How is patient safety understood by healthcare professionals? The case of Bhutan

Objective: The aim of the study was to explore how the term patient safety is understood by healthcare professionals (nurses, educators, doctors, ward managers, senior managers, and health assistants), all of whom are responsible for promoting the patient safety agenda in the Bhutanese healthcare system.&nbsp;&nbsp;Methods: The study was conducted as a naturalistic inquiry using qualitative exploratory descriptive inquiry. A purposeful sample of 94 healthcare professionals and managers was recruited from three different hospitals, a training institute, and the Ministry of Health. Data were collected via in-depth individual interviews. All data were subsequently analyzed using thematic analysis strategies. &nbsp;Results: Data analysis revealed variation in the understanding of patient safety among healthcare professionals. Although most participants understood patient safety as fundamentally concerning &ldquo;doing no harm&rdquo; or &ldquo;reducing the risk of harm or injuries&rdquo; to patients, some understood patient safety as simply having sturdy infrastructure/buildings with sufficient space to manage public health emergencies such as earthquakes, floods, and epidemics. Some confused patient safety with quality of care and patient rights. &nbsp;Conclusions: Inadequate understanding of the term patient safety has potential to hinder improvement of patient safety processes and practices in the Bhutanese healthcare system. To improve patient safety in Bhutan&rsquo;s healthcare system, patient safety training and education need to be provided to all categories of healthcare professionals.</div

Patient safety issues and concerns in Bhutan’s healthcare system: a qualitative study.

This study identified medication errors, healthcare associated infections, diagnostic errors, surgical errors, laboratory errors and a lack of infrastructure to progress patient safety in hospital contexts as major concerns in the resource poor nation of Bhutan. A culturally adaptive Bhutanised approach to redress these concerns and improve patient safety is proposed

An Exploration of the Gross National Happiness Approach to Assure Patient Safety and Healthcare Quality in Bhutan

Although the principles of Gross National Happiness (GNH) are currently being used as the overall framework for Bhutan’s development programs (including healthcare services), little is known about how Bhutanese healthcare professionals perceive the relationship between GNH and patient safety or how the GNH principles could help in improving patient safety in Bhutan’s healthcare system. The aim of this study was to explore how Bhutanese healthcare professionals, educators, managers, and policy makers perceive the relationship between GNH and patient safety and what they believe should be done to improve patient safety in Bhutan. A qualitative exploratory descriptive study using in-depth interviews was undertaken. All audio-recordings were transcribed verbatim and analyzed using content and thematic analysis strategies. Four major themes were identified: patient safety being important for GNH; incorporating the concept of GNH in healthcare; adopting the GNH values, whereby everyone believes that “someone’s happiness would be our happiness”; and educating healthcare professionals about GNH. Incorporation of the concept of GNH in healthcare could help transform the attitudes and behaviors of healthcare professionals toward patient care by producing a “Bhutanized” doctors and healthcare professionals and creating a Bhutanized healthcare system

Establishing cultural integrity in qualitative research: reflections from a cross-cultural study

This article contributes to the growing body of literature on the methods and techniques that might be used to help ensure the cultural integrity and rigor of research that has a cross-cultural dimension. Drawing upon our experiences while conducting a study investigating patient safety concerns in Bhutan, we will reflect on how the study was conceptualized and framed around the elements of the Bhutanese traditional cultural values; how the researchers were positioned; and how the intercultural perceptions, representations, languages, and attitudes influenced the fieldwork processes. It is anticipated that the approach described in this article will help qualitative researchers to understand how important it is to recognize and be responsive to the cultural and linguistic nuances of given research settings to achieve cultural integrity

Patient safety issues and concerns in Bhutan\u27s healthcare system: a qualitative exploratory descriptive study

OBJECTIVES: To investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan\u27s healthcare system. DESIGN: Qualitative exploratory descriptive inquiry. SETTINGS: Three different levels of hospitals, a training institute and the Ministry of Health, Bhutan. PARTICIPANTS: In total, 140 healthcare professionals and managers. METHODS: Narrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies. RESULTS: The data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting \u27good\u27 communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system. CONCLUSION: Patient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised

Nurses\u27 understanding of patient-centred care in Bhutan

Aim The purpose of the study was to explore nurses\u27 perceptions and understanding of patient-centred care (PCC) in Bhutan. Background Nurses\u27 perceptions and understanding of PCC in Bhutan are unknown. Methods A non-probability convenience sample was taken and a mixed method (quantitative and qualitative descriptive) used. Survey questionnaires were administered to 87 Bhutanese nurses in three types of hospitals -- the National Referral Hospital, the regional referral hospital and the district hospital. Descriptive statistics including frequency distribution, mean and standard deviation (SD) were used for analysis. Spearman\u27s correlation coefficients were used to investigate relationships between demographic variables. Results The nursing labour force in Bhutan knows which behaviours are considered necessary for practising PCC. The mean (SD) rating of behaviours considered critical for practising PCC was 4.29 (0.22), five being the highest score. Bhutanese nurses described PCC, according to qualitative descriptive analysis, as being based on individual patient assessment (22/87 or 25% of respondents), using a holistic model of care (38/87 or 44%) that was based on evidence (38/87 or 44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in terms of insufficient numbers of staff and lack of advanced practitioners (56/87 or 64%), was revealed as the main factor that hinders development of PCC. Conclusion Bhutanese nurses believed certain behaviours were critical to PCC. Reform of higher nursing education, putting an emphasis on PCC, would improve nursing practice and increase its scope

Culture matters: indigenizing patient safety in Bhutan

Studies show that if quality of healthcare in a country is to be achieved, due consideration must be given to the importance of the core cultural values as a critical factor in improving patient safety outcomes. The influence of Bhutan\u27s traditional (core) cultural values on the attitudes and behaviours of healthcare professionals regarding patient care are not known. This study aimed to explore the possible influence of Bhutan\u27s traditional cultural values on staff attitudes towards patient safety and quality care. Undertaken as a qualitative exploratory descriptive inquiry, a purposeful sample of 94 healthcare professionals and managers were recruited from three levels of hospitals, a training institute and the Ministry of Health. Interviews were transcribed verbatim and analysed using thematic analysis strategies. The findings of the study suggest that Bhutanese traditional cultural values have both productive and counterproductive influences on staff attitudes towards healthcare delivery and the processes that need to be in place to ensure patient safety. Productive influences encompassed: karmic incentives to avoid preventable harm and promote safe patient care; and the prospective adoption of the \u27four harmonious friends\u27 as a culturally meaningful frame for improving understanding of the role and importance of teamwork in enhancing patient safety. Counterproductive influences included: the adoption of hierarchical and authoritative styles of management; unilateral decision-making; the legitimization of karmic beliefs; differential treatment of patients; and preferences for traditional healing practices and rituals. Although problematic in some areas, Bhutan\u27s traditional cultural values could be used positively to inform and frame an effective model for improving patient safety in Bhutan\u27s hospitals. Such a model must entail the institution of an \u27indigenized\u27 patient safety program, with patient safety research and reporting systems framed around local patient safety concerns and solutions, including religious and cultural concepts, values and perspectives