title: Sustainability assessment of a short-term international medical mission.
abstract: BACKGROUND
  Few studies have analyzed the tangible impact of global, philanthropic medical missions. We used qualitative methods to analyze the work of one such mission, Operation Walk Boston, which has made yearly trips to a Dominican Republic hospital since 2008.
  
  
  METHODS
  We interviewed twenty-one American and Dominican participants of the Operation Walk Boston team to investigate how the program led to changes at the host Dominican hospital and how the experience caused both mission protocols and U.S. practices to change. Transcripts were analyzed with the use of content analysis.
  
  
  RESULTS
  Participants noted that Operation Walk Boston's technical knowledge transfer and managerial examples led to sustainable changes at the Dominican hospital. Additionally, participants observed an evolution in nursing culture, as the program inspired greater independence in decision-making. Participants also identified barriers such as language and organizational hierarchy that may limit bidirectional knowledge transfer. U.S. participants noted that their practices at home changed as a result of better appreciation for different providers' roles and for managing cost in a resource-constrained environment.
  
  
  CONCLUSIONS
  Operation Walk Boston catalyzed sustainable changes in the Dominican hospital. Cultural norms and organizational structure are important determinants of program sustainability.
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research (J.B., R.G., D.A.D., and J.N.K.), The Brigham and Women's Physicians Organization (R.G.), Department of Orthopedic Surgery (J.B., D.A.D, B.M.A., T.S.T., and J.N.K.), Department of Nursing (B.M.A.), and Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bido
authors.affiliation: Harvard Medical School, 651 Huntington Avenue, Boston, MA 02115.
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Singer
authors.affiliation: Departments of Project Management (D.D.P.) and Orthopedic Surgery (L.A.A.), Hospital General de la Plaza de la Salud, Avenida Ortega y Gasset, Ensanche La Fe, Santo Domingo, Dominican Republic.
authors.forename: Desirée
authors.initials: D
authors.lastname: Diez Portela
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research (J.B., R.G., D.A.D., and J.N.K.), The Brigham and Women's Physicians Organization (R.G.), Department of Orthopedic Surgery (J.B., D.A.D, B.M.A., T.S.T., and J.N.K.), Department of Nursing (B.M.A.), and Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org.
authors.forename: Roya
authors.initials: R
authors.lastname: Ghazinouri
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research (J.B., R.G., D.A.D., and J.N.K.), The Brigham and Women's Physicians Organization (R.G.), Department of Orthopedic Surgery (J.B., D.A.D, B.M.A., T.S.T., and J.N.K.), Department of Nursing (B.M.A.), and Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Driscoll
authors.affiliation: Departments of Project Management (D.D.P.) and Orthopedic Surgery (L.A.A.), Hospital General de la Plaza de la Salud, Avenida Ortega y Gasset, Ensanche La Fe, Santo Domingo, Dominican Republic.
authors.forename: Luis
authors.initials: L
authors.lastname: Alcantara Abreu
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research (J.B., R.G., D.A.D., and J.N.K.), The Brigham and Women's Physicians Organization (R.G.), Department of Orthopedic Surgery (J.B., D.A.D, B.M.A., T.S.T., and J.N.K.), Department of Nursing (B.M.A.), and Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: Aggouras
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research (J.B., R.G., D.A.D., and J.N.K.), The Brigham and Women's Physicians Organization (R.G.), Department of Orthopedic Surgery (J.B., D.A.D, B.M.A., T.S.T., and J.N.K.), Department of Nursing (B.M.A.), and Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Thornhill
authors.affiliation: Orthopedic and Arthritis Center for Outcomes Research (J.B., R.G., D.A.D., and J.N.K.), The Brigham and Women's Physicians Organization (R.G.), Department of Orthopedic Surgery (J.B., D.A.D, B.M.A., T.S.T., and J.N.K.), Department of Nursing (B.M.A.), and Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for J.N. Katz: jnkatz@partners.org.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000592:standards; D019645:Arthroplasty, Replacement, Knee / Q000592:standards; D001900:Boston; D002983:Clinical Competence / Q000592:standards; D004293:Dominican Republic; D066275:Health Information Exchange / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008493:Medical Missions / Q000592:standards*; D059408:Pain Management / Q000592:standards; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000592:standards; D015397:Program Evaluation / Q000592:standards*; D058996:Quality Improvement; D011787:Quality of Health Care; D035862:Vulnerable Populations