Background Although patient safety programs improve clinical outcomes in a variety of settings, little is known about factors affecting successful implementation of safety programs in low and middle-income countries (LMICs).

Objectives Our goal was to investigate the implementation of a comprehensive patient safety program for pediatric care in Guatemala.

Methods We performed a mixed-methods implementation analysis of a comprehensive patient safety program in 11 pediatric units at the Roosevelt Hospital in Guatemala. The safety program was contextualized to each unit, and included assessment of the safety culture, perioperative checklists, and targeted QI interventions. We performed qualitative analysis of implementation challenges using semi-structured interviews with hospital staff (n=82) using the Consolidated Framework for Implementation Research (CFIR), with follow-up focus group interviews one year later. We also measured staff views towards implementation challenges using the quantitative Evidence Based Practice Attitude Scale (EBPAS-36). All data were triangulated to identify emerging themes as well as barriers and facilitators to implementation.

Results We classified implementation challenges within 25 CFIR constructs. We identified several emerging themes: 1) High staff receptivity to safety programs, including recognition of relevance to their patient population; 2) Importance of increasing staff knowledge and awareness about patient safety, 3) Difficulties with high patient care demands; 4) Limited governance and leadership engagement; 5) Contextualization of safety programs to local needs.

Conclusions Our study provides insight into hospital staff perspectives on implementation challenges for patient safety programs in Guatemala. Definition of implementation challenges may enhance successful adoption of safety practices in low-resource settings.