Building a safety culture in global health: lessons from Guatemala

Abstract

Programmes to modify the safety culture have led to lasting improvements in patient safety and quality of care in high-income settings around the world, although their use in low-income and middle-income countries (LMICs) has been limited. This analysis explores (1) how to measure the safety culture using a health culture survey in an LMIC and (2) how to use survey data to develop targeted safety initiatives using a paediatric nephrology unit in Guatemala as a field test case. We used the Safety, Communication, Operational Reliability, and Engagement survey to assess staff views towards 13 health climate and engagement domains. Domains with low scores included personal burnout, local leadership, teamwork and work–life balance. We held a series of debriefings to implement interventions targeted towards areas of need as defined by the survey. Programmes included the use of morning briefings, expansion of staff break resources and use of teamwork tools. Implementation challenges included the need for education of leadership, limited resources and hierarchical work relationships. This report can serve as an operational guide for providers in LMICs for use of a health culture survey to promote a strong safety culture and to guide their quality improvement and safety programmes.

Factors Related to the Differential Development of Inter-Professional Collaboration Abilities in Medicine and Nursing Students

“…This educational gap is a pending task in Latin America, where an important part of the 6 years of medical training is done in public hospitals. Recent studies warn of a dominant hierarchical work culture in those public healthcare institutions (Rocha et al, 2014;San-Martín et al, 2017a;Rice et al, 2018). Finding out whether a long exposition to a hierarchical environment influences how medicine students develop their attitudes toward inter-professional collaboration with nurses is an important educational concern (Fox et al, 2018).…”

Developing a national patient safety plan in Guatemala

“…Although the national patient safety plan is one indicator that the building blocks are in place to provide high-quality care, a national strategy alone has limited capacity to promote action. To augment these policy efforts, we advocate efforts to promote a “just culture,” or support a safety culture that values transparency, communication, and investment in trained personnel and systems to promote continuous quality improvement (11).…”

“…Most of the regions with the highest MMR levels also have the lowest health spending per capita (12). Both patients and health care personnel have expressed concerns about health care quality in Guatemala, which has led to new programs to improve patient safety (11, 18).…”

“…Health systems around the world have adopted common strategies to promote patient safety, including enhanced systems to measure medical errors, use of performance indicators, and implementation of evidence-based clinical guidelines (2). Several Latin American countries have led patient safety efforts, including Brazil, Guatemala, and Mexico (8-11). However, the successful implementation of comprehensive national patient safety programs in Latin America remains limited.…”

Teaching patient safety in global health: lessons from the Duke Global Health Patient Safety Fellowship

“…The Duke Global Health Patient Safety Fellowship grew from a collaboration between Duke University and the Roosevelt Hospital/University of San Carlos in Guatemala. Over the recent years, we have expanded this partnership to programmes in healthcare safety, focusing on initiatives to enhance patient safety in Guatemala 26 27. We conducted a formal needs assessment using semistructured interviews early in this collaboration, which identified several institutional needs to improve patient safety, such as enhanced understanding of the value of measuring medical errors, improved data collection systems and access to tools to modify the safety culture.…”