Date of Award

10-7-2022

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Rubina Barolia

Second Advisor

Dr. Shahan Waheed

Third Advisor

Dr. Asad Latif

Department

Community Health Sciences

Abstract

Background: Trauma is one of the leading causes of death worldwide, and its management necessitates a coordinated and collaborative effort. Trauma team is one of the core ingredients of the trauma resuscitation process. It possesses a few characteristics that must be acquired to accomplish goals in the trauma cycle. Both technical and non-technical skills are included in these traits. Trauma mechanics and human factors science are currently popular in the western world. It is the science that deals with the settings in which people typically work, such as the hospital environment, physical space, each person's level of expertise, competency, available tools and technology, communication, team dynamics, cognitive skills, and so forth. This study aims to explore and understand various human factors involved in trauma resuscitation dynamics among trauma team members of a level-1 trauma center in a developing country.
Methods: In our study, we employed a sequential exploratory mixed method design. It took place in Karachi, Pakistan, at the Aga Khan University Hospital. The study was divided into two phases: a qualitative and a quantitative one. 14 in-depth interviews and 6 focus groups with a variety of trauma care specialists from across the hospital were undertaken using non-purposing sampling. After analyzing the data, qualitative themes and sub-themes were developed keeping our conceptual framework, the System Engineering Initiative for Patient Safety (SEIPS) model, as a reference. Later, a structured tool was developed, which was used to collect data for quantitative part. The quantitative web-based self-directed survey questionnaire was sent to 63 trauma team members in order to collect data on the team members' level of understanding of the human factors involved in trauma care. We divided understanding levels into three categories: insufficient, acceptable, and sufficient. The Chi-square test was used to determine the relationship between categorical variables and trauma team members' understanding of human factors. The findings from both phases were mixed at the interpretation stage of the study.
Results: The understanding level of trauma team members was significantly correlated with the human factors involved in trauma care, including the availability of technology and tools, adequate physical environment, tasks assigned during trauma situations, and care delivery processes required for trauma mechanics (p-value < 0.005). However, there was a poor association between the understanding of the trauma team with the “persons” and “organizations” (p-value >0.005). There were also strong correlation between the understanding of trauma team with the patient outcomes (p-values 0.486, 0.002, 0.011), organization outcomes (p-values 0.000, 0.076, 0.000) and individual outcomes (p-values 0.005, 0.018, 0.001). Themes from our study's qualitative data also supported these conclusions. Other important findings from our study included the need for an adequate trauma workforce and leadership's proactive role in providing effective and highquality trauma care. The thematic analysis from qualitative phase endorsed the findings that the understanding of human factors involved in the trauma cycle among trauma team members is extremely crucial to improve quality of trauma care and patient outcome. Higher authorities should engage in innovative and critical thinking to improve standardization in our current trauma care system.
Conclusion: The human factors and system reengineering has shown positive outcomes in developed countries and this study has also demonstrated this effect of human factors ergonomics in trauma care management in low-middle income country, despite its limitation to the private sector. The understanding of our working environment and redesigning our work system model and its processes will eventually be a success in the management of trauma care, thereby, reducing trauma and injury burden across the country. This study can serve as a guide for future research as well as feasible quality measures in trauma care and management, with the goal of enhancing performance at various stages of the trauma process while also optimizing quality of healthcare.

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1

Last Page

135

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