Abstract
Background
With high mortality rates and persisting constraints on resources, the question of how to implement quality care in a low-resource setting is imperative to answer to prevent excess deaths. In Tanzania, it was found that the mean average of knowledge in critical care settings was 38.6% in hospitals. Moreover, despite the Ministry of Health and Social Welfare implementing a Quality Improvement (QI) program, there have been continual obstacles to the success of patient outcomes, sparking high mortality rates. This research aims to understand the barriers and facilitators to implementing sustainable quality improvement and educational projects in Tanzania to transform quality care in a low resource setting.
Methods
After a needs assessment identifying local gaps in knowledge, a two-day site- and context-specific critical care training program was developed for providers working in the intensive care unit at the National Hospital. It included modules on Vital Signs Directed Therapy (VSDT), Cardiopulmonary and Brain Resuscitation (CPBR) knowledge and critical care concepts. Alongside medical knowledge topics, quality improvement measures and change management were also highlighted during the education. Qualitative semi-structured interviews were used to understand the experience of those involved in the training program. Utilizing rapid qualitative analysis, interview themes were extracted. A total of seven providers were interviewed.
Results
All providers recognized a positive impact of trainings and QI at their institution, noting that QI is institution-wide and engenders a culture shift. The themes that emerged included the following: A supportive team dynamic with identified advocates to champion QI practices has been a key factor. Moreover, the interviewees consistently identified barriers to providing quality care and to integrating QI at the National Hospital. Respondents perceived that change management has had an effect on their practice and the hospital culture.
Conclusion
Themes from interviews showed respondents appreciated the training and found change management concepts useful. This study suggests that combining Critical Care Training Program with QI concepts can impact a culture of change and may be of benefit to incorporate within a systematic approach to strengthening capacity of critical care delivery in limited resource settings, with implications for further innovation in other LMICs.