TY - JOUR T1 - Implementation challenges to patient safety in Guatemala: a mixed methods evaluation JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 353 LP - 363 DO - 10.1136/bmjqs-2020-012552 VL - 31 IS - 5 AU - Bria J Hall AU - Melany Puente AU - Angie Aguilar AU - Isabelle Sico AU - Monica Orozco Barrios AU - Sindy Mendez AU - Joy Noel Baumgartner AU - David Boyd AU - Erwin Calgua AU - Randall Lou-Meda AU - Carla C Ramirez AU - Ana Diez AU - Astrid Tello AU - J Bryan Sexton AU - Henry Rice Y1 - 2022/05/01 UR - http://qualitysafety.bmj.com/content/31/5/353.abstract N2 - 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.Data are available upon reasonable request. To protect the confidentiality of study participants, data are available upon reasonable request to the corresponding author. ER -