Browsing by Author "Rice, Henry"

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    Implementation challenges to patient safety in Guatemala: a mixed methods evaluation.
    (BMJ quality & safety, 2021-05-26) Hall, Bria J; Puente, Melany; Aguilar, Angie; Sico, Isabelle; Orozco Barrios, Monica; Mendez, Sindy; Baumgartner, Joy Noel; Boyd, David; Calgua, Erwin; Lou-Meda, Randall; Ramirez, Carla C; Diez, Ana; Tello, Astrid; Sexton, J Bryan; Rice, Henry

    Background

    Little is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety programme for paediatric care in Guatemala.

    Methods

    We used a mixed methods design to examine the implementation of a patient safety programme across 11 paediatric units at the Roosevelt Hospital in Guatemala. The safety programme included: (1) tools to measure and foster safety culture, (2) education of patient safety, (3) local leadership engagement, (4) safety event reporting systems, and (5) quality improvement interventions. Key informant staff (n=82) participated in qualitative interviews and quantitative surveys to identify implementation challenges early during programme deployment from May to July 2018, with follow-up focus group discussions in two units 1 year later to identify opportunities for programme modification. Data were analysed using thematic analysis, and integrated using triangulation, complementarity and expansion to identify emerging themes using the Consolidated Framework for Implementation Research. Salience levels were reported according to coding frequency, with valence levels measured to characterise the degree to which each construct impacted implementation.

    Results

    We found several facilitators to safety programme implementation, including high staff receptivity, orientation towards patient-centredness and a desire for protocols. Key barriers included competing clinical demands, lack of knowledge about patient safety, limited governance, human factors and poor organisational incentives. Modifications included use of tools for staff recognition, integration of education into error reporting mechanisms and designation of trained champions to lead unit-based safety interventions.

    Conclusion

    Implementation of safety programmes in low-resource settings requires recognition of facilitators such as staff receptivity and patient-centredness as well as barriers such as lack of training in patient safety and poor organisational incentives. Embedding an implementation analysis during programme deployment allows for programme modification to enhance successful implementation.
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    ItemOpen Access
    Program Evaluation of a Gun Violence Listening Intervention in Durham, NC
    (2024) Swandell, Jordan

    This project sought to evaluate the effectiveness of Prescriptions for Repair (P4R). P4R is a listening intervention in which trained community-based facilitators help survivors of gun violence or the loved ones of victims of gun violence tell their stories. Objectives of the evaluation were to determine to what degree P4R was conducted as designed, assess whether P4R achieved its intended outcomes, assist the project’s leadership and staff know what aspects of the program were effective and why, and help capture lessons that can be applied to other gun violence interventions or to other partnerships between academic/healthcare institutions and community-based organizations. Evaluation questions were developed through a process that involved interviews and surveys of P4R interested parties. Evaluation questions were answered utilizing exit surveys of participants; exit surveys of facilitators; interviews and surveys of P4R leadership, staff, and other interested parties; and review of program administrative data. This evaluation found that nearly all program participants felt that the P4R listening sessions contributed to their personal healing, nearly all program participants felt they had the opportunity to share their thoughts about breaking cycles of gun violence in Durham, nearly all program participants and facilitators believed that P4R can contribute to reducing gun violence, and cooperation between academic/healthcare institutions and local community-based organizations can lay the groundwork for positive change in the community.