Tianyu Liu, Ee Lin Ong, Xixi Yan, Xinxing Guo, Mingguang He, David Friedman,
and Nathan Congdon
Abstract
PURPOSE. To explore factors potentially influencing the success or failure of rural Chinese hospitals in increasing cataract surgical output and quality.
METHODS. Focus groups (FGs, n ¼ 10) were conducted with hospital administrators, doctors, and nurses at 28 county hospitals in Guangdong Province. Discussions explored respondents’ views on increasing surgical volume and quality and improving patient satisfaction. Respondents numerically ranked possible strategies to increase surgical volume and quality and patient satisfaction. FG transcripts were independently coded by two reviewers utilizing the constant comparative method following the grounded theory approach, and numerical responses were scored and ranked.
RESULTS. Ten FGs and 77 ranking questionnaires were completed by 33 administrators, 23 doctors, and 21 nurses. Kappa values for the two coders were greater than 0.7 for all three groups. All groups identified a critical need for enhanced management training for hospital directors. Doctors and nurses suggested reducing surgical fees to enhance uptake, although administrators were resistant to this. Although doctors saw the need to improve equipment, administrators felt current material conditions were adequate. Respondents agreed that patient satisfaction was generally high, and did not view increasing patient satisfaction as a priority.
CONCLUSIONS. Our findings highlight agreements and disagreements among the three stakeholder groups about improving surgical output and quality, which can inform strategies to improve cataract programs in rural China. Respondents’ beliefs about high patient satisfaction are not in accord with other studies in the area, highlighting a potential area for intervention.
Opinion:
Some points which are important to make rural cataract surgery successful and can be adopted in Indonesia based on this study below:
1. Provide management training for hospital administrators and increase salary for staff. Doctors and nurses expressed dissatisfaction stemming from factors such as lack of salary incentives and equipment and poor delineation of responsibilities. Given that hospital administrators themselves recognized a need for more management training, cataract surgery programs may improve their effectiveness and sustainability by offering administrative training focused on topics, such as proper staffing and equipment, design and implementation of salary incentives, delineation of responsibilities, and creation of standardized protocols.
2. Reduce surgical fees or make the surgery free for patient
3. Provide OR and peri operative training for nurses.
Our results suggest that nurses could benefit from additional training in three specific areas: OR tasks, basic clinical assessment (e.g., visual acuity measurement), and patient education.
4. Improve and expand training for surgeons. Although doctors generally praised the quality of current surgery training programs provided by ZOC, they highlighted weaknesses, such as a steep learning curve for doctors without basic surgery skills and lack of hands-on opportunities.
5. Attend to patient satisfaction. Low patient satisfaction with the perceived quality of care has been shown to be a key factor preventing uptake of cataract services in this and other parts of rural China,27 whereas increased patient satisfaction has been associated with increased patient compliance, reduced complaints against the institution, and improved provider morale.
But, further study to adjust the implementation in Indonesia is essential because some limitation of this study. The sample size of the present study was based on a convenience sample from hospitals in Guangdong Province, and therefore generalization of these findings must only be done with care.
Reference:
http://iovs.arvojournals.org/article.aspx?articleid=2188702 (Invest Ophthalmol Vis Sci. 2013;54:266–273) DOI:10.1167/iovs.12-10906
Image:www.thestandard.co.zw
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