Noble Helen E, Scott John W, Nyinawankusi Jeanne D, Uwitonze Jean M, Kabagema Ignace, Maine Rebecca G, Riviello Robert, Dushime Theophile, Enumah Samuel, Hu Yiyuan, Mutabazi Zeta, Byiringiro Jean C, Jayaraman Sudha
Virginia Commonwealth University, United States of America.
University of Michigan, United States of America.
Afr J Emerg Med. 2020;10(Suppl 1):S78-S84. doi: 10.1016/j.afjem.2020.07.007. Epub 2020 Sep 3.
Injuries are a leading cause of death and disability globally. Over 90% of injury-related mortality happens in low- and middle- income countries (LMICs). Rwanda's pre-hospital emergency system - Service d'Aide Medicale Urgente (SAMU) - and their partners created an electronic pre-hospital registry and Continuous Quality Improvement (CQI) project in 2014. The CQI showed progress in quality of care, sparking interest in factors enabling the project's success. Healthcare workers (HCW) are critical pieces of this success, yet we found a void of information linking pre-hospital HCW motivation to CQI programs like SAMU's.
Our mixed methods approach included a 40-question survey using questions regarding HCW motivation. We scored the surveys to compare SAMU staff motivation with other HCWs in LMICs, and used a Likert scale to elicit agreement or disagreement. A semi-structured interview based on employee motivation theory qualitatively explored SAMU staff motivation using constructivist grounded theory. To find interview themes, two researchers independently performed line-by-line analysis.
SAMU staff received 5-21% higher motivation scores relative to other cohorts of HCWs in LMICs. Questions showing disagreement (five) asked about reprimand, damaged social standing, and ease of using the CQI technology. Three questions did not show consensus. Questions showing agreement (23) and strong agreement (nine) asked about organizational commitment, impact, and research improving patient care. Major themes were: improvements in quality of care, changes in job expectations, views on research, and positive experiences with data feedback.
The CQI project provides constant feedback vital to building and sustaining successful health systems. It encourages communication, collaboration, and personal investment, which increase organizational commitment. Continuous feedback provides opportunities for personal and professional development by uncovering gaps in knowledge, patient care, and technological understanding. Complete, personalized data input encouraged by the CQI improves resource allocation, building robust health systems that improve HCW agency and motivation.
伤害是全球死亡和残疾的主要原因。超过90%与伤害相关的死亡发生在低收入和中等收入国家（LMICs）。卢旺达的院前急救系统——紧急医疗援助服务（SAMU）——及其合作伙伴在2014年创建了一个电子院前登记册和持续质量改进（CQI）项目。CQI在护理质量方面显示出进展，引发了对促成该项目成功的因素的兴趣。医护人员（HCW）是这一成功的关键因素，但我们发现缺乏将院前医护人员的动机与SAMU这样的CQI项目联系起来的信息。
我们的混合方法包括一项40个问题的调查，使用关于医护人员动机的问题。我们对调查进行评分，以比较SAMU工作人员的动机与LMICs中其他医护人员的动机，并使用李克特量表来引出同意或不同意的意见。基于员工动机理论的半结构化访谈使用建构主义扎根理论定性地探索了SAMU工作人员的动机。为了找到访谈主题，两名研究人员独立进行逐行分析。
相对于LMICs中其他医护人员群体，SAMU工作人员的动机得分高出5%-21%。显示不同意的问题（5个）涉及谴责、社会地位受损以及CQI技术的易用性。有3个问题未达成共识。显示同意的问题（23个）和强烈同意的问题（9个）涉及组织承诺、影响以及改善患者护理的研究。主要主题包括：护理质量的提高、工作期望的变化、对研究的看法以及数据反馈的积极体验。
CQI项目提供了对建立和维持成功的卫生系统至关重要的持续反馈。它鼓励沟通、协作和个人投入，从而增强组织承诺。持续反馈通过揭示知识、患者护理和技术理解方面的差距，为个人和专业发展提供机会。CQI鼓励的完整、个性化数据输入改善了资源分配，建立了强大的卫生系统，提高了医护人员的能动性和动机。
