Department of Public Health and Policy, Institute of Psychology, Health and Society, The University of Liverpool, Liverpool, UK.
BMJ Open. 2016 Apr 25;6(4):e009379. doi: 10.1136/bmjopen-2015-009379.
To identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC).
In-depth interviews were conducted and analysed using qualitative content analysis.
Governmental referral teaching hospital in Eastern DRC.
We purposively selected 2-4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed.
Economics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs' reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance.
The complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all.
从在刚果民主共和国（DRC）东部手术室工作的外科团队成员的角度出发，确定患者安全（PS）干预措施的潜在障碍。
采用深入访谈法，并使用定性内容分析法进行分析。
DRC 东部的政府转诊教学医院。
我们从每个专业中分别有目的地选择了 2-4 名国家和外籍外科团队成员。在 31 名符合条件的外科卫生工作者（HWs）中，有 17 名自愿接受采访。
经济问题影响了整个卫生系统的 PS，从人力资源和医院管理到患者获得医疗保健。外科团队成员似乎处于家长式的组织结构和归咎文化中，同时还伴随着被认为效率低下的支持服务和低工资。武装冲突不仅使这些系统故障恶化，还直接威胁到患者和 HWs，并导致复杂的间接后果，危及 PS。卫生组织内部腐败的增加，以及卫生人员的贫困和滥用药物，都对安全护理产生了不利影响。同时，HWs 报告了他们应对 PS 障碍的适应能力和创造力。参与者对外援的看法因相关性而异。
战争与 PS 之间的复杂联系强调了采用全面方法的重要性，包括职业健康，以增强 HWs 的适应能力，外部临床审计以限制腐败，以及 PS 教育计划以支持以患者为中心的护理并解决归咎文化。最后，改善卫生融资系统中的公平性似乎对于确保所有人都能获得医疗保健和安全的围手术期结果至关重要。
