A multimodal mentorship intervention to improve surgical quality in Tanzania’s Lake Zone: a convergent, mixed methods assessment

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.

The impact of training on self-reported performance in reproductive, maternal, and newborn health service delivery among healthcare workers in Tanzania: a baseline- and endline-survey

“…This findings provides evidence that the training and onsite mentorship intervention to have a statistically significant positive impact on the RMNH service performance among healthcare workers. The finding of the current study is consistent with another study from the same context that used a multimodal mentorship intervention for improving the quality surgical care [ 44 ]. Moreover, other studies reported that a mentorship intervention that follows training, uses a side-by-side approach, high-quality mentee–mentor relationships, and provides nonjudgmental feedback leads to success in low-resource settings [ 28 , 44 , 45 ].…”

“…The finding of the current study is consistent with another study from the same context that used a multimodal mentorship intervention for improving the quality surgical care [ 44 ]. Moreover, other studies reported that a mentorship intervention that follows training, uses a side-by-side approach, high-quality mentee–mentor relationships, and provides nonjudgmental feedback leads to success in low-resource settings [ 28 , 44 , 45 ]. Therefore, it is plausible that the training that supplemented with mentorship might be the effective approach for skills improvement among healthcare workers.…”

Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned

“…In LMICs, research on the role of mentorship in surgery is at a nascent stage [ 53 , 54 ] and surgical mentorship program implementation has not been sufficiently analyzed to guide policy and practice; this is important to successfully design and implement mentorship programs [ 6 ]. We found results from implementing SS2020 mentorship in Ethiopia similar to Tanzania [ 5 ], with strong support from mentees and similar perceived impacts, including safer care, strengthened surgical ecosystems, increased confidence, and stronger learning cultures in both countries. Common supportive features included a holistic approach, multidisciplinary mentorship team, psychologically safe relationships, mentors that were friendly, accessible, and understanding of the local context, and a receptive implementation climate.…”

“…In 2015, the Lancet Commission on Global Surgery placed surgical workforce development on top of the health, welfare, and economic development agenda [3]. Building the capacity of surgical systems through mentorship is a promising strategy to improve access and quality of care [4,5]. However, implementation of surgical mentorship in African healthcare settings has not been thoroughly analyzed [6].…”

Patient Safety Efforts in Tanzania: A Rapid Review of Two-Decades Efforts (2002-2022) to Inform Interventions towards Attainment of 2030 Targets

“…In the years after the life of the World Alliance for Patient Safety (2015)(2016)(2017)(2018)(2019)(2020)(2021), the WHO has moved further to engage with a bigger number of stakeholders DOI: 10.4236/aid.2022.123036 468 Advances in Infectious Diseases and partners in order to be able to improve patient safety globally [4]. One of the early efforts was the launch of the Third Global Patient Safety Challenge, called "Medication Without Harm," which aimed at addressing medication safety [13] [14].…”