Online Program

Building systems to enhance surgical safety and value in low resource settings

Monday, November 4, 2013 : 9:00 a.m. - 9:15 a.m.

Samuel Finlayson, MD MPH, Department of Surgery, Brigham and Women's Hospital and Harvard Medical School, Center for Surgery and Public Health, Boston, MA
Providing access to high quality surgical care in resource constrained settings is a universal challenge. Two approaches to this challenge exist: (1) increase the yield of existing resources (increase value) and (2) recruit more resources (infrastructure, workforce). While the first approach best characterizes the US response to this challenge, the second has been the focus of most efforts in developing countries. However, because of severe resource limitations in low income countries, efforts to expand surgical capacity by increasing resources dedicated to infrastructure and workforce has had limited success, and has the potential to divert valuable resources from other health priorities. Because higher quality surgical care decreases complications and conserves resources, implementing scalable, low cost quality improvement measures can increase capacity without requiring greater resource allocation. This presentation will describe two efforts to increase quality and safety of surgical care in resource limited settings: implementation of the WHO Surgical Safety Checklist on a countrywide basis in the Republic of Rwanda, and use of the National Surgical Quality Improvement Program (NSQIP) in a referral hospital in the United Republic of Tanzania. The WHO Surgical Safety Checklist has been proven to decrease morbidity and mortality in a both developed and developing country settings, and the NSQIP has been widely demonstrated to increase value in the US, and is just beginning to be used in non-domestic settings. This presentation will focus on lessons learned implementing these programs in low resource settings, with attention to quality improvement workforce, systems redesign, information technology, and safety culture.

Learning Areas:

Clinical medicine applied in public health
Program planning
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Discuss approaches to increasing quality and value in surgical care delivery in settings with constrained resources. Describe two programs to enhance patient safety and the value of surgical care delivered in resource limited settings. Describe barriers to implementation of safety and quality programs in low income countries

Keyword(s): Developing Countries, Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a content expert in surgical quality and safety, and in delivery of surgical care in resource limited settings. I am currently director of the Center for Surgery and Public Health, a joint program of Harvard Medical School and the Harvard School of Public Health, and am responsible for programmatic development in the field of global surgery. I lead two surgical quality and safety program partnerships in Sub-Saharan Africa.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.