An approach to assessing patient safety in hospitals in low-income countries.

OBJECTIVE: The aim of the study was to assess non-technical aspects of patient safety practices using non-participant observation in different clinical areas. DESIGN: Qualitative study using non-participant observation and thematic analysis. SETTING: Two eye care units in Uganda. PARTICIPANTS: Staff members in each hospital. MAIN OUTCOME MEASURES: A set of observations of patient safety practices by staff members in clinical areas that were then coded using thematic analysis. RESULTS: Twenty codes were developed that explained patient safety practices in the hospitals based on the observations. These were grouped into four themes: the team, the environment, patient-centred care and the process. The complexity of patient safety in each hospital was described using narrative reports to support the thematic analysis. Overall both hospitals demonstrated good patient safety practices however areas for improvement were staff-patient communication, the presence and use of protocols and a focus on consistent practice. CONCLUSIONS: This is the first holistic assessment of patient safety practices in a low-income setting. The methods allowed the complexity of patient safety to be understood and explained with areas of concern highlighted. The next step will be to develop a useful and easy to use tool to measure patient safety practices in low-income settings