Implementation and Validation of a Comprehensive Unit-Based Safety Program to Improve Safety Culture in a Developing Country
Current conceptual thinking about patient safety places the prime responsibility for adverse events on deficiencies in system design, organization, and operation rather than on individual practitioners or products. Countermeasures based on changes in the system are, therefore, more productive than those that target the behavior of individuals and their propensity to commit errors. The World Health Organization (WHO) acknowledges that to tackle patient safety internationally, a comprehensive, multifaceted approach involving cultural change, system development, and technical expertise is necessary. Using the comprehensive unit-based safety program (CUSP) in Baltimore and Michigan, our group has previously produced statistically significant improvements in safety culture, central line-associated bloodstream infections (CLABSI), and intensive care unit (ICU) length of stay. Recent evidence suggests that patients in developing countries suffer from substantial preventable harm that is likely greater than that in the developed world, but strategies to reduce that harm have yet to be properly developed and tested, let alone implemented. In this proposal, our goals are to implement CUSP in ICUs in Karachi, Pakistan; to identify the unique barriers to implementing these measures in developing countries; to evaluate the efficacy of CUSP in improving the existing safety culture in a developing country and in training healthcare personnel to learn from mistakes; and to reduce the incidence of CLABSI. By identifying potential barriers and learning to adapt to local context, we can use what we learn to produce scalable programs that can be broadly applied, with the ultimate goal of improving healthcare safety around the world.
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