Table 3 Illustrative quotations of themes about features of and challenges to a successful mentorship intervention
Themes and sub-themes | Illustrative Quotations* |
|---|---|
Valuable elements of the mentorship intervention | |
Multimodality of the mentorship intervention | They are all valuable, because they all depend on each other and none can stand on behalf of the other. (Surgical Provider, Region 1, Facility 2) |
Supportive side-by-side clinical coaching | They will perform the first case and we observe and identify the gaps that they have. The second case we all scrub in together -both the mentors and the mentees – and we can perform together so in that way we can impact the knowledge through doing procedures together. (Mentor 1) |
Standardization of practices | Nowadays we hardly forget the use of the checklist. The theater staff now has a system of preparing the trays for vaginal cleansing prior whereas in the past days that was not present. Therefore, when there is a ruptured membrane you could just order for a tray that has been prepared and sterilized so it has changed the way people work. (Region 1, Facility 3, Facility Leader) |
Useful features of the mentor–mentee relationship | |
Relationship-building | If you have a mentorship relationship it has to be close. Even if you have something it can be easily shared with them. This makes it easy even to share knowledge and interest between mentors and mentees and it can increase the relationship, because you know each other even outside work and if you have something to ask you may communicate with him or her. (Region 2, Facility 4, Surgical Provider) |
Friendliness | We get feedback from mentees and most of the time, they give us feedback that they benefitted from what we offered them and the way we offered is friendly…and we participated as part of their team. And all this is because we had training before we performed mentorship compared to the formal medical training in Tanzania where there is a gap between a lecturer and a student. (Mentor 5) |
Psychological safety | It is a fine one, because someone who is not a dictator to you, you may have a conversation and you are able to exchange views. We are comfortable to admit mistake and ask questions and help. (Region 2, Facility 4, Surgical Provider) |
Mentors as part of the surgical team | The relationship is good, because when they come here we work together and they become like team members of the facility. We work together like team members for quality improvement of services. (Nurse, Region 1, Facility 4) |
Understanding of context | Mentors were trying to understand the local context and condition of the facility, and we started from the entrance gate. (Region 2, Facility 3, Nurse) |
Helpful characteristics of the mentor | |
Non-judgmental feedback | The mentors were not judgmental as in once you fail they will not judge you. So it is a conversation. They tell you something and you will ask questions and they will correct like ‘do this and you were not supposed to do this’ in a guiding manner and they give a chance to ask questions. (Surgical Provider, Region 2, Facility 4) |
Mentor experience level | I think when you bring mentors at the facility, they should be senior mentors. For example, I am a senior nurse anaesthetist. When you bring a mentor that is junior to me like someone who has been practicing for less than 6 months in the field then usually cannot add value to me. (Anaesthetist, Region 2, Facility 1) The mentors are skilled, the whole team is skilled from the surgeon, anesthetist and the nurse are all skilled so when they come and they face the challenges of the facility they can assist and tackle together with discussion. (Region 1, Facility 1, Surgical Provider) |
Accessibility of the mentor | They leave behind their numbers and they let people know that they are available so when someone is in trouble they can contact them…There was a time they [surgical team] had a fistula patient, they communicated, and they found a way forward so it has been a team. (Facility Leader, Region 2, Facility 2) |
Challenges to mentorship | |
Resistance/lack of buy-in | The challenge is some of the providers were taking this program like it belonged to those that only attended the [SS2020] training. They were not ready to involve directly on the mentorship program so sometimes you may find that when mentors come to the facility there is high effort used to get all members that are needed for the program. There is still some resistance at the facility in relation to the mentorship program. (Surgical Provider, Region 1, Facility 2) |
Shortage of surgical providers | Some of the barriers are time, because you may find people have other activities to attend to during the time of presentations/sessions…Another thing is the shortage of staff. Providers may be alone in the ward and it is difficult for them to leave patients and attend the sessions. (Focus Group Discussion, Region 1, Facility 2) |
Mentorship dose | I think the frequency can increase – at least that they should come monthly and they could stay at least if possible for a week for the mentorship. (Region 2, Facility 1, Surgical Provider) |
Logistical challenges | The main problem in this is the language barrier, because our country is based very much on Swahili…It would be better to have handouts and translation if possible in Swahili. Sometimes the internet is a problem and it is not stable. (Focus Group Discussion, Facility 1, Region 1) |