Alidina Shehnaz, Zanial Noor, Meara John G, Barash David, Buberwa Ladislaus, Chirangi Bwire, Hellar Augustino, Kisakye Steve, Mazhiqi Adelina, Mnyonyela William, Nyanda Meck P, Reynolds Cheri, Tinuga Florian, Kapologwe Ntuli A, Maongezi Sarah
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School.
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School.
J Am Coll Surg. 2021 Aug;233(2):177-191.e5. doi: 10.1016/j.jamcollsurg.2021.04.006. Epub 2021 May 3.
Access to safe, high-quality surgical care in sub-Saharan Africa is a critical gap. Interventions to improve surgical quality have been developed, but research on their implementation is still at a nascent stage. We retrospectively applied the Exploration, Preparation, Implementation, Sustainment framework to characterize the implementation of Safe Surgery 2020, a multicomponent intervention to improve surgical quality.
We used a longitudinal, qualitative research design to examine Safe Surgery 2020 in 10 health facilities in Tanzania's Lake Zone. We used documentation analysis with confirmatory key informant interviews (n = 6) to describe the exploration and preparation phases. We conducted interviews with health facility leaders and surgical team members at 1, 6, and 12 months (n = 101) post initiation to characterize the implementation phase. Data were analyzed using the constant comparison method.
In the exploration phase, research, expert consultation, and scoping activities revealed the need for a multicomponent intervention to improve surgical quality. In the preparation phase, onsite visits identified priorities and barriers to implementation to adapt the intervention components and curriculum. In the active implementation phase, 4 themes related to the inner organizational context-vision for safe surgery, existing surgical practices, leadership support, and resilience-and 3 themes related to the intervention-innovation-value fit, holistic approach, and buy-in-facilitated or hindered implementation. Interviewees perceived improvements in teamwork and communication and intra- and inter-facility learning, and their need to deliver safe surgery evolved during the implementation period.
Examining implementation through the exploration, preparation, implementation, and sustainment phases offers insights into the implementation of interventions to improve surgical quality and promote sustainability.
在撒哈拉以南非洲地区，获得安全、高质量的外科护理是一个关键差距。已制定了提高手术质量的干预措施，但对其实施情况的研究仍处于初期阶段。我们回顾性地应用探索、准备、实施、维持框架来描述“2020年安全手术”的实施情况，这是一项旨在提高手术质量的多组分干预措施。
我们采用纵向定性研究设计，对坦桑尼亚湖区的10个医疗机构的“2020年安全手术”进行研究。我们使用文献分析和验证性关键信息人访谈（n = 6）来描述探索和准备阶段。在启动后的1个月、6个月和12个月，我们对医疗机构领导和手术团队成员进行访谈（n = 101），以描述实施阶段。使用持续比较法对数据进行分析。
在探索阶段，研究、专家咨询和范围界定活动表明需要采取多组分干预措施来提高手术质量。在准备阶段，实地考察确定了实施的优先事项和障碍，以调整干预措施的组成部分和课程。在积极实施阶段，出现了4个与内部组织背景相关的主题——安全手术愿景、现有手术实践、领导支持和适应力，以及3个与干预措施相关的主题——创新-价值契合、整体方法以及促进或阻碍实施的认同。受访者认为团队合作、沟通以及机构内部和机构间的学习有所改善，并且他们在实施期间提供安全手术的需求也有所变化。
通过探索、准备、实施和维持阶段来审视实施情况，有助于深入了解提高手术质量和促进可持续性的干预措施的实施情况。
