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Implementation challenges to patient safety in Guatemala: a mixed methods evaluation.

Publication ,  Journal Article
Hall, BJ; Puente, M; Aguilar, A; Sico, I; Orozco Barrios, M; Mendez, S; Baumgartner, JN; Boyd, D; Calgua, E; Lou-Meda, R; Ramirez, CC; Diez, A ...
Published in: BMJ Qual Saf
May 2022

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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Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

May 2022

Volume

31

Issue

5

Start / End Page

353 / 363

Location

England

Related Subject Headings

  • Quality Improvement
  • Qualitative Research
  • Patient Safety
  • Humans
  • Health Policy & Services
  • Guatemala
  • Focus Groups
  • Child
  • 1302 Curriculum and Pedagogy
  • 1117 Public Health and Health Services
 

Citation

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Hall, B. J., Puente, M., Aguilar, A., Sico, I., Orozco Barrios, M., Mendez, S., … Rice, H. (2022). Implementation challenges to patient safety in Guatemala: a mixed methods evaluation. BMJ Qual Saf, 31(5), 353–363. https://doi.org/10.1136/bmjqs-2020-012552
Hall, Bria J., Melany Puente, Angie Aguilar, Isabelle Sico, Monica Orozco Barrios, Sindy Mendez, Joy Noel Baumgartner, et al. “Implementation challenges to patient safety in Guatemala: a mixed methods evaluation.BMJ Qual Saf 31, no. 5 (May 2022): 353–63. https://doi.org/10.1136/bmjqs-2020-012552.
Hall BJ, Puente M, Aguilar A, Sico I, Orozco Barrios M, Mendez S, et al. Implementation challenges to patient safety in Guatemala: a mixed methods evaluation. BMJ Qual Saf. 2022 May;31(5):353–63.
Hall, Bria J., et al. “Implementation challenges to patient safety in Guatemala: a mixed methods evaluation.BMJ Qual Saf, vol. 31, no. 5, May 2022, pp. 353–63. Pubmed, doi:10.1136/bmjqs-2020-012552.
Hall BJ, Puente M, Aguilar A, Sico I, Orozco Barrios M, Mendez S, Baumgartner JN, Boyd D, Calgua E, Lou-Meda R, Ramirez CC, Diez A, Tello A, Sexton JB, Rice H. Implementation challenges to patient safety in Guatemala: a mixed methods evaluation. BMJ Qual Saf. 2022 May;31(5):353–363.

Published In

BMJ Qual Saf

DOI

EISSN

2044-5423

Publication Date

May 2022

Volume

31

Issue

5

Start / End Page

353 / 363

Location

England

Related Subject Headings

  • Quality Improvement
  • Qualitative Research
  • Patient Safety
  • Humans
  • Health Policy & Services
  • Guatemala
  • Focus Groups
  • Child
  • 1302 Curriculum and Pedagogy
  • 1117 Public Health and Health Services