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Patient safety issues and concerns in Bhutan’s healthcare system: a qualitative exploratory descriptive study
  1. Rinchen Pelzang1,
  2. Alison M Hutchinson1,2
  1. 1 Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
  2. 2 Deakin Centre for Quality and Patient Safety Research, Monash Health, Melbourne, Victoria, Australia
  1. Correspondence to Dr Rinchen Pelzang; rpelzang1970{at}


Objectives To investigate what healthcare professionals perceived and experienced as key patient safety concerns in Bhutan’s healthcare system.

Design Qualitative exploratory descriptive inquiry.

Settings Three different levels of hospitals, a training institute and the Ministry of Health, Bhutan.

Participants In total, 140 healthcare professionals and managers.

Methods Narrative data were collected via conversational in-depth interviews and Nominal Group Meetings. All data were subsequently analysed using thematic analysis strategies.

Results The data revealed that medication errors, healthcare-associated infections, diagnostic errors, surgical errors and postoperative complications, laboratory/blood testing errors, falls, patient identification and communication errors were perceived as common patient safety concerns. Human and system factors were identified as contributing to these concerns. Instituting clinical governance, developing and improving the physical infrastructure of hospitals, providing necessary human resources, ensuring staff receive patient safety education and promoting ‘good’ communication and information systems were, in turn, all identified as processes and strategies critical to improving patient safety in the Bhutanese healthcare system.

Conclusion Patient safety concerns described by participants in this study were commensurate with those identified in other low and middle-income countries. In order to redress these concerns, the findings of this study suggest that in the Bhutanese context patient safety needs to be conceptualised and prioritised.

  • clinical governance
  • health policy
  • quality in health care
  • qualitative research

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  • Contributors RP conceived the study, collected and analysed the data. AMH supervised data collection and data analysis. Both authors prepared and approved this paper, designed the study and developed the study protocol.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approvals were obtained from the Research Ethics Board of Health, Ministry of Health, Bhutan (REBH/Approval/2012/018) and the Deakin University Human Research Ethics Committee (DUHREC 2012-221).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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