Building safe surgery knowledge and capacity in Cambodia: a mixed-methods evaluation of an innovative training and mentorship intervention

ABSTRACT

Background

Working in partnership with the Cambodian Ministry of Health, the Safe Surgery 2020 initiative (SS2020) supports the prioritization of surgery and mobilization of resources to target limited workforce capacity. An evaluation study was conducted to assess the impact of SS2020 on intervention hospitals in Cambodia.

Objective

To understand the impact of the SS2020 program on intervention hospitals in Cambodia by assessing the changes in key surgical performance indicators before and after the intervention, identifying key barriers and facilitators to adoption of learnings, and discovering lessons on the uptake and diffusion of this initiative in Cambodia and other similar contexts.

Methods

This study is a convergent mixed-methods evaluation of a one-year multicomponent SS2020 intervention. Surgical observations were conducted in 8 intervention hospitals at baseline and endline to evaluate pre and post adherence to 20 safety, teamwork, and communication items. Fifteen focus groups were conducted in all intervention sites at endline to assess key facilitators and barriers to positive impact.

Results

There was significant improvement in 19 of 20 indicators assessed during surgical observations. Among the highest performing indicators were safety items; among the lowest were communication items. Participants self-reported improved knowledge and positive behavior change after the intervention. Institutional change and direct patient impact were not widely reported. Most participants had favorable views of the mentorship model and were eager for the program to continue implementation.

Conclusions

The results provide evidence that change in surgical ecosystems can be achieved on a short timeline with limited resources. The hub-and-spoke mentorship model can be successful in improving knowledge and changing behavior in surgical safety. Workforce development is important to improving surgical systems, but greater financial and human resources are needed. Ministry support in adopting, leading, and scaling is crucial to the continued success of safe surgery interventions in Cambodia.

KEYWORDS:

• Global surgery
• monitoring and evaluation in safe surgery
• surgery in Cambodia
• surgical safety checklist
• surgical capacity building

Responsible Editor Jennifer Stewart Williams

Responsible Editor Jennifer Stewart Williams

Acknowledgments

Authors would like to acknowledge all partners involved in implementation of this project: The Cambodian Ministry of Health was instrumental in launching SS2020 in Cambodia. Calmette Hospital was a leader in hosting and implementing the program. Dalberg, Jhpiego, Assist International, SPECT, and WFSA were integral programmatic partners as part of Safe Surgery 2020. We also acknowledge the field operations assistance from Aplus Consulting, specifically Meas Keovorleak. Finally, we would like to thank the integral data collection team that made this study possible: Sun Youra, Orng Long Heng, Ek Vattanak, Hom Hean, Roeun Ratana, Chea Sokpeoupisey, Khom Veasna, Ly Rathana, Khun Sophen, Nit Buntongyi, Thong Chanvitou, Kim Setha, Tiet Layheak, and Morm Pheakdey.

Ethics and consent

All study participants were informed of the study components and provided verbal consent to participate. IRB approval was obtained for all activities by both Harvard Medical School and the Cambodian National Ethics Committee for Health Research.

Paper context

The availability of safe surgical care is an ongoing challenge in low-resource settings. An innovative safe surgery workforce training and mentorship intervention was implemented in eight hospitals in Cambodia. A mixed-methods evaluation of this intervention was implemented. Results provide evidence that this model of building knowledge and capacity among the surgical workforce should be adapted and implemented in similar contexts.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the GE Foundation [28045607].

Notes on contributors

Sehrish Bari

All authors have made substantial contributions to the conception or design of the work or the acquisition, analysis, or interpretation of data for the work; have been involved in drafting the work or revising it critically for important intellectual content; have provided final approval of the version to be published; and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.