Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo

Abstract

ObjectiveTo identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC).DesignIn-depth interviews were conducted and analysed using qualitative content analysis.SettingGovernmental referral teaching hospital in Eastern DRC.ParticipantsWe purposively selected 2–4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed.ResultsEconomics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs’ reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance.ConclusionsThe complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all.

A Narrative Synthesis of Qualitative Studies Conducted to Assess Patient Safety Culture in Hospital Settings

“…In addition, staff attitudes were perceived as important. Commitment to patient safety and compliance with clinical practice and patient safety standards were thought to play a vital role in determining the level of patient safety in the workplace 23–26,29,31–35. Job satisfaction and staff turnover rate were also identified as key determinants of patient safety 25,32…”

“…Communication factors commonly perceived as determinants of patient safety were teamwork, healthcare provider-patient relationships, handovers and transitions. 22–29,32,33,35–37 For example, Zhu et al .’s study found that feedback and communication concerning errors were seen as important determinants of patient safety 22…”

“…There was widespread agreement among the different studies’ participants that the availability and appropriateness of non-human resources, including policies, procedures, equipment, supplies, the physical environment, technology and medical records in healthcare organisations were key factors for providing safe services. 21–25,27–35,37–39…”

Exploring Patient Safety Culture in a Kuwaiti Secondary Care Setting

“…For example, a study conducted in a university hospital in the conflict-ridden Eastern Democratic Republic of Congo also found that national politics affected healthcare. 29 It is critical to examine differences between these groups given the large number of expatriate healthcare professionals in Kuwait. Evidence strongly suggests that an organisational safety culture is constituted by a mixture of safety subcultures and that the presence of contrasting views between these subcultures can compromise the achievement of organisation-wide safety goals.…”

Baseline Patient Safety Culture in Cameroon: Setting a Foundation for Trauma Quality Improvement

“…14 Studies on trauma-related patient safety culture in SSA are scarce, and there is currently no baseline data on patient safety culture in Cameroonian hospitals. [15][16][17][18][19] The majority of existing studies assessing patient safety culture amongst hospital personnel in SSA countries have been qualitative. 16,18 Although these studies may provide more detailed knowledge on the intricacies of patient safety culture, quantitative approaches allow for serial evaluations to track improvements following interventions to strengthen patient safety culture.…”