Abstract:
Ways to address the increasing global health workforce shortage include improving
the occupational health and safety of health workers, particularly those in high-risk, low-resource
settings. The World Health Organization and International Labour Organization designed
HealthWISE, a quality improvement tool to help health workers identify workplace hazards to
find and apply low-cost solutions. However, its implementation had never been systematically
evaluated. We, therefore, studied the implementation of HealthWISE in seven hospitals in three
countries: Mozambique, South Africa, and Zimbabwe. Through a multiple-case study and thematic
analysis of data collected primarily from focus group discussions and questionnaires, we examined
the enabling factors and barriers to the implementation of HealthWISE by applying the integrated
Promoting Action on Research Implementation in Health Services (i-PARiHS) framework. Enabling
factors included the willingness of workers to engage in the implementation, diverse teams that
championed the process, and supportive senior leadership. Barriers included lack of clarity about how
to use HealthWISE, insu cient funds, stretched human resources, older buildings, and lack of incident
reporting infrastructure. Overall, successful implementation of HealthWISE required dedicated local
team members who helped facilitate the process by adapting HealthWISE to the workers’ occupational
health and safety (OHS) knowledge and skill levels and the cultures and needs of their hospitals,
cutting across all constructs of the i-PARiHS framework.
