Contextual Challenges to Safe Surgery in a Resource-limited Setting: A Multicenter, Multiprofessional Qualitative...

Area of Science:

• Global Surgery
• Health Systems Research
• Surgical Outcomes

Background:

• Optimal surgical performance requires integrating patient, task, team, and environmental information for safe, timely, and effective care.
• Low- and middle-income countries (LMICs) present unique challenges to surgeons due to common resource limitations, which remain undescribed.
• Safe surgical care is a global health priority, yet accessibility varies significantly across different healthcare settings.

Purpose of the Study:

• To explore context-specific challenges to safe surgical care in low- and middle-income countries (LMICs).
• To understand how surgical teams in LMICs overcome challenges to provide safe surgical care.
• To identify strategies for improving surgical safety in resource-limited environments.

Main Methods:

• Grounded theory approach utilized with 34 experienced providers (surgeons, anesthetists, nurses) in Rwanda.
• Data collected through interviews at 4 tertiary referral centers.
• Transcripts were coded line-by-line and iteratively analyzed until thematic saturation was achieved.

Main Results:

• Challenges to safe surgical care in Rwanda were categorized into physical resources, human resources, systems support, and communication/language.
• Variability in the quantity or quality of these resources, rather than outright lack, was the primary source of challenges.
• Surgical providers demonstrated resilient strategies to anticipate, monitor, respond to, and learn from these challenges.

Conclusions:

• Resource variability, not just lack of resources, significantly impacts safe surgical care in LMIC settings.
• Understanding these contextual challenges and the resilient strategies employed is crucial for surgical providers in LMICs.
• Knowledge gained is vital for surgeons from high-income countries (HICs) working in similar resource-limited environments.