Exploring Barriers and Facilitators to Incorporating New Practices and Innovations in the Pediatric Perioperative Ecosystem in Sub‐Saharan Africa: A Mixed Methods Study

Abstract

BACKGROUND: Integrating evidence-based findings into perioperative medicine is key to allowing improvements in care. The perioperative environment involves multiple stakeholders and processes that require coordination to deliver high-quality care. Various barriers can challenge the implementation of changes in this setting, but key facilitators may enable them. This research explored barriers and facilitators to implementing new practices and innovations in the pediatric perioperative ecosystem, as experienced by pediatric anesthetists returning to work in a sub-Saharan African country. METHODS: This was a mixed methods study following an explanatory sequential design. A survey was sent to 28 fellowship-trained pediatric anesthetists identified through fellowship leads of established programs, who had returned to work in sub-Saharan Africa post-fellowship. Respondents were invited to participate in interviews. Reflexive thematic analysis was used to represent the experiences described by the participants, and to categorize barriers and facilitators. RESULTS: Seventeen anesthetists from 10 countries responded to the survey (response rate 17/28, 61%). All respondents indicated that they had encountered barriers to change implementation (17/17, 100%), and 12/15 (80%) indicated that facilitators that enabled change existed. Resource constraints were the main barrier, followed by resistant behaviors by individuals and at the organizational level. Ten anesthetists were subsequently interviewed. Respondents attempted to bring about change in a variety of areas, including operational logistics, patient safety, clinical practice, and organizational culture. Key barriers were encountered at individual, environmental and organizational levels. Key enablers included personal traits such as persistence and adaptability, ongoing mentorship, supportive leadership, and the strategic contextualization of skills. CONCLUSION: Fellows experience significant challenges when attempting to implement changes based on the knowledge and skills acquired during advanced training. Facilitators enabling successful change implementation exist. Including training in leadership and change management in fellowship programs may better prepare those from sub-Saharan Africa to introduce their envisioned improvements to the perioperative environment upon their return.