Assessment of Hospitals Readiness in Implementing a Non-Technical Skills for Surgery Training Program: A Mixed-Methods Study.

Background: Non-technical skills for Surgeons (NOTSS) lead to safer intraoperative patient care. There is a need to understand how to sustain the implementation of NOTSS training programs. The study aims were (1) to quantitatively assess perioperative care providers perceptions of the hospitals' readiness to sustain implementation of a NOTSS training program, and (2) to qualitatively investigate factors associated with hospitals' readiness to implement a NOTSS training program.

Methods: This Mixed Methods study was conducted in 11 Rwandan hospitals from March 2022 to October 2023. Perioperative care providers previously trained in NOTSS were invited to attend a two-hour NOTSS refresher course. Immediately after the course, quantitative data were collected from participants using the paper-based Safe Surgery Organizational Readiness Tool (SSORT), and Safety Attitude Questionnaire. Qualitative data were collected via semi-structured interviews and focus groups.

Results: Of the 477 participants (94.5% response rate) who completed the survey, 248 (51.9%) were female. The overall participants' SSORT score was 4.01, Interquartile range (IQR): 3.68-4.28. Most participants perceived that NOTSS training was appropriate Median 5, IQR: 4.5-5. Participants who reported satisfaction with hospital readiness to sustain the implementation of the NOTSS training program (overall SSORT score) were also satisfied with safety climate, adjusted odds Ratio (aOR): 1.02, 95% CI: 1.01-1.040), and teamwork climate, aOR: 1.05, 95% CI: 1.03-1.06. Qualitatively, four themes emerged: (1) the NOTSS training program was appropriate to improve patient safety, (2) understaffing compromised implementation of the quality improvement, (3) Hospital leaders supported quality improvement projects, and (4) there was a lack of enough resources for the hospital to support quality improvement projects.

Conclusion: Perioperative care providers in Rwanda perceived that NOTSS training programs were appropriate and supported by leadership. Insufficient financial resources and work overload led to participants' lower satisfaction with the capacity of their hospitals to implement NOTSS training programs.