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Short Communication Volume 10 Issue 3
Simple ways to improve adherence to guidelines/standard operating procedures by health care workers in resource constrained and emergency settings
Kufakwanguzvarova Wilbert Pomerai, Mazuru Babigo Pomerai, Mazuru Batholowmew Gundidza
Department of Biomedical Science, Great Zimbabwe University, Zimbabwe
Correspondence: Kufakwanguzvarova Wilbert Pomerai, Faculty of Medicine, University of Zimbabwe, Zimbabwe
Received: July 04, 2025 | Published: August 13, 2025
Citation: Pomerai KW, Pomerai MB, Gundidza MB. Simple ways to improve adherence to guidelines/standard operating procedures by health care workers in resource constrained and emergency settings. MOJ Gerontol Ger. 2025;10(3):66‒67 DOI: 10.15406/mojgg.2025.10.00341
Abstract
Quality is adherence to standards and the standards are enshrined is standard operating procedures(SOP). There fore it is imperative for health workers to develop and adhere to SOPs even in emergency settings. This precise manual was developed to educate health workers the importance of SOPs and adhere to them. Review of literature using reputable search engines was done to generate imperial evidence for the production of this manual. In conclusion this manual is not exhaustive and must be used in conjunction with other relevant documents
Introduction
A standard Operation Procedure/ Practice (SOP) can is defined as established or prescribed methods to be followed routinely for the performance of designated operations or in designated situations they are at times called also standing operating procedure1 Other sources define SOP as is a set of step-by-step instructions compiled by an organisation to help workers carry out routine operations. SOPs aim to achieve efficiency, quality output, and uniformity of performance, while reducing miscommunication and failure to comply with industry regulations.2,3
Adherence to the Standard Operating Procedures (SOPs) by health workers is crucial for improving maternal and other health outcomes. Recurrence and prevention of deaths critically depends on adherence to SOPs. The area of adherence to SOPs in resource constrained areas is under researched.
Factors influencing adherence to SOPs
Health workers adherence/compliance to SOPs can be influenced by various factors, such as Training. A study in Kenya reported compliance of 47,2% due to low Awareness of SOP[3] Knowledge of the SOP and its benefits is essential. Regular training sessions on SOPs and their application improve adherence.3
Availability of resources: Adequate resources, such as trained personnel, time , case review forms, are critical. Supportive infrastructure, including data management systems, encourages compliance.3,4 This maybe the reason why Ministries of health are embarking on Electronic Health Records (EHR) so that documentation is made easier as compared to hard copies. The availability of the SOP makes it easy for referencing by staff and if it is not available staff have nowhere to refer and may fail to comply.4
Supportive leadership facility: It is crucial for management to actively support, supervise ,monitor and prioritize compliance to SOPs so that they foster adherence by staff at their facilities and programs including treatment camps. Clear communication about expectations and time lines of actions improves adherence. A study in Kenya on compliance to documentation SOP reported that facility leadership who are supportive have a positive impact on compliance.2,3
Workload and time constraints: The impact of workload on SOP compliance is significant and multifaceted. High workload leads to increased stress on health workers, cognitive overload, and time pressure, all of which negatively impact adherence to established procedures. However, with appropriate organizational support, resource allocation, and workload management strategies, the adverse effects can be mitigated. Ensuring a balanced workload is essential for maintaining compliance to SOPs, thereby upholding efficiency, safety, and overall organizational performance.5 Heavy workloads especially in outbreaks and staff shortages in public sectors may limit the ability to conduct thorough reviews. Most public health sectors are strained with high staff shortage due to brain drain. This has been reported by health managers as well. So when they provide service they may be few and tired and therefore fail to adhere to SOP.
