Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
World J Surg. 2013 Nov;37(11):2512-9. doi: 10.1007/s00268-013-2169-4.
Most quality improvement (QI) activities in developing countries, established with funds from external donors, are focused on specific diseases or outreach programs, such as family planning or child survival. District hospitals in developing countries serve as the primary entry point for patients with surgical problems in developing countries, yet little is known about the extent to which formal QI activities for surgical services are present in these settings or the perceptions of hospital staff about the barriers to improving quality in this setting. This study aimed to document surgical QI efforts at district hospitals and perceived barriers to improving quality in a developing country-Ghana. It also provides a summary of the existing published scientific literature concerning surgical QI in developing countries.
A survey team visited 10 government district hospitals in Ghana, one in each of Ghana's 10 regions. The number and type of QI activities (surgical and nonsurgical) at these district hospitals and the perspectives of hospital staff regarding the steps required to improve the quality of surgical services in their facility were recorded.
Of the 10 hospitals assessed, nine reported having some type of QI activity, ranging from satisfaction surveys to assessing quality of infection prevention. Only one hospital reported having QI activity addressing surgical care. To improve the quality of surgical care, seven hospitals reported the need for trained specialists in surgery, obstetrics, and gynecology. Six cited the need for an appropriately equipped operating theater and recovery ward. The primary barrier to achieving these recommendations, cited by 70 % of the hospitals, was the inability to recruit and retain qualified specialists with surgical skills.
For Ghana to improve significantly the quality of surgical care provided in its district hospitals, greater emphasis is needed for continuous, systematic QI monitoring and for solving the problems identified. Increasing the number of appropriately trained surgical care providers is essential to strengthen the quality of surgical services in district hospitals. These findings likely apply to other resource-limited countries as well. Increased attention to improving the quality of surgical services at district hospitals in developing countries is urgently needed.
大多数在发展中国家开展的质量改进（QI）活动，都是由外部捐助者提供资金，主要集中在特定疾病或外展项目上，如计划生育或儿童生存。发展中国家的地区医院是发展中国家外科问题患者的主要就诊点，但对于这些地区医院是否存在正式的外科服务质量改进活动以及医院工作人员对改善该环境质量的障碍的看法，知之甚少。本研究旨在记录发展中国家地区医院的外科 QI 工作，并了解在发展中国家加纳改善质量的感知障碍。它还概述了关于发展中国家外科 QI 的现有已发表科学文献。
一个调查小组访问了加纳的 10 家政府地区医院，加纳的每个地区都有一家。记录了这些地区医院的 QI 活动（外科和非外科）的数量和类型，以及医院工作人员对改善其设施外科服务质量所需步骤的看法。
在所评估的 10 家医院中，有 9 家报告开展了某种类型的 QI 活动，从满意度调查到评估感染预防质量不等。只有一家医院报告开展了针对外科护理的 QI 活动。为了提高外科护理质量，有 7 家医院报告需要接受过外科、产科和妇科培训的专家。有 6 家医院提到需要配备适当设备的手术室和恢复病房。70%的医院认为，无法招聘和留住具有外科技能的合格专家是实现这些建议的主要障碍。
为了显著提高加纳地区医院提供的外科护理质量，需要更加重视持续的、系统的 QI 监测，并解决所确定的问题。增加数量适当的受过外科护理培训的提供者对于加强地区医院的外科服务质量至关重要。这些发现可能也适用于其他资源有限的国家。迫切需要更多地关注改善发展中国家地区医院的外科服务质量。
