RESUMO
We have limited understanding of the organisational issues at the health facility-level that impact providers and care as it relates to mistreatment in childbirth, especially in low- and middle-income countries (LMICs). By extension, it is not clear what types of facility-level organisational changes or changes in working environments in LMICs could support and enable respectful maternity care (RMC). While there has been relatively more attention to health system pressures related to shortages of staff and other resources as key barriers, other organisational challenges may be less explored in the context of RMC. This scoping review aims to consolidate evidence to address these gaps. We searched literature published in English between 2000-2021 within Scopus, PubMed, Google Scholar and ScienceDirect databases. Study selection was two-fold. Maternal health articles articulating an organisational issue at the facility- level and impact on providers and/or care in an LMIC setting were included. We also searched for literature on interventions but due to the limited number of related intervention studies in maternity care specifically, we expanded intervention study criteria to include all medical disciplines. Organisational issues captured from the non-intervention, maternal health studies, and solutions offered by intervention studies across disciplines were organised thematically and to establish linkages between problems and solutions. Of 5677 hits, 54 articles were included: 41 non-intervention maternal healthcare studies and 13 intervention studies across all medical disciplines. Key organisational challenges relate to high workload, unbalanced division of work, lack of professional autonomy, low pay, inadequate training, poor feedback and supervision, and workplace violence, and these were differentially influenced by resource shortages. Interventions that respond to these challenges focus on leadership, supportive supervision, peer support, mitigating workplace violence, and planning for shortages. While many of these issues were worsened by resource shortages, medical and professional hierarchies also strongly underpinned a number of organisational problems. Frontline providers, particularly midwives and nurses, suffer disproportionately and need greater attention. Transforming institutional leadership and approaches to supervision may be particularly useful to tackle existing power hierarchies that could in turn support a culture of respectful care.
RESUMO
BACKGROUND: Previously we evaluated the effectiveness of videotaped feedback as a teaching tool for surgical residents using 3 different core skills in the field of orthopedics. Our results revealed no significant differences in technical skill among surgical residents who were exposed to videotaped feedback and those who were not. Several limitations in the study were identified, including the presence of only a single exposure to videotaped feedback. In the present study we included repeated exposures to determine if skill acquisition was enhanced. METHODS: Thirty-three surgical residents were randomly assigned to receive either no videotaped feedback (control group) or repeated video feedback over 3 consecutive weekly practice sessions on a vascular anastomosis bench model. On the fourth week, vascular surgeons blinded to the 2 groups evaluated the residents on the same vascular anastomosis task using a global rating scale and technical checklist forms. RESULTS: Twenty-six (79%) of the residents participated. Independent t tests comparing the scores of each of the 2 different measures between the control group and repeated videotaped feedback group revealed no statistically significant differences. CONCLUSIONS: There was no significant difference in the performance of a vascular anastomosis in a bench-training model between residents who were exposed to video feedback over several practice sessions and those who received no video feedback.
