International Journal Of Health Care Quality Assurance[JOURNAL]
Sun
200 papers
A DEMATEL-based model to analyze causal factors affecting patients' informed consent.
Zarin S, Bahadori M, Alimohammadzadeh K
Int J Health Care Qual Assur · 2026 Jul · PMID 42391417 · Publisher ↗
PURPOSE: Patients' informed consent is recognized as a fundamental pillar of medical ethics and patient rights. Failure to acknowledge or adequately implement informed consent carries serious consequences for the integri...
PURPOSE: Patients' informed consent is recognized as a fundamental pillar of medical ethics and patient rights. Failure to acknowledge or adequately implement informed consent carries serious consequences for the integrity and effectiveness of the healthcare system. This study aims to analyze the systematic relationships among factors influencing patients' informed consent. DESIGN/METHODOLOGY/APPROACH: This descriptive-analytical cross-sectional study was conducted at a private hospital in Tehran in early 2025. A sample of 11 specialist physicians and nurses was selected using purposive and snowball sampling methods. Data were collected using a pairwise comparison matrix questionnaire. Descriptive data analysis was performed using SPSS 26.0, and the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was applied using MATLAB software. FINDINGS: The results showed that in the interactive model and systematic relationship analysis among components influencing the obtaining of informed consent from patients, interpersonal and individual factors belong to the group of influential factors, while organizational and environmental fact ors belong to the group of influenced factors. Interpersonal and environmental factors were identified as the most influential and most influenced factors, respectively. ORIGINALITY/VALUE: The DEMATEL-based model identified interpersonal and individual factors as key influencers of informed consent, while organizational and environmental factors were primarily influenced. This suggests that improving communication quality and patient understanding may generate system-wide benefits. However, findings reflect a single private hospital context and should be considered exploratory. The model provides a hypothesis-generating foundation for future validation and targeted interventions in similar Iranian healthcare settings.
Examining the relationship between perceived behavioral control and purchasing intention toward health insurance with a moderating effect of demographics.
Kaur S, Maan VK, Bhullar PS
Int J Health Care Qual Assur · 2026 Jul · PMID 42383817 · Publisher ↗
PURPOSE: This study investigates the relationship between customers' intention to purchase health insurance in Northern India and perceived behavioral control (PBC), which is based on the decomposed theory of planned beh...
PURPOSE: This study investigates the relationship between customers' intention to purchase health insurance in Northern India and perceived behavioral control (PBC), which is based on the decomposed theory of planned behavior (DTPB). Three core dimensions of PBC are identified: social influence, perceived ease of access and financial affordability, discovered through the use of exploratory factor analysis (EFA). The study further investigates how gender and marital status moderate these relationships to inform targeted marketing strategies. DESIGN/METHODOLOGY/APPROACH: Convenience sampling was used to gather primary data through an online poll with 400 participants. The three PBC dimensions were extracted and validated using EFA, and their direct impacts on purchase intention were then tested using partial least squares structural equation modeling (PLS-SEM). Moderation effects by marital status and gender were investigated using multi-group analysis (MGA), which produced strong t-statistics and p-values. FINDINGS: PLS-SEM reveals perceived ease of access is the best predictor of purchase intention (t = 6.070, p < 0.001), followed by social influence (t = 4.400, p < 0.001) and financial affordability (t = 5.486, p < 0.001). Financial affordability and social influence have a greater impact on women, whereas perceived ease of access had a greater impact on males, according to MGA, which shows significant gender-based moderation. These associations are also moderated by marital status; married people react more strongly to accessibility, whereas single people are more impacted by affordability and social influence. RESEARCH LIMITATIONS/IMPLICATIONS: These results offer practical applications for lawmakers and insurance companies undertaking business in developing nations. The study makes recommendations for future longitudinal and cross-cultural research while acknowledging the drawbacks of convenience sampling and a cross-sectional approach. ORIGINALITY/VALUE: This study examines the dimensional structure of PBC in relation to health insurance purchase intention in a developing-nation situation by integrating PLS-SEM and EFA in a novel way inside the TPB framework. It fills a major vacuum in culturally nuanced consumer Behavior research in emerging nations and provides actionable data for insurers looking to segment their marketing strategies by revealing innovative moderations based on gender and marital status.
