Improving quality in resource poor settings: observational study from rural Rwanda

Kotagal, Meera; Lee, Patrick; Habiyakare, Caste; Dusabe, Raymond; Kanama, Philibert; Epino, Henry; Rich, Michael; Farmer, Paul

doi:10.1136/bmj.b3488

Cited by 39 publications

(34 citation statements)

References 11 publications

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“…Checklists are neither a ‘quick-fix’ nor a tool that can be effectively implemented in isolation; in resource-constrained settings, they are especially unlikely to be free of costs and risks. Safety checklists are most likely to be effective and sustainable when implemented as part of broader, multifaceted programmes addressing social, behavioural, logistical and organisational issues,14 26 41 42 where there is strong institutional focus on patient safety, multidisciplinary leadership, monitoring systems in place and consequences at all levels for non-compliance.…”

Section: Discussionmentioning

confidence: 99%

A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries

2013

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ObjectiveBold claims have been made for the ability of the WHO surgical checklist to reduce surgical morbidity and mortality and improve patient safety regardless of the setting. Little is known about how far the challenges faced by low-income countries are the same as those in high-income countries or different. We aimed to identify and compare the influences on checklist implementation and compliance in the UK and Africa.DesignEthnographic study involving observations, interviews and collection of documents. Thematic analysis of the data.SettingOperating theatres in one African university hospital and two UK university hospitals.Participants112 h of observations were undertaken. Interviews with 39 theatre and administrative staff were conducted.ResultsMany staff saw value in the checklist in the UK and African hospitals. Some resentment was present in all settings, linked to conflicts between the philosophy behind the checklist and the realities of local cultural, social and economic contexts. Compliance—involving use, completeness and fidelity—was considerably higher, though not perfect, in the UK settings. In these hospitals, compliance was supported by established structures and systems, and was not significantly undermined by major resource constraints; the same was not true of the low-income context. Hierarchical relationships were a major barrier to implementation in all settings, but were more marked in the low-income setting. Introducing a checklist in a professional environment characterised by a lack of accountability and transparency could make the staff feel jeopardised legally, professionally, and personally, and it encouraged them to make misleading records of what had actually been done.ConclusionsSurgical checklist implementation is likely to be optimised, regardless of the setting, when used as a tool in multifaceted cultural and organisational programmes to strengthen patient safety. It cannot be assumed that the introduction of a checklist will automatically lead to improved communication and clinical processes.

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Section: Discussionmentioning

confidence: 99%

A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries

2013

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“…Administrators who do not initiate quality improvement methods that identify and rectify resource gaps and provide funding to stock sufficient supplies such as personal protection materials in the practice setting are putting faculty, students and staff at risk for occupational hazards and could be held accountable for workplace injuries and infections (Kotagal et al, 2009). It is therefore recommended that basic teaching and working supplies be accessible to CIs in the practice setting so they are able to demonstrate and teach skills and safety measures proficiently .…”

Section: Administrationmentioning

confidence: 99%

Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter’s and Spreitzer’s Theories

Thuss

Babenko-Mould

Andrusyszyn

et al. 2016

International Journal of Nursing Education Scholarship

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Clinical instructors (CIs) play a vital role in students' development by facilitating learning in various health care practice environments. Quality nursing education hinges on the CI's ability to enact his or her professional role. The purpose of this study was to explore Rwandan nursing clinical instructors' experiences of structural and psychological empowerment.A descriptive qualitative method was used to obtain an understanding of CIs empowerment experiences in practice settings. Kanter's (1993) Theory of Structural Power in Organizations and Spreitzer's (1995) Psychological Empowerment Theory were used as a theoretical framework to interpret their experiences. Interview data from 21 nursing CIs in Rwanda were used to complete a secondary data analysis for this study.Most study participants perceived the structural components of informal power, resources, and support while formal power and opportunity were limited, diminishing their sense of structural empowerment. Psychological empowerment for the CIs in Rwanda stemmed from a sense of competence, meaning, impact and self-determination they had for their teaching roles and responsibilities in the practice setting. Implications and recommendations for CIs and administration are suggested to support, recruit and retain clinical instructors.

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“…These services include outpatient and inpatient services, 24 h emergency and delivery services,11 laboratory diagnostics,12 13 x-ray and ultrasound services, an on-site pharmacy, ambulance service and community health programs 5. Minor surgical procedures are performed, including the repair of lacerations, drainage of abscesses, closed reductions, casting and manual vacuum aspiration.…”

Section: Methods and Analysismentioning

confidence: 99%

“…The implementation of surgical services will occur within the framework of quality management using Plan-Do-Study-Act (PDSA) and Root Cause Analysis (RCA) models 12 13 17. Methods will include regular data management reviews, clinical- and operational-level checklists, and a mortality and morbidity conference program.…”

Section: Methods and Analysismentioning

confidence: 99%

Implementing surgical services in a rural, resource-limited setting: a study protocol: Table 1

Maru

Schwarz

et al. 2011

BMJ Open

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IntroductionThere are well-established protocols and procedures for the majority of common surgical diseases, yet surgical services remain largely inaccessible for much of the world's rural poor. Data on the process and outcome of surgical care expansion, however, are very limited, and the roll-out process of rural surgical implementation in particular has never been studied. Here, we propose the first implementation research study to assess the surgical scale-up process in the rural district of Achham, Nepal.Methods and analysisBased primarily on the protocols of the WHO's Integrated Management for Emergency and Essential Surgical Care (IMEESC), this study's threefold implementation strategy will include: (1) the core IMEESC surgical care program, (2) community-based follow-up via health workers, and (3) hospital-based quality improvement programs. The implementation program will employ additional emergency and surgical care protocols developed collaboratively by physicians, nurses and the authors. This strategy will be referred to as IMEESC-Plus. This study will employ both qualitative and quantitative research methodologies to collect clinical data and information on the reception and utilisation of services. The first 18 months of the implementation process will be studied and divided into an initial phase (first 6 months) and a consolidation phase (subsequent 12 months).DiscussionThis study aims to describe the logistics of the implementation process of IMEESC-Plus, and assess the quality of the resulting IMEESC-Plus services during the course of the implementation process. Using data generated from this study, larger, multi-site implementation studies can be planned that assess the scale-up of surgical services worldwide in resource-limited areas.

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Improving quality in resource poor settings: observational study from rural Rwanda

Cited by 39 publications

References 11 publications

A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries

A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries

Nursing Clinical Instructor Experiences of Empowerment in Rwanda: Applying Kanter’s and Spreitzer’s Theories

Implementing surgical services in a rural, resource-limited setting: a study protocol: Table 1

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