
|
|
LE1 7RH, Leics, England.'
|
|
article-number: '393'
|
|
author: Aveling, Emma-Louise and Zegeye, Desalegn Tegabu and Silverman, Michael
|
|
author-email: eaveling@hsph.harvard.edu
|
|
author_list:
|
|
- family: Aveling
|
|
given: Emma-Louise
|
|
- family: Zegeye
|
|
given: Desalegn Tegabu
|
|
- family: Silverman
|
|
given: Michael
|
|
da: '2023-09-28'
|
|
doi: 10.1186/s12913-016-1639-4
|
|
files: []
|
|
issn: 1472-6963
|
|
journal: BMC HEALTH SERVICES RESEARCH
|
|
keywords: Quality improvement; Surgery; Patient safety; Partnership; Ethiopia
|
|
keywords-plus: PATIENT SAFETY; COMMUNITY-DEVELOPMENT; CARE; INFRASTRUCTURE; UNIVERSITY
|
|
language: English
|
|
month: AUG 17
|
|
number-of-cited-references: '36'
|
|
orcid-numbers: Zegeye, Desalegn Tegabu/0000-0002-5231-9967
|
|
papis_id: d878e9e2d53e8f84b031f111e7ddb672
|
|
ref: Aveling2016obstaclesimplementat
|
|
times-cited: '17'
|
|
title: 'Obstacles to implementation of an intervention to improve surgical services
|
|
in an Ethiopian hospital: a qualitative study of an international health partnership
|
|
project'
|
|
type: article
|
|
unique-id: WOS:000381463200002
|
|
usage-count-last-180-days: '0'
|
|
usage-count-since-2013: '9'
|
|
volume: '16'
|
|
web-of-science-categories: Health Care Sciences \& Services
|
|
year: '2016'
|