TableĀ 3

Main codes, themes and domains

DomainThemeSubthemeMain codes
General determinants of PSHuman factorsProfessional ethicsGlobal perception of the level of local PS conditions; powerlessness; failure in implementation of punishment and blame related to misbehaviour; professional ethics; staff misbehaviour and patient risk
ExpertiseExperience/on the job training; overseas training; need for continuous medical education; HW staff theoretical knowledge; lack of continuous education for nurses; patient information to be adapted based on patient education level
Knowledge-practice gapCultural specificities; flexibility of surgical HW in resource-constrained environment; mistakes and resource constraints; knowledge practice gap; litigation
OT managementHierarchical organisationLeadership in OT; power conflict between seniority and hierarchical/professional position; doctor/nurse differences in setting priority related to work organisation; inequity in accountability related to hierarchical position
Work organisationHygiene in OT; equipment check, OT check before surgery; operating schedule (or lack of); work organisation/distribution; OT rules and regulation; medical record
TeamworkTeamwork and knowledge about team members expertise, capacity; work climate and teamwork; team communication; multidisciplinary team
AE managementInterest and understanding of surgical checklist principles; AE reporting system; AE and individual responsibility, accountability; AE management; AE prevention system; Evaluation of practice; supervision; expertise in anaesthesia, anaesthesia monitoring and anaesthesia risk
Hospital managementSupport servicesAccess to support services; blood bank issues; drug supply
ResourcesLack of human resources; availability of surgical equipment; staff salary and incentives
ManagementCommunication between hospital management and HW
Perceived influence of the chronic conflict in PSDirect influenceEthnic issues and patient lack of trust in HW; impact of armed conflict on HW/managers' private life, own safety; chronic conflict and psycho-socio-economic consequences; armed conflict and work load; impact of criminality/armed conflict in healthcare access; armed conflict and security issues between patients/relatives; health centres targeted by criminality/armed groups; HW attitude towards ethnic differences; HW neutrality in healthcare
Indirect influenceIndividualsChronic crisis and HW resilience; conflict and opportunity for local training
Hospital managementCorruption; hospital management (board of directors) commitment and accountability; national/provincial governance
Humanitarian aidHumanitarian aid support and PS; gap in safety conditions between IO theatre and other OT in the same hospital; modernisation, new technologies
EnvironmentImpact of economic context on HW performance; lack of access to surgical care for poor people
  • AE, adverse event; HW, health worker; OT, operating theatre; PS, patient safety.