Barriers to Improving Patient Safety in India: Focus Groups with Providers in the Southern State of Kerala

OBJECTIVE: To understand the perceptions of health care providers about barriers to improved patient safety in the Indian state of Kerala. MATERIALS AND 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. SETTING: One rural primary care clinic, one secondary care hospital and one tertiary care center in Kerala, India. PARTICIPANTS: 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.