title: Patient safety in maternal healthcare at secondary and tertiary level facilities in Delhi, India.
abstract: BACKGROUND
  There is insufficient information on causes of unsafe care at facility levels in India. This study was conducted to understand the challenges in government hospitals in ensuring patient safety and to propose solutions to improve patient care.
  
  
  METHODS
  Desk review, in-depth interviews, and focused group discussions were conducted between January and March 2014. Healthcare providers and nodal persons for patient safety in Gynecology and Obstetrics Departments of government health facilities from Delhi state of India were included. Data were analyzed using qualitative research methods and presented adopting the "health system approach."
  
  
  RESULTS
  The patient safety was a major concern among healthcare providers. The key challenges identified were scarcity of resources, overcrowding at health facilities, poor communications, patient handovers, delay in referrals, and the limited continuity of care. Systematic attention on the training of care providers involved in service delivery, prescription audits, peer reviews, facility level capacity building plan, additional financial resources, leadership by institutional heads and policy makers were suggested as possible solutions.
  
  
  CONCLUSIONS
  There is increasing awareness and understanding about challenges in patient safety. The available local information could be used for selection, designing, and implementation of measures to improve patient safety at facility levels. A systematic and sustained approach with attention on all functions of health systems could be beneficial. Patient safety could be used as an entry point to improve the quality of health care services in India.
authors.affiliation: World Health Organization Country Office for India, New Delhi, India.
authors.forename: Chandrakant
authors.initials: C
authors.lastname: Lahariya
authors.affiliation: World Health Organization Country Office for India, New Delhi, India.
authors.forename: Ankita
authors.initials: A
authors.lastname: Choure
authors.affiliation: Department of Anaesthesiology, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India.
authors.forename: Baljit
authors.initials: B
authors.lastname: Singh
keywords: Health systems; patient safety; quality of healthcare; universal health coverage