To Örebro University

BACKGROUND: This study outlines key aspects of professional development among health professionals in low- and middle-income countries (LMIC). LMICs need support in developing their continuing medical education, and non-technical skills (NTS) that have been neglected in this respect. Given the nature of NTS, educational methods should be used experientially. This study aims to explore an interactive educational approach to increase NTS among health care professionals in an LMIC setting.

METHODS: A design-based research approach was applied to develop an educational method. Key NTS concepts were identified, which directed the selection of research-based surveys. A series of workshops was designed in which a survey-based experiential approach was developed. The educational process followed a pattern of individual reflection, small group discussion and relating the concepts to the local practice in a wider group.

RESULTS: An approach to increase NTS in LMIC settings emerged in iterative development through conducting workshops with health care teams in the Balkans. The topics could be grouped into individual, team, and organisational dimensions. The approach can be described as survey-based experiential learning involving steps in recurring interaction with participants. The steps include identifying concepts in individual, team and organization dimensions and contextualising them using experiential learning on the individual and group levels.

CONCLUSION: An overarching approach has been developed that addresses NTS in an LMIC setting. The survey-based experiential learning approach can be beneficial for raising professional awareness and the development of sustainable healthcare settings in LMICs.

Background: The aim of this project is to create understanding on the determinant factors enhancing adherence to treatment guidelines for the emergency medical services in Kosovo (EMSK). Focus is on barriers, and enablers while introducing the guidelines. It is aiming to create clearance and understanding of how and why the implementation outcomes are achieved. The factors influencing implementation will be mapped in three main domains. The domains are part of the determinant framework Promoting Action on Research Implementation in Health Services (PARIHS). Each of the domains is further divided into sub-constructs.

Methods: The process of implementing treatment guidelines into the emergency medical services in Kosovo was observed and documented by 4 researchers, using a participatory research design. The PARIHS framework that consists of three core components: evidence, context, and facilitation was applied to make clarity on what works better and why, in order to achieve the outcomes of the implemented guidelines.

Results: The preliminary results have shown that the three constructs have an important role in the process of implementation. The domain evidence determined the way the evidence based practice is conceived in this particular setting. The domain context concerns the organization and teamwork shaped challenges and possibilities for adherence to the guidelines. The role of an external facilitator was of specific importance.

Conclusions: The PARIHS framework serves in both practical and theoretical planning of an intervention. In the present project it provides clarity on planning of the process, while also offer understanding of the elements that contribute to the sustainability of the intervention. Finally the lessons from the approach can be replicated in similar context.

Key messages:

• Implementation projects can be more successful suing a framework to direct the effort.
• Such interventions should be premised with clarity on the evidence, the local context, and facilitation factors.

Background: The use of clinical practice guidelines in clinical and organizational decision-making improves the care of patients and patient safety. Guidelines make healthcare consistent and efficient. In many low- and middle income countries healthcare workers depend on guidelines developed in higher income countries. For these to be useful and accepted they need to be adapted to the local setting. The aim of the study was to implement pre-hospital treatment guidelines into an organization that was not currently using guidelines. The study was partnership between a Swedish pre-hospital training organization and local ambulance service organizations in Kosovo.

Methods: An iterative process of implementing the guidelines was used:

• Identify guidelines appropriate for the local organization.
• In sets of five, have the guidelines translated into Albanian.
• Adapt the guidelines to the local conditions and context.
• Approval of guidelines by an expert group.
• Begin using the guidelines within the target organization.

Results: The first set of five guidelines was translated, approved, and implemented into the organizations. To improve acceptance, both practitioners and decision-makers were involved in the process. Seven workshops were held, with a total of 104 participants. In follow-up discussions participants said they accepted the guidelines and that they would be useful in their daily work.

Conclusions: It is important to evaluate to what extent the guidelines have been accepted, understood, and used. The success and acceptance is due to the flexible procedure managing the full implementation process. Adapting guidelines to fit with local needs and requirements using local experts made the guide-lines accessible and useful. The workshop discussions established justification and approval.

Key messages:

• Involve local experts in contextualising guidelines to increase acceptance from the start.
• Support building a robust local implementation organization to assist and administer change.

Background: Healthcare in post-war Balkans is still under development. Healthcare changes towards more complex clinical scenarios that need different competencies around patients. This study reports on survey based learning to increasing professional awareness for developing sustainable healthcare settings using an experiential learning approach.

Methods: In this study, researchers and educators identified non-technical skills concepts on individual, team, and organizational levels. These concepts were contextualized into the local setting through interactive workshops. Two pediatric surgery clinics in Kosovo and Bosnia and Herzegovina participated who were part of an international clinical skills training project. The tools and surveys were: Johari window, Kolb’s learning style questionnaire, team members exchange quality scale, the IPEC framework for interprofessional competence, Team STEPPS observation tool and organizational models.

Results: A model is developed for contextualizing core concepts on professional awareness into a local developing healthcare setting. It entails three steps conducted in consecutive workshops: Identifying research-based concepts on professional compe-tence on individual, team and organizational levels. Facilitating local contextualization of these concepts by using surveys in interactive workshops. Agreeing on indicators to maintain high professional awareness.

Conclusions: Capacity-building in public health can be conducted through increasing professional awareness. Professional awareness can be approached in individual, team and organizational dimensions. Established core concepts of non-technical skills can be contextualized in other cultures through a survey-based experiential learning approach.

Key messages:

• Professional individual, team and organizational awareness is a vital part of conducting efficient healthcare.
• The professional awareness can be enhanced through processing core concepts in a local context through facilitated workshops.