Abstract 49: Building a Culture of Quality Improvement at Butaro Cancer Center of Excellence in Rwanda
Authors: Sebahungu Fidele , Tuyisenge David , Buswell Lori , Habimana Olivier , Benemariya Esperance , Mugabo Fred , Ndayisaba Aphrodis , Shyirambere Cyprien , Tuyishime Hubert , Lee Yeonsoo Sara , Stauber Catherine , Cleveland Jessica , Kadish Sarah , Potiris Spyridon , Gunderson Dan , Fadelu Temidayo , Bigirimana Jean Bosco , Manzi Anatole , Pace Lydia 
Published: July 2021

Abstract
Purpose: As access to cancer care expands in sub-Saharan Africa, it is essential to develop strategies to examine and improve cancer care quality. We designed and implemented a quality improvement (QI) training and mentorship program for clinicians at Butaro Cancer Center of Excellence (BCCOE) in Rwanda to foster a culture of continual improvement. We report our early experience.
Methods: The BCCOE QI curriculum was adapted from programs from Dana-Farber Cancer Institute and Partners In Health-Rwanda and included didactic training, mentored QI projects and leadership development. Prior to the program, staff QI needs, experiences and perspectives were assessed through two focus group discussions (FGDs) with 18 participants. Written surveys assessed staff QI self-efficacy and knowledge immediately before and after a one-day training. Three BCCOE clinicians selected as QI mentors received an additional 3-day intensive training and longitudinal coaching by Rwanda- and US-based QI coaches. Mentors worked with clinician colleagues and coaches to identify quality gaps and devise and implement metric-based QI projects.
Results: FGD participants expressed eagerness to engage in QI efforts but identified challenges to QI implementation, including insufficient time, staff and financial resources. Forty oncology staff members (70% nurses) participated in one-day didactic trainings; 37 completed pre- and post-surveys. Perceived QI knowledge, confidence applying QI methods, and perception of adequate time for QI improved after the training (p&lt;0.001 for all using paired t-tests). Mean performance on knowledge assessment items increased from 64% to 73% (p=0.001). Mentor-led teams designed and launched projects to: improve cancer staging/documentation before treatment; increase chemotherapy order double-checking; and reduce chemotherapy wait times.
Conclusions: BCCOE's QI program has engaged oncology clinicians as QI leaders and participants, building a culture of team-based QI. Didactic training increased staff self-efficacy and knowledge, facilitating successful launch of projects. Future assessments will examine staff experience, attitudes and knowledge after project engagement.
Citation Format: Fidele Sebahungu, David Tuyisenge, Lori Buswell, Olivier Habimana, Esperance Benemariya, Fred Mugabo, Aphrodis Ndayisaba, Cyprien Shyirambere, Hubert Tuyishime, Yeonsoo Sara Lee, Catherine Stauber, Jessica Cleveland, Sarah Kadish, Spyridon Potiris, Dan Gunderson, Temidayo Fadelu, Jean Bosco Bigirimana, Anatole Manzi, Lydia Pace. Building a Culture of Quality Improvement at Butaro Cancer Center of Excellence in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 49.