Cultural and attitudinal factors: A blame-free culture encourages honest and accurate reporting and feedback on adherence to SOP. The processes of assessing adherence is all about learning from experiences so that they do not recur not to penalise staff. Therefore if it’s treated as a learning point health workers will not be afraid to report errors and also failures to adhere. Again there is limited information on this topic and the writer is using applied knowledge through experience. Addressing stigma and fear of repercussions can improve participation.4
Policy and regulation: Policies are high level organisational guidelines that form the framework within which SOPs will be developed. Policies ensure that there is alignment between organisational goals and SOPs.6 It is critical to have clear policies mandating adherence to SOPs and emphasizing their importance. However it is the compliance to guidelines and SOPs that has not been measured objectively .Regular monitoring and feedback mechanisms to ensure compliance. The feedback system is not documented in any literature.
Strategies to improve adherence to maternal death audit SOPs
A strategy is defined as a general plan to achieve one or more long-term or overall goals under conditions of uncertainty.7 The following are the strategies.
Capacity building: Training provides employees with the necessary knowledge to understand SOPs and their importance in addition skills development helps health workers develop key skills needed to carry out SOPs accurately and efficiently.5 A good example may be that in medicine manufacturing training on SOPs for medicine manufacturing ensures that employees follow precise procedures to maintain product quality.
Continuous training programs, coaching mentorships and peer learning are key. Continuous quality improvement using styles like KAIZEN are also key. The assumption is the more the capacity building of adherence to SOPs the better the adherence, leading to reduced variance, improved confidence, less errors and high quality3 and the opposite is true. The capacity building can be in the form of training, coaching, mentorship. Simulations can also be very practical and effective for improvement of capacity8 Furthermore this is cost effective as it may be integrated in orientation or departmental meetings
Strengthening systems: Simplify and streamline SOPs to ensure feasibility. Integrate audits into routine health facility activities. There is a culture of separating audits like maternal deaths, Malaria Tuberculosis and other death audits done separately. Because of the complexities and uniqueness in these conditions it is also better to separate them.9
Motivation and incentives: Recognize and reward compliance to SOPs. Create peer networks for sharing experiences and solutions. Rewards in the ministries are not based on compliance to SOPs but on other performance parameters like reduction in infections, deaths and many others. The researcher did not find much literature on this topic. If rewards are made on compliance to SOPs then adherence will improve.8
Monitoring and evaluation: Regular audits of the audit process to ensure adherence. Provide constructive feedback and follow up on recommendations. Auditing can be a very effective strategy to improve compliance and also the quality of the audits by identifying gaps in the process. This may lead to reduced deaths.8
Engaging stakeholders: Involve all levels of health workers in the audit process. Collaborate with external partners to ensure impartiality and broader insights. The extent to which all health workers are involved is unknown. A separate research on inclusivity in SOP adherence audit needs to be done.8–10
Acknowledgments
None.
Funding
No funding support has been taken from any organization.
Conflicts of interest
No conflict of interest has been declared by the authors.
References
- Standard operating procedure definition & meaning - merriam-webster accessed on. 2025
- Standard operating procedure. Merriam-Webster.com Dictionary, Merriam-Webster. 2025.
- Measuring the extent of compliance to standard operating procedures for documentation of medical records by healthcare workers in Kenya David F. O. Omoit , George O. Otieno , Kenneth K. Ruc.
- Dhananjaya S, Michael C. Over overcoming the barriers between resource constraints and healthcare quality. Trop Doct. 2023; 53(3):341–343.
- Business process Experts. The role of clear SOPs in regulatory compliance.
- Henry George Liddell, Robert Scott, A greek-english lexicon, on Perseus Wragg, David W. 1973.
- A dictionary of aviation (first ed.). Osprey. p. 251. ISBN 9780850451634.
- Heuser, Beatrice. The evolution of strategy : thinking war from antiquity to the present (Illustrated ed.). Cambridge, UK: Cambridge University Press. pp. 2010; 27–28.
- Academy to Innovate HR (AIHR). "How to make standard operating procedures (SOPs) Work for your organization.
- "Compliance management and the role of policies and procedures.
©2025 Pomerai, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.