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Exploring healthcare workers' perceptions on the use of morbidity and mortality audits as an avenue for learning and care improvement in Kenyan hospitals' newborn units

BMC health services research, 2022-02, Vol.22 (1), p.172-172, Article 172 [Peer Reviewed Journal]

2022. The Author(s). ;COPYRIGHT 2022 BioMed Central Ltd. ;2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. ;The Author(s) 2022 ;ISSN: 1472-6963 ;EISSN: 1472-6963 ;DOI: 10.1186/s12913-022-07572-8 ;PMID: 35144594

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  • Title:
    Exploring healthcare workers' perceptions on the use of morbidity and mortality audits as an avenue for learning and care improvement in Kenyan hospitals' newborn units
  • Author: Jepkosgei, Joyline ; Nzinga, Jacinta ; Adam, Mary B ; English, Mike
  • Subjects: Analysis ; Audit ; Audits ; Beliefs, opinions and attitudes ; Care and treatment ; Content analysis ; Data collection ; Ethnography ; Female ; Health care ; Health Personnel ; Hospitals ; Humans ; Infant, Newborn ; Infants ; Interviews ; Kenya - epidemiology ; Maternal ; Medical errors ; Medical personnel ; Meetings ; Morbidity ; Mortality ; Newborn ; Nurses ; Patient outcomes ; Patient safety ; Perinatal ; Pregnancy ; Qualitative Research ; Teams
  • Is Part Of: BMC health services research, 2022-02, Vol.22 (1), p.172-172, Article 172
  • Description: In many sub-Saharan African countries, including Kenya, the use of mortality and morbidity audits in maternal and perinatal/neonatal care as an avenue for learning and improving care delivery is sub-optimal due to structural, organizational, and human barriers. While attempts to address these barriers have been reported, lots of emphasis has been paid to addressing the role of tangible inputs (e.g., availing guidelines and training staff in the success of mortality and morbidity audits), while process-related factors (i.e., the role of the people, their experiences, relationships, and motivations) remain inadequately explored. We examined the processes of neonatal audits, their potential in promoting learning from gaps in care and improving care delivery, with a deliberate focus on process-related factors that generally influence mortality and morbidity (M&M) audits. This was an exploratory qualitative study, conducted in three hospitals, in Nairobi and Muranga counties. We employed a mix of in-depth interviews (17) and observation of 12 mortality and morbidity audit meetings. Our study participants included: nurses, doctors, trainee clinicians (i.e., junior doctors on internships), and nursing students involved in providing newborn care. These data were coded using NVivo12 employing a thematic content analysis approach. Perceived shortcomings in the conduct of M&M audits such as unclear structure was reported to have contributed to its sub-optimal nature in promoting learning. These shortcomings, in addition to hierarchy and power dynamics, poor implementation of audit recommendations, and negative experiences, (e.g., blame) also demotivated health workers from attendance and participation in audits. Despite these, positive outcomes linked to audit recommendations, such as revision of care protocols, were reported. Overall, leadership and a blame-free culture enabled positive changes and promoted learning from audit-identified modifiable factors. Our findings indicate that M&M audits provide a space for meaningful discussions, which may lead to learning and improvement in care delivery processes. However, a lack of participation, lack of observed positive outcomes, and negative experiences may reduce their usefulness. An enabling environment characterized by minimized effects of hierarchy and positive use of power and a blame-free culture may promote active participation, enhancing positive relationships and interactions thus promoting team learning.
  • Publisher: England: BioMed Central Ltd
  • Language: English
  • Identifier: ISSN: 1472-6963
    EISSN: 1472-6963
    DOI: 10.1186/s12913-022-07572-8
    PMID: 35144594
  • Source: GFMER Free Medical Journals
    MEDLINE
    PubMed Central
    ROAD: Directory of Open Access Scholarly Resources
    ProQuest Central
    DOAJ Directory of Open Access Journals
    Springer Nature OA Free Journals
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