Inside the Utstein Process

Chris

Once the ECO strategy was adopted at the World Health Assembly, the natural next step was a way to tell countries whether they’re making progress. That means a monitoring framework with a set of global indicators. To build it, we first had to understand what indicators already exist.

Chris

It started with a literature search that identified more than 1,300 indicators. After de-duplication, that was narrowed to about 130. Those went through three rounds of Delphi voting, two before we met in person and one at the meeting itself.

Amy Leah

We also held a “rescue” session. There was a lot of overlap between indicators, so some good ones were eliminated along the way. If the group agreed an indicator belonged, it went back in.

Chris

Feasibility was a major driver. The government data specialists in the room kept us grounded. An indicator that's collected once a decade can't track progress. There was a strong preference for indicators countries already collect, such as those tied to the SDGs, so we don't add to the data burden. Indicators also had to measure ECO care directly, not conditions upstream of it.

Amy Leah

The ECO continuum is so broad that a single well-chosen indicator can speak to emergency, trauma and surgical care all at once.

Amy Leah

What made this group work was that we weren't there as SOTA representatives. We were there for all of ECO care. Having people that diverse in one room, looking across the whole spectrum, was inspiring.

Chris

Everyone came in with priorities they were passionate about, and nobody got everything they wanted. What came out of it is a genuinely negotiated consensus, and that's what gives it credibility.

Chris

Working within the ECO continuum means we're advocating for an entire system of care, with a much broader set of partners. It also fixes a problem we've had before. Many of the surgical indicators proposed after the 2015 Lancet Commission were never tied to a monitoring framework, so no one owned them and they weren't consistently measured. Indicators embedded in a WHO framework are far more likely to be collected.

Amy Leah

It's a two-way street. Surgical care benefits from strong emergency systems, and emergency care depends on surgical capacity. The everyday strength of operative care is the baseline for how well a health system can respond in an emergency.

Chris

You're surrounded by people with remarkable backgrounds, and yes, you get some imposter syndrome. But everyone is there for the same reason. The days were long, and it was inspiring.

Amy Leah

The meeting also included a group hike, and I would still be on that mountain today if it weren't for Chris.