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

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.