Health insurance, health care utilization and health outcomes in Nigeria: evidence from DHS data.
Urama CE, Obodoechi DN, Agu C … +1 more , Urama CC
Int J Health Care Qual Assur · 2026 Jun · PMID 42377260 · Publisher ↗
PURPOSE: One vital concern of health policy globally is to achieve equity in access to health care services for all. This study aims to examine the interconnectedness of health insurance, healthcare utilization and healt...
PURPOSE: One vital concern of health policy globally is to achieve equity in access to health care services for all. This study aims to examine the interconnectedness of health insurance, healthcare utilization and health outcomes in Nigeria. It set out to ascertain how enrollment in health insurance impacts healthcare utilization and health outcomes in Nigeria. DESIGN/METHODOLOGY/APPROACH: The study utilized the latest demographic survey data collected by the National Bureau of Statistics in Nigeria. The data was analyzed using binary logistic regression models. FINDINGS: The study demonstrates that father's education and occupation are positively associated with health outcomes, while age and decision on healthcare utilization have negative associations. It also observed that insurance enrollment does not significantly improve child and maternal health outcomes even though insurance ownership and the type of plan significantly influence health service use in Nigeria. This result is further supported by the ordinary least squares regression result, serving as a robustness check. ORIGINALITY/VALUE: The results provide evidence that investments in health insurance infrastructure, educational attainment (especially among men) and geographic equity in service provision are critical levers for improving population health in Nigeria. The study recommends that strengthening the health system in Nigeria requires multidimensional efforts targeting insurance access, educational empowerment, employment stability and geographical service distribution so as to achieve Sustainable Development Goal 3: "Good Health and Well-Being for all."
Leveraging the MBNQA framework to advance quality assurance in healthcare.
Nasir D, Rahman H
Int J Health Care Qual Assur · 2026 Jun · PMID 42311174 · Publisher ↗
PURPOSE: This study examines the quality management system of a large hospital in Northern India, utilising the Malcolm Baldrige National Quality Award (MBNQA) framework. It aims to identify both strengths and gaps in th...
PURPOSE: This study examines the quality management system of a large hospital in Northern India, utilising the Malcolm Baldrige National Quality Award (MBNQA) framework. It aims to identify both strengths and gaps in the hospital's practices to support continuous improvement and organisational excellence. DESIGN/METHODOLOGY/APPROACH: A structured 76-item questionnaire based on the MBNQA criteria was given to 125 staff members from medical, dental, nursing and paramedical departments. The survey responses were combined with interviews, document reviews and on-site observations. Data were analysed using the scoring system prescribed in the MBNQA model. FINDINGS: The hospital achieved a score of 64.3%, placing it in the "moderate" category. Strong performance was observed in operations and leadership, but weaker results were found in workforce focus and strategic planning. The primary issues include limited employee involvement, inadequate adaptability to change, unsatisfactory customer feedback, and a lack of robust financial performance metrics. RESEARCH LIMITATIONS/IMPLICATIONS: The findings are based on staff self-reports and do not fully capture patient perspectives, which may limit the depth of insights into service quality. Future research could include multiple hospitals, patient viewpoints and longitudinal studies to better assess changes over time. PRACTICAL IMPLICATIONS: The results offer hospital leaders a clear roadmap for improvement. Priorities include engaging and recognising staff, strengthening long-term strategic planning, improving financial accountability and enhancing patient satisfaction. Addressing these issues can help build resilience, improve efficiency and enhance the quality of care. ORIGINALITY/VALUE: This is one of the few empirical studies applying the MBNQA model in Indian healthcare. By combining quantitative scoring with qualitative insights, it provides a comprehensive view of hospital performance rather than focusing on isolated aspects.
