K. E. Smiley1, L. Ofori3, C. Spangler1, R. Acquaah-Arhin3, D. Deh2, J. Enos2, S. Manortey2, F. Baiden2, S. R. Finlayson1, R. R. Price1, M. McCrum1 1University Of Utah Health Sciences,Department Of Surgery,Salt Lake City, UT, USA 2Ensign College Of Public Health,Kpong, EASTERN REGION, Ghana 3Volta River Authority Hospital,Akosombo, Eastern Region, Ghana
Introduction: The Volta River Authority (VRA) Hospital is the healthcare component of a large public works project and functions as a district hospital in Akosombo, Ghana. The VRA hospital has a reputation regionally for patient safety and high quality care. We hypothesized that this stems from standardized processes and an underlying culture of safety typical of high-risk engineering environments. We therefore sought to evaluate the degree of perioperative process variability, as well as staff and patient perceptions of safety and quality of care.
Methods: Perioperative observations of general surgery, obstetrics and gynecology procedures were used to generate process maps, which were analyzed for process variability and presence of waste steps. The Safety Attitudes Questionnaire (SAQ) and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to evaluate staff and patient perceptions of safety culture and quality in a cross-sectional study. The SAQ was analyzed for proportion of respondents with a categorical score ≥75/100, indicating an overall positive perception. HCAHPS results were analyzed with standard “top-box” methods, calculating the proportion of patients selecting the most favorable response to each question.
Results: Fifteen elective surgical procedures were observed. Process map analysis demonstrated streamlined operative processes with little process variation between cases (Figure 1). There was 100% adherence to the World Health Organization Safe Surgery Checklist and no waste steps consistently identified. 31 SAQs were administered with Cronbach’s alpha of 0.84 for teamwork and 0.74 for safety climate, reflecting acceptable internal consistency. 83.9% of workers held positive perceptions of teamwork [median score 91.67, IQR 83.3 – 95.8], while 77.4% held positive perceptions of safety culture [median score 85.71, IQR 79.2 – 92.9]. 15 HCAHPS surveys of surgical inpatients showed 90% of patients giving highest possible scores for pain management and 84.4% for nurse communication, while only 31.3% and 55.6% of patients gave highest possible scores for medication communication and discharge information respectively. The median overall HCAHPS hospital rating was 10 [IQR 8.5 – 10] on a 10-point scale.
Conclusion: Perioperative process mapping displayed low levels of variability and waste and is a useful tool for evaluating standardization of care. Staff and patient surveys suggest an institutional commitment to safety with strong teamwork culture and patient communication. Targets for improvement include medication counseling and discharge planning. VRA Hospital demonstrates the feasibility of delivering high standards of perioperative care in a low-resource setting.
