Background The setting of this work is Andhra Pradesh (AP), the fourth largest state Indian state with 76 million people in which the AP patient safety alliance was recently launched. This paper describes the results of assessment of patient safety culture in select hospitals of Hyderabad during September– November 2009.

Aim To understand the safety culture of hospitals in Hyderabad, to assess current levels of implementation and barriers to two of the Global Patient Safety Challenges, Clean Care is Safer Care Safe Surgery Saves Lives.

Methodology Three government and four private hospital superintendents, doctors, nurses, occupational therapy staff and ward boys participated in the study. In depth interviews, focus group discussions, structured questionnaires and facility audits were conducted. Data was analysed with SAS.

Results Hand hygiene preferences were variable. Some used hand rubs because they are less messy than soap, but others objected to strong smell of hand rubs. Hospitals locally adapted checklists for surgical procedures with private hospitals having more elaborate checklists, and government hospitals, basic ones. 60% thought their hospital is doing more for patient safety now, than last year. 25% were unable to express disagreement with physicians. Most errors here are due to ego problems and communication gaps between departments –nurse and barriers to implementation: high attrition rate and need for constant training (private hospitals), severe shortages of staff (government hospitals).

Conclusion Management support and leadership are crucial in implementing patient safety. Private hospitals adhere to protocols better than government hospitals in Hyderabad, which are grappling with more basic problems like staff shortage.