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Implementation challenges to patient safety in Guatemala: a mixed methods evaluation
Bria J Hall1, Melany Puente1, Angie Aguilar2
1Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
Patient safety programs in low-resource settings face challenges like limited training and incentives. Recognizing staff receptivity and patient-centeredness can improve implementation success.
Area of Science:
- Healthcare Management
- Patient Safety
- Implementation Science
Background:
- Limited understanding of patient safety program implementation in low and middle-income countries.
- Need to evaluate patient safety initiatives in resource-constrained environments.
Purpose of the Study:
- To evaluate the implementation of a patient safety program in paediatric care in Guatemala.
- Identify facilitators and barriers to program success.
Main Methods:
- Mixed methods design across 11 paediatric units.
- Utilized surveys, interviews, and focus groups with 82 key informants.
- Employed thematic analysis and the Consolidated Framework for Implementation Research.
Main Results:
- Facilitators included staff receptivity, patient-centeredness, and desire for protocols.
- Barriers comprised competing demands, lack of knowledge, limited governance, and poor incentives.
- Modifications involved staff recognition, integrated education, and trained champions.
Conclusions:
- Successful implementation in low-resource settings requires addressing facilitators and barriers.
- Ongoing analysis during deployment enables program modification for enhanced success.
Background:
Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala.
Methods:
We used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation.
Results:
We found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions.
Conclusion:
Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.
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