背景:先前关于手术能力和挑战的埃塞俄比亚文献集中在定量研究上,缺乏语境理解。这项解释性序贯混合方法研究(MMR)旨在评估埃塞俄比亚南部三所教学医院的围手术期能力和环境挑战。
方法:定量调查评估了劳动力,基础设施,服务交付,融资,和信息系统。通过对20名围手术期提供者的定性半结构化访谈来解释调查结果。使用叙事挥舞方法将描述性统计与定性主题分析结果相结合。使用联合显示表链接来自两个数据集的关键发现。
结果:调查显示,专业劳动力短缺(比率为每10万人0.58),手术量(每100,000人115例手术),设备,用品,融资,和围手术期数据跟踪。医院的放射学服务和血液制品只有25-50%的时间,而麻醉剂和基本实验室服务通常在51-75%的时间内可用。很少使用围手术期管理方案(1-25%的时间)。超过90%的患者缺乏健康保险。定性数据还显示,围手术期资源和设备稀缺;负担不起的围手术期费用,缺乏健康保险,和不可预见的费用;不良的患者安全文化和整个围手术期连续护理的沟通障碍;劳动力短缺,工作不满意,以及对能力的关注;以及薄弱的国家治理,和社会政治动荡,全球市场波动加剧了当地的挑战。这些挑战与护理质量和患者安全方面的风险有关。根据临床医生的说法。
结论:该研究发现了卫生系统和社会政治环境中的缺陷,影响了安全手术的进行。它强调需要全面加强卫生系统以扩大劳动力,升级设施,完善安全文化,弹性,和领导,以确保及时获得必要的手术。探索外部因素,例如国家治理和社会政治稳定对改革努力的影响也至关重要。
BACKGROUND: Previous Ethiopian literature on surgical capacity and challenges has focused on quantitative investigations, lacking contextual understanding. This explanatory sequential mixed-methods research (MMR) aimed to assess perioperative capacity and contextual challenges at three teaching hospitals in southern Ethiopia.
METHODS: A quantitative survey assessed workforce, infrastructure, service delivery, financing, and information systems. The survey findings were explained by qualitative semi-structured interviews of twenty perioperative providers. Descriptive statistics were integrated with qualitative thematic analysis findings using the narrative waving approach. Key findings from both datasets were linked using a joint display table.
RESULTS: The survey revealed shortages in the specialist workforce (with a ratio of 0.58 per 100,000 population), surgical volume (at 115 surgeries per 100,000 population), equipment, supplies, financing, and perioperative data tracking. Hospitals\' radiology services and blood products were only available 25-50% of the time, while anesthetic agents and essential laboratory services were often available 51-75% of the time. Perioperative management protocols were used rarely (1-25% of the time). Over 90% of patients lack health insurance coverage. Qualitative data also revealed scarcity of perioperative resources and equipment; unaffordable perioperative costs, lack of health insurance coverage, and unforeseen expenses; poor patient safety culture and communication barriers across the perioperative continuum of care; workforce shortages, job dissatisfaction, and concerns of competence; and weak national governance, and sociopolitical turmoil, and global market volatility exacerbating local challenges. These challenges are linked to risks in quality of care and patient safety, according to clinicians.
CONCLUSIONS: The study identifies deficiencies in the health system and sociopolitical landscape affecting safe surgery conduct. It highlights the need for comprehensive health system strengthening to expand workforce, upgrade facilities, improve safety culture, resilience, and leadership to ensure timely access to essential surgery. Exploring external factors, such as the impact of national governance and sociopolitical stability on reform efforts is also essential.