Culture matters: indigenizing patient safety in Bhutan

Pelzang, Rinchen, Johnstone, Megan-Jane and Hutchinson, Alison M. 2017, Culture matters: indigenizing patient safety in Bhutan, Health policy and planning, vol. 32, no. 7, pp. 1042-1048, doi: 10.1093/heapol/czx042.

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Title Culture matters: indigenizing patient safety in Bhutan
Author(s) Pelzang, Rinchen
Johnstone, Megan-JaneORCID iD for Johnstone, Megan-Jane
Hutchinson, Alison M.ORCID iD for Hutchinson, Alison M.
Journal name Health policy and planning
Volume number 32
Issue number 7
Start page 1042
End page 1048
Total pages 7
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2017-09-01
ISSN 1460-2237
Keyword(s) Bhutan
cultural context
patient safety
quality healthcare
traditional cultural values
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
Summary Studies show that if quality of healthcare in a country is to be achieved, due consideration must be given to the importance of the core cultural values as a critical factor in improving patient safety outcomes. The influence of Bhutan's traditional (core) cultural values on the attitudes and behaviours of healthcare professionals regarding patient care are not known. This study aimed to explore the possible influence of Bhutan's traditional cultural values on staff attitudes towards patient safety and quality care. Undertaken as a qualitative exploratory descriptive inquiry, a purposeful sample of 94 healthcare professionals and managers were recruited from three levels of hospitals, a training institute and the Ministry of Health. Interviews were transcribed verbatim and analysed using thematic analysis strategies. The findings of the study suggest that Bhutanese traditional cultural values have both productive and counterproductive influences on staff attitudes towards healthcare delivery and the processes that need to be in place to ensure patient safety. Productive influences encompassed: karmic incentives to avoid preventable harm and promote safe patient care; and the prospective adoption of the 'four harmonious friends' as a culturally meaningful frame for improving understanding of the role and importance of teamwork in enhancing patient safety. Counterproductive influences included: the adoption of hierarchical and authoritative styles of management; unilateral decision-making; the legitimization of karmic beliefs; differential treatment of patients; and preferences for traditional healing practices and rituals. Although problematic in some areas, Bhutan's traditional cultural values could be used positively to inform and frame an effective model for improving patient safety in Bhutan's hospitals. Such a model must entail the institution of an 'indigenized' patient safety program, with patient safety research and reporting systems framed around local patient safety concerns and solutions, including religious and cultural concepts, values and perspectives.
Language eng
DOI 10.1093/heapol/czx042
Field of Research 1605 Policy And Administration
1117 Public Health And Health Services
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Author
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