Exploring Barriers and Facilitators to Incorporating New Practices and Innovations in the Pediatric Perioperative
Anisa Bhettay1, Romy Parker2, Salome Maswime3
1Division of Paediatric Anaesthesia, Department of Anaesthesia and Perioperative Medicine, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Pediatric anesthetists returning to sub-Saharan Africa face significant barriers to implementing evidence-based practices. However, facilitators like leadership support and personal traits enable change, suggesting a need for enhanced fellowship training in change management.
Area of Science:
- Perioperative Medicine
- Pediatric Anesthesia
- Healthcare Innovation
Background:
- Integrating evidence-based findings into perioperative medicine is crucial for enhancing patient care.
- The perioperative environment requires coordination among multiple stakeholders, facing challenges in implementing changes.
- This study investigates barriers and facilitators for pediatric anesthetists implementing innovations in sub-Saharan Africa.
Purpose of the Study:
- To explore the barriers and facilitators encountered by pediatric anesthetists returning to sub-Saharan Africa.
- To understand the challenges in implementing new practices and innovations within the pediatric perioperative ecosystem.
- To identify factors that enable or hinder the adoption of evidence-based changes.
Main Methods:
- A mixed-methods study with an explanatory sequential design was employed.
- A survey was distributed to 28 fellowship-trained pediatric anesthetists in sub-Saharan Africa.
- Reflexive thematic analysis was used for survey and subsequent interview data from 10 participants.
Main Results:
- All 17 respondents (61% response rate) reported barriers to change implementation.
- Resource constraints, individual, and organizational resistance were primary barriers.
- Key enablers included persistence, adaptability, mentorship, leadership support, and contextualization of skills.
Conclusions:
- Pediatric fellows face substantial challenges implementing changes post-training in sub-Saharan Africa.
- Successful change implementation is facilitated by personal traits, leadership, and mentorship.
- Fellowship programs should incorporate leadership and change management training for improved practice implementation.
Background:
Integrating evidence-based findings into perioperative medicine is key to allowing improvements in care. The perioperative environment involves multiple stakeholders and processes that require coordination to deliver high-quality care. Various barriers can challenge the implementation of changes in this setting, but key facilitators may enable them. This research explored barriers and facilitators to implementing new practices and innovations in the pediatric perioperative ecosystem, as experienced by pediatric anesthetists returning to work in a sub-Saharan African country.
Methods:
This was a mixed methods study following an explanatory sequential design. A survey was sent to 28 fellowship-trained pediatric anesthetists identified through fellowship leads of established programs, who had returned to work in sub-Saharan Africa post-fellowship. Respondents were invited to participate in interviews. Reflexive thematic analysis was used to represent the experiences described by the participants, and to categorize barriers and facilitators.
Results:
Seventeen anesthetists from 10 countries responded to the survey (response rate 17/28, 61%). All respondents indicated that they had encountered barriers to change implementation (17/17, 100%), and 12/15 (80%) indicated that facilitators that enabled change existed. Resource constraints were the main barrier, followed by resistant behaviors by individuals and at the organizational level. Ten anesthetists were subsequently interviewed. Respondents attempted to bring about change in a variety of areas, including operational logistics, patient safety, clinical practice, and organizational culture. Key barriers were encountered at individual, environmental and organizational levels. Key enablers included personal traits such as persistence and adaptability, ongoing mentorship, supportive leadership, and the strategic contextualization of skills.
Conclusion:
Fellows experience significant challenges when attempting to implement changes based on the knowledge and skills acquired during advanced training. Facilitators enabling successful change implementation exist. Including training in leadership and change management in fellowship programs may better prepare those from sub-Saharan Africa to introduce their envisioned improvements to the perioperative environment upon their return.
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