Abstract
BackgroundA Surgical Unit-based Safety Programme (SUSP) has been shown to improve perioperative prevention practices and to reduce surgical site infections (SSI). It is critical to understand the factors influencing the successful implementation of the SUSP approach in low- and middle-income settings. We undertook a qualitative study to assess viability, and understand facilitators and barriers to implementing the SUSP approach in 5 African hospitals.MethodsQualitative study based on interviews with individuals from all hospitals participating in a WHO-coordinated before-after SUSP study. The SUSP intervention consisted of a multimodal strategy including multiple SSI prevention measures combined with an adaptive approach aimed at improving teamwork and safety culture.ResultsThirteen interviews (5 head surgeons, 3 surgeons, 5 nurses) were conducted with staff from five hospital sites. Identified facilitators included influential individuals (intrinsic motivation of local SUSP teams, boundary spanners, multidisciplinary engagement, active leadership support), peer-to-peer learning (hospital networking and positive deviance, benchmarking), implementation fitness (enabling infrastructures, momentum from previous projects), and timely feedback of infection rates and process indicators. Barriers (organisational ‘constipators’, workload, mistrust, turnover) and local solutions to these were also identified.ConclusionsParticipating hospitals benefitted from the SUSP programme structures (e.g. surveillance, hospital networks, formation of multidisciplinary teams) and adaptive tools (e.g. learning from defects, executive rounds guide) to change perceptions around patient safety and improve behaviours to prevent SSI. The combination of technical and adaptive elements represents a promising approach to facilitate the introduction of evidence-based best practices and to improve safety culture through local team engagement in resource-limited settings.
Highlights
A Surgical Unit-based Safety Programme (SUSP) has been shown to improve perioperative prevention practices and to reduce surgical site infections (SSI)
For me that's the greatest success is the awareness that patient safety is an issue and there's something that can be done about it to just improve patient safety.”. This qualitative study draws on the experience of five African hospitals and reveals the following key facilitators to implementation of the SUSP programme: influential individuals, who spanned boundaries to accelerate change and establish support for the intervention among colleagues and hospital leadership; peer-to-peer learning across participating hospitals, which fostered synergies and positive deviance across institutions; implementation fitness, where hospitals built on the momentum and enabling infrastructures that had been established through previous quality improvement initiatives; and timely feedback of data, which established tension for change among participants and sustained project engagement
These conclusions are supported by our findings and further justify the comprehensive SUSP approach, which combines technical and adaptive elements to facilitate the introduction of evidence-based best practices while working to improve safety culture
Summary
A Surgical Unit-based Safety Programme (SUSP) has been shown to improve perioperative prevention practices and to reduce surgical site infections (SSI). It is critical to understand the factors influencing the successful implementation of the SUSP approach in low- and middle-income settings. Surgical site infections (SSI) are the most surveyed and most frequent type of HAI in low- and middle-income countries (LMICs) as well as Europe and the United States (US) [2,3,4,5,6]. A Surgical Unit-based Safety Programme (SUSP) has been developed by the American Agency for Healthcare Research and Quality to reduce SSI and other surgical complications [8]. Implementation of similar multifaceted approaches have been associated with significant and sustained reductions in HAIs and improvements in
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