title: Are we monitoring the quality of cataract surgery services? A qualitative situation analysis of attitudes and practices in a large city in South Africa.
abstract: OBJECTIVE
  To evaluate the current quality "assurance" and "improvement" mechanisms, the knowledge, attitudes and practices of cataract surgeons in a large South African city.
  
  
  METHODS
  A total of 17 in-depth semi-structured interviews were conducted with ophthalmologists in June 2012 at 2 tertiary institutions in the Republic of South Africa. Recruitment of the purposive sample was supplemented by snowball sampling. The study participants were 5 general ophthalmologists and 2 pediatric ophthalmologists; 4 senior and 4 junior registrars and a medical officer. Participants were interviewed by a trained qualitative interviewer. The interview lasted between 20 and 60 min. The interviews were recorded, transcribed verbatim and analyzed for thematic content.
  
  
  RESULTS
  Mechanisms for quality assurance were trainee logbooks and subjective senior staff observation. Clinicians were encouraged, but not obliged to self-audit. Quality improvement is incentivized by personal integrity and ambition. Poorly performing departments are inconspicuous, especially nationally, and ophthalmologists rely on the impression to gauge the quality of service provided by colleagues. Currently, word of mouth is the method for determining the better cataract surgical centers.
  
  
  CONCLUSIONS
  The quality assurance mechanisms were dependent on insight and integrity of the individual surgeons. No structures were described that would ensure the detection of surgeons with higher than expected complication rates. Currently, audits are not enforced, and surgical outcomes are not well monitored due to concerns that this may lead to lack of openness among ophthalmologists.
authors.affiliation: Department of Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Oluwatosin O O
authors.initials: OO
authors.lastname: Haastrup
authors.affiliation: Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
authors.forename: John C
authors.initials: JC
authors.lastname: Buchan
authors.affiliation: Academic Unit of Public Health, Nuffield Institute for International Health, Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Cassels-Brown
authors.affiliation: Department of Ophthalmology, Grootes Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: Colin
authors.initials: C
authors.lastname: Cook
mesh_terms: D001291:Attitude of Health Personnel; D019985:Benchmarking; D002387:Cataract Extraction / Q000592:standards*; D002983:Clinical Competence / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D009885:Ophthalmology / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000592:standards*; D013019:South Africa; D011795:Surveys and Questionnaires
keywords: Blindness Prevention; Cataract Surgery; Monitoring; Quality; Vision 2020