Qualitative study exploring surgical team members' perception of patient safety in conflict-ridden Eastern Democratic Republic of Congo.
OBJECTIVE
To identify potential barriers to patient safety (PS) interventions from the perspective of surgical team members working in an operating theatre in Eastern Democratic Republic of Congo (DRC).


METHODS
In-depth interviews were conducted and analysed using qualitative content analysis.


METHODS
Governmental referral teaching hospital in Eastern DRC.


METHODS
We purposively selected 2-4 national and expatriate surgical team members from each specialisation. Of the 31 eligible surgical health workers (HWs), 17 volunteered to be interviewed.


RESULTS
Economics issues affected PS throughout the entire health system, from human resources and hospital management, to access to healthcare for patients. Surgical team members seemed embedded in a paternalistic organisational structure and blame culture accompanied by perceived inefficient support services and low salaries. The armed conflict did not only worsen these system failures, it also carried direct threats to patients and HWs, and resulted in complex indirect consequences compromising PS. The increased corruption within health organisations, and population impoverishment and substance abuse among health staff adversely altered safe care. Simultaneously, HWs' reported resilience and resourcefulness to address barrier to PS. Participants had varying views on external aid depending on its relevance.


CONCLUSIONS
The complex links between war and PS emphasise the importance of a comprehensive approach including occupational health to strengthen HWs' resilience, external clinical audits to limit corruption, and educational programmes in PS to support patient-centred care and address blame culture. Finally, improvement of equity in the health financing system seems essential to ensure access to healthcare and safe perioperative outcomes for all.
Department of Public Health and Policy, Institute of Psychology, Health and Society, The University of Liverpool, Liverpool, UK.
Francoise
F
Labat
Department of Public Health and Policy, Institute of Psychology, Health and Society, The University of Liverpool, Liverpool, UK.
Anjali
A
Sharma
D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000592:standards*; D015023:Democratic Republic of the Congo; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000191:economics* / Q000592:standards*; D036301:Qualitative Research; D014857:Warfare; D055815:Young Adult
ANAESTHETICS; QUALITATIVE RESEARCH; SURGERY