ArticleBMJ quality & safety2021
Improving surgical quality in low-income and middle-income countries: why do some health facilities perform better than others?
Article in BMJ quality & safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
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Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Teamwork and implementation of innovations in healthcare and human service settings: a systematic review.Implementation science : IS · 2024Pooled it
- Interventions for improving critical care in low- and middle-income countries: a systematic review.Intensive care medicine · 2024Pooled it
- Patient safety culture in the operating room of African hospitals: a systematic review.Patient safety in surgery · 2026Review
- Perioperative outcomes of abdominal surgery in Ethiopia: a national clinical audit (2019-2024).Scientific reports · 2025Article
- The Ethiopian Surgical Outcome Study (Ethio-SOS): a 7-day multicentre national prospective observational cohort study.BMJ global health · 2025Observational
- Factors associated with successful implementation of Clean Cut: a perioperative surgical site infection prevention quality improvement programme-a cohort study of low-resource hospitals.BMJ global health · 2025Article
- Article
- Surgical Practice in Resource-Limited Settings: Perspectives of Medical Students and Early Career Doctors: A Narrative Review.Health science reports · 2025Article
- Exploring the concept of surgical transition: surgical activity in the light of economic development in Sierra Leone, Liberia, Ghana and India.Frontiers in surgery · 2025Article
- Global surgery is stronger when infection prevention and control is incorporated: a commentary and review of the surgical infection landscape.BMC surgery · 2024Review
- The use of positive deviance approach to improve health service delivery and quality of care: a scoping review.BMC health services research · 2024Article
- Improving the management of open tibia fractures, Malawi.Bulletin of the World Health Organization · 2024Article
- Improving surgical safety checklist utilisation at 23 public health facilities in Ethiopia: a collaborative quality improvement project.BMJ open quality · 2023Article
- Implementing surgical mentorship in a resource-constrained context: a mixed methods assessment of the experiences of mentees, mentors, and leaders, and lessons learned.BMC medical education · 2022Article
- Addressing quality and safety in anatomic pathology in low- and middle-income countries.Frontiers in medicine · 2022Article
- A multimodal mentorship intervention to improve surgical quality in Tanzania's Lake Zone: a convergent, mixed methods assessment.Human resources for health · 2021Article
- Building safe surgery knowledge and capacity in Cambodia: a mixed-methods evaluation of an innovative training and mentorship intervention.Global health action · 2021Article
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Authors and funding
44 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEvidence on heterogeneity in outcomes of surgical quality interventions in low-income and middle-income countries is limited. We explored factors driving performance in the Safe Surgery 2020 intervention in Tanzania's Lake Zone to distil implementation lessons for low-resource settings.
methodsWe identified higher (n=3) and lower (n=3) performers from quantitative data on improvement from 14 safety and teamwork and communication indicators at 0 and 12 months from 10 intervention facilities, using a positive deviance framework. From 72 key informant interviews with surgical providers across facilities at 1, 6 and 12 months, we used a grounded theory approach to identify practices of higher and lower performers.
resultsPerformance experiences of higher and lower performers differed on the following themes: (1) preintervention context, (2) engagement with Safe Surgery 2020 interventions, (3) teamwork and communication orientation, (4) collective learning orientation, (5) role of leadership, and (6) perceived impact of Safe Surgery 2020 and beyond. Higher performers had a culture of teamwork which helped them capitalise on Safe Surgery 2020 to improve surgical ecosystems holistically on safety practices, teamwork and communication. Lower performers prioritised overhauling safety practices and began considering organisational cultural changes much later. Thus, while also improving, lower performers prioritised different goals and trailed higher performers on the change continuum.
conclusionFuture interventions should be tailored to facility context and invest in strengthening teamwork, communication and collective learning and facilitate leadership engagement to build a receptive climate for successful implementation of safe surgery interventions.
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