“The experience of establishing and carrying out quality improvement projects in Ethiopia has taught me that even the smallest change can make a difference to improving patient safety.”
Dr Ben Parsons is now back working at Kings College Hospital in London after a six month placement as a Lifebox® Fellow at Jimma University Hospital in Ethiopia. We recently caught up with him to learn more about this life changing experience.
You’ve just returned from your placement, how would you sum up your experience?
It was a fantastic experience, an amazing place to go in the world. Jimma is a small city in South West Ethiopia, so a very different experience to living and working in London. There were lots of different challenges in terms of work and life but it was amazing to go there and work with Lifebox to help make surgery and anaesthesia safer.
I got involved in lots of different projects and work to try and achieve those goals and make a difference.
What were some of your highlights/most memorable experiences?
The biggest highlight was working with both the people in the hospital and the local population. My Ethiopian colleagues were very friendly, accommodating and welcoming to me. The anaesthesiologists and anaesthesia providers were very keen to get involved in working together to try and improve the way that anaesthesia is provided in the hospital and improve patient safety.
Do you think some/all of the projects you implemented will continue since you’ve left?
We were working on a number of different projects during my time in Jimma. These included following up the projects the previous Lifebox Fellow (Nick Owen) started, which encouragingly are still going strong.
One of the ongoing projects that Lifebox is involved in is implementing the WHO Surgical Safety Checklist. Nick had spent a lot of time trying to implement it and it’s still being used in the operating theatres. I was working alongside another Lifebox Fellow, Jared Forrester, who’s doing a lot of work with Lifebox’s Clean Cut® programme, which is being piloted in Jimma. A large part of this work involves reinforcing the use of the Checklist, and implementing other interventions to try and reduce surgical site infection rates.
I also worked on anaesthesia related projects and did lots of teaching and training. We found a lot of equipment in the hospital that wasn’t being used, including monitoring and difficult airway equipment. I ran training sessions and put together a difficult airway bag so that all the anaesthetic providers have easy access to vital and life-saving emergency equipment in the future. The interest and enthusiasm of the anaesthetists and theatre staff I worked with makes me confident these projects will continue for a long time after I’ve left.
What was your biggest challenge not only in reinforcing use of the Checklist but also providing safe anaesthesia in this setting? And how did you overcome it?
With regards to the Checklist, there were a lot of people who were enthusiastic about using it, particularly the trainees because it’s been introduced early on in their careers. Some of the older generation in the surgical teams, were a little reluctant and questioned its use. Which is understandable when you’ve spent a long career not using something, and someone comes along suggesting something new to do. It’s not unreasonable to question whether it’s going to make any difference.
Understanding people’s reservations and what their concerns are, working together and providing evidence of its impact was key. When people saw it being used in theatre they began to realise its usefulness and that it wasn’t going to take long. Also, once you start using it regularly it becomes much more routine.
We also highlighted where the Checklist could improve safety. For example, there were two cases of retained surgical swabs where the checklist hadn’t been used. Presenting these to the multi-disciplinary team allowed us to highlight that if the Checklist had been used to count equipment this might not have happened. This really made people begin to realise that the Checklist does improve patient safety.
Having local champions from all specialties who are enthusiastic about carrying the project on is important. The management staff were also very enthusiastic about the implementation of the Checklist and getting involved in Clean Cut as well.
Did you get a chance to visit other hospitals or parts of the country?
When I first arrived, I got to go to Addis Ababa to present at the Ethiopian Association of Anaesthetists Annual Conference for anaesthetist providers – these were nurses and non-physician anaesthetists who provide the vast proportion of anaesthesia across the country.
It was very interesting, and I got to tell them about Lifebox and our plans. I also got a lot of information from them through a needs assessment to learn about their hospital settings, what equipment they have or don’t have, and learned what their main challenges were with regards to providing safe anaesthesia. We will use this information to direct future Lifebox projects in Ethiopia.
How will your experience in Ethiopia impact your work in the UK?
It will impact my work for my entire future career. It’s a very different experience working in a low-income country where resources are much less available than in the UK. The things we take for granted on a daily basis like simple monitoring during surgery, a reliable source of oxygen, even having electricity and water – you sometimes just don’t have access to.
I’ve definitely become more resourceful, using lots of lateral thinking, and having a ‘can do’ attitude as well as being more adaptive when doing my job.
The experience of establishing and carrying out quality improvement projects in Ethiopia has taught me that even the smallest change can make a difference to improving patient safety. And I’ll be continuing to do those things to improve surgical and anaesthetic safety in the UK – there are always things that can be done to improve safety and efficiency.
I had a great time in Ethiopia and I’d love to go back.
Do you think you’ve achieved what you set out to do?
Yes. One of my aims before I left was to totally throw myself into the working environment and culture, and I certainly achieved that. They were a very welcoming group of people in the hospital and local community and they made me feel at home.
My other aim was to get involved with Lifebox’s projects including implementation of the WHO Checklist, pulse oximeter training and distribution, and helping with the Clean Cut project. I got to continue a lot of the good work Nick Owen had done as the Lifebox Fellow before me, and establish some of my own quality improvement projects, which I hope will continue to improve surgical and anaesthetic safety in Jimma long into the future.