Egide Abahuje

Background: How user-centred prototyping is carried out to solve adult critical care issues depends on the unique characteristics of this context. This review aimed to characterise prototyping in the context of critical care in terms of the types of prototypes developed, activities used to generate prototypes and settings in which prototypes were generated. Methods: Four databases (PubMed, CINAHL, SCOPUS and IEEExplore) were searched for articles published from inception to 25 September 2025, in English, that involved prototyping to address issues in adult critical care. Two reviewers independently screened the search results to identify eligible articles and reviewed retained articles. Results: 22 of 860 articles met the eligibility criteria. Role, look and feel, implementation and integration prototype types which combined two or more of these prototypes were identified. Prototypes addressing both role and look and feel were most common. 10 prototyping activities were reported, namely sketching, storyboarding, interactivity simulation, digitalising and adapting paper-based forms, rank ordering, building a functional device model, survey for item selection, card sorting, adapting a predeveloped high-tech prototype to a low-tech version, and revising existing workflow. Six of 22 articles reported multiple activities. Sketching was the most often used activity, and the in-person hospital setting was the most reported. Conclusions: Overall, there was a lack of reporting on the details of the prototyping processes. Such details could help future researchers anticipate the unique challenges of prototyping to develop solutions to solve adult critical care issues, learn from prior successful experiences and better plan strategies to address these challenges.

Background: Clinician perspectives on machine learning and artificial intelligence (ML/AI) vary with discipline. However, fewer studies describe patient perspectives and address medical situations that require rapid decisions with durable consequences for patient outcomes. This study characterized perspectives (qualitatively) and sentiment (quantitatively) regarding the use of ML/AI for patient management in neurological emergencies. Methods: We conducted semi-structured interviews with survivors (or their proxy) of intracranial hemorrhage, and clinicians who care for such patients. Interviews were analyzed qualitatively using thematic analysis, and quantitatively using sentiment analysis to assess attitudes using a transformer-based language model with scores from -1 (most negative) to 1 (most positive). Results: We enrolled 21 participants (14 patients, 1 proxy, and 6 clinicians) and reached thematic saturation. Help with clinical decision-making was cited as an advantage of ML/AI. Participants noted the importance of considering ML/AI as an adjunct to clinical care, not as a replacement for clinicians. Over-reliance on recommendations, potentially leading to diminution of clinician skill, incorrect ML/AI recommendations, potential liability, and bias were cited as challenges. Clinician and patient education were noted as a potential burden. Median sentiment scores ranged from 0.0 (neutral) to 0.3 (positive). Sentiment varied with question type (P < .001). Questions about clinicians using ML/AI for patient care had the highest sentiment score. Discussion and Conclusion: Patients and clinicians expressed mixed views about ML/AI. Potential benefits related to improved decision-making and concerns focused on bias, liability, and the need for further education. Future work should address how best to incorporate ML/AI into education and obviate potential burdens as ML/AI is integrated into clinical care.

Background: Non‐technical skills for Surgeons (NOTSS) lead to safer intraoperative patient care. There is a need to understand how to sustain the implementation of NOTSS training programs. The study aims were (1) to quantitatively assess perioperative care providers perceptions of the hospitals' readiness to sustain implementation of a NOTSS training program, and (2) to qualitatively investigate factors associated with hospitals' readiness to implement a NOTSS training program. Methods: This Mixed Methods study was conducted in 11 Rwandan hospitals from March 2022 to October 2023. Perioperative care providers previously trained in NOTSS were invited to attend a two‐hour NOTSS refresher course. Immediately after the course, quantitative data were collected from participants using the paper‐based Safe Surgery Organizational Readiness Tool (SSORT), and Safety Attitude Questionnaire. Qualitative data were collected via semi‐structured interviews and focus groups. Results: Of the 477 participants (94.5% response rate) who completed the survey, 248 (51.9%) were female. The overall participants' SSORT score was 4.01, Interquartile range (IQR): 3.68–4.28. Most participants perceived that NOTSS training was appropriate Median 5, IQR: 4.5–5. Participants who reported satisfaction with hospital readiness to sustain the implementation of the NOTSS training program (overall SSORT score) were also satisfied with safety climate, adjusted odds Ratio (aOR): 1.02, 95% CI: 1.01–1.040), and teamwork climate, aOR: 1.05, 95% CI: 1.03–1.06. Qualitatively, four themes emerged: (1) the NOTSS training program was appropriate to improve patient safety, (2) understaffing compromised implementation of the quality improvement, (3) Hospital leaders supported quality improvement projects, and (4) there was a lack of enough resources for the hospital to support quality improvement projects. Conclusion: Perioperative care providers in Rwanda perceived that NOTSS training programs were appropriate and supported by leadership. Insufficient financial resources and work overload led to participants' lower satisfaction with the capacity of their hospitals to implement NOTSS training programs.

Background: Strengthening health systems through planned safety and quality improvement initiatives is an imperative to achieve more equitable, resilient, and effective care. And yet, years of organizational behavior research demonstrate that change initiatives often fall short because managers fail to account for organizational readiness for change. This finding remains true especially among surgical safety and quality improvement initiatives in low-income countries and middle-income countries. In this study, our aim was to psychometrically assess the construct validity and internal consistency of the Safe Surgery Organizational Readiness Tool (SSORT), a short survey tool designed to provide change leaders with insight into facility infrastructure that supports learning and readiness to undertake change. Materials and methods: To demonstrate generalizability and achieve a large sample size (n=1706) to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), a collaboration between seven surgical and anesthesia safety and quality improvement initiatives was formed. Collected survey data from health care workers were divided into pilot, exploration, and confirmation samples. The pilot sample was used to assess feasibility. The exploration sample was used to conduct EFA, while the confirmation sample was used to conduct CFA. Factor internal consistency was assessed using Cronbach’s alpha coefficient. Results: Results of the EFA retained 9 of the 16 proposed factors associated with readiness to change. CFA results of the identified 9 factor model, measured by 28 survey items, demonstrated excellent fit to data. These factors (appropriateness, resistance to change, team efficacy, team learning orientation, team valence, communication about change, learning environment, vision for sustainability, and facility capacity) were also found to be internally consistent. Conclusion: Our findings suggest that communication, team learning, and supportive environment are components of change readiness that can be reliably measured prior to implementation of projects that promote surgical safety and quality improvement in low-income countries and middle-income countries. Future research can link performance on identified factors to outcomes that matter most to patients.