Paediatric Critical Care Implementation in Lower-Resource Settings: Application of Community-Based Group Model Building.

Objectives: Given the significant burden of critical illness and high mortality in Low-Middle Income Countries (LMICs), ICU care could substantially improve patient outcomes in LMICs. No systematic approach is available to identify the perceived and actual challenges of developing and maintaining high-quality intensive care units in LMICs. This study aimed to use community-based group model building (GMB) as an intervention to evaluate the barriers and facilitators of establishing a Paediatric Intensive Care Unit (PICU) in LMIC. Design: A GMB workshop was conducted with 27 participants, representing all the stakeholders. The workshop objectives were: assess GMB as a tool for implementation planning in a lower resource clinical care setting; assess barriers and facilitators of PICU implementation as perceived by conference attendees; develop a shared vision for goals, processes, and challenges for the PICU. Setting: PICU at the Mercy James Center for Paediatric Surgery and Critical Care (MJC) within the established system of Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi. Interventions: None. Main Results: The GMB workshop produced a synthesized causal map comprised of the individual participatory groups' causal maps. Participants created actionable ideas to promote collaboration or mitigate deleterious feedback loops undermining productivity. Conclusions: Group model building is valuable as a participatory process involving multiple stakeholders in understanding challenges in implementing, functioning, and sustainability of a PICU in lower resource settings. The flexibility in designing the GMB workshops to incorporate the voices of different stakeholders and openly address their concerns made it a valuable participatory process in addressing various perceived challenges in implementing and sustaining high-quality PCCM in lower resource settings.