PT  - JOURNAL ARTICLE
AU  - Henry E Rice
AU  - Randall Lou-Meda
AU  - Anthony T Saxton
AU  - Bria E Johnston
AU  - Carla C Ramirez
AU  - Sindy Mendez
AU  - Eli N Rice
AU  - Bernardo Aidar
AU  - Brad Taicher
AU  - Joy Noel Baumgartner
AU  - Judy Milne
AU  - Allan S Frankel
AU  - J Bryan Sexton
TI  - Building a safety culture in global health: lessons from Guatemala
AID  - 10.1136/bmjgh-2017-000630
DP  - 2018 Mar 01
TA  - BMJ Global Health
PG  - e000630
VI  - 3
IP  - 2
4099  - http://gh.bmj.com/content/3/2/e000630.short
4100  - http://gh.bmj.com/content/3/2/e000630.full
AB  - 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.