title: Barriers to improving patient safety in India: focus groups with providers in the southern state of kerala.
abstract: OBJECTIVE
  To understand the perceptions of health care providers about barriers to improved patient safety in the Indian state of Kerala.
  
  
  METHODS
  Five focus group discussions were held with 16 doctors and 20 nurses across three institutions (primary, secondary and tertiary care centers) in Kerala, India. Transcripts were analyzed by thematic analysis.
  
  
  METHODS
  One rural primary care clinic, one secondary care hospital and one tertiary care center in Kerala, India.
  
  
  METHODS
  16 doctors and 20 nurses participated in five focus groups.
  
  
  RESULTS
  Overall, there were 129 unique mentions of barriers to patient safety; these barriers were categorized into five major themes. 'Limited resources' was the most prominent theme, followed by barriers related to health systems issues, the medical culture, provider training and patient education/awareness.
  
  
  CONCLUSIONS
  Although inadequate resources are likely a substantial challenge to the improvement of patient safety in India, other patient safety barriers such as health systems changes, training, and education, could be addressed with fewer resources. While initial approaches to improving patient safety in India and other low- and middle-income countries have focused on implementing processes that represent best practices, this study suggests that multifaceted interventions to also address more structural problems (such as resource constraints, systems issues, and medical culture) may be important.
authors: UC Berkeley - UCSF Joint Medical Program, University of California, Berkeley, California, USA.
authors: John
authors: J
authors: Landefeld
authors: Clinical Epidemiology Research and Training Centre, Government Medical College, Thiruvananthapuram, Kerala, India.
authors: Remadevi
authors: R
authors: Sivaraman
authors: The INCLEN Trust International, New Delhi, India.
authors: Narendra Kumar
authors: NK
authors: Arora
keywords: Attitudes; patient safety; qualitative research; safety culture