Hospital service quality and patient loyalty: a comparative analysis of government and private hospitals in Chhattisgarh.
Tripathi PN, Bakhshi D, Mishra AK
Int J Health Care Qual Assur · 2026 Jun · PMID 42246239 · Publisher ↗
PURPOSE: To develop a research model to investigate the impact of hospital service quality (HSQ) on patient satisfaction (PS), trust (PT), and loyalty (PL) among elderly patients with chronic conditions in government and...
PURPOSE: To develop a research model to investigate the impact of hospital service quality (HSQ) on patient satisfaction (PS), trust (PT), and loyalty (PL) among elderly patients with chronic conditions in government and private medical facilities in Chhattisgarh, India. DESIGN/METHODOLOGY/APPROACH: This quantitative study employed the survey approach. The study used Matlab and the structured model analysis approach to evaluate the data. AMOS and SPSS Statistics were used for reliability analysis and descriptive statistics. The measurement model was utilized to evaluate reliability and validity, and the structural model was employed to examine the proposed relationship. FINDINGS: HSQ positively influences PT and PL in both government and private hospital settings. However, PS's positive effect on PL was found to be significant only in private hospitals. RESEARCH LIMITATIONS/IMPLICATIONS: The results emphasize that service quality and trust are vital for promoting enduring patient loyalty in both hospital contexts, but suggest that the relationship dynamic with patient satisfaction differs between government and private healthcare settings. This highlights the need for tailored strategies for improving patient relationships in each sector. ORIGINALITY/VALUE: The findings from Study 1 and Study 2 reveal distinct patterns in the associations between Hospital Quality of Service, Patient Trust, Patient Satisfaction, and Patient Loyalty. In both studies, HSQ consistently demonstrated a significant impact on PT and PL, underscoring the critical role of service quality in fostering trust and loyalty among patients.
Technology meets trust: a UTAUT-driven exploration of AI-based medical device implementation in healthcare.
Baral MM, Nagariya R, Srivastava SC … +2 more , Chittipaka V, Kumar N
Int J Health Care Qual Assur · 2026 May · PMID 42175970 · Publisher ↗
PURPOSE: Healthcare sectors are increasingly adopting artificial intelligence (AI) to speed up disease diagnosis, tailor treatments to individual patients, streamline routine processes, and improve overall patient safety...
PURPOSE: Healthcare sectors are increasingly adopting artificial intelligence (AI) to speed up disease diagnosis, tailor treatments to individual patients, streamline routine processes, and improve overall patient safety in hospitals. Despite its great potential, there remains resistance among healthcare professionals towards AI adoption. The current study has identified the determinants influencing intentions to adopt AI-based medical devices among healthcare professionals. DESIGN/METHODOLOGY/APPROACH: The data were collected from various healthcare professionals using a structured questionnaire. The collected data were analyzed using partial least squares structural equation modeling (PLS-SEM). FINDINGS: The findings indicate that performance expectancy, facilitating conditions, effort expectancy, and social influence have a significant influence on trust. Further, facilitating conditions, effort expectancy, and performance expectancy positively influence adoption intention. Again, trust holds substantial positive implications for the intention to adopt AI-based medical devices. Further, social influence shows an adverse effect. It does not provide a significant contribution towards adoption intention, but when the mediating relationship is tested, all the mediating relationships are supported, including social influence and adoption intention. PRACTICAL IMPLICATIONS: The findings offer valuable insights for healthcare professionals to introduce innovative medical devices that support the integration of AI-based medical technologies, thereby enhancing service efficiency and quality. ORIGINALITY/VALUE: This study makes a valuable contribution to the current body of literature pertaining to technology adoption with a focus on AI adoption among healthcare professionals.
Vision-zero: a roadmap for implementing metal screening devices to reduce preventable harm during MRI.
Olsen B, Atsu M, Fatima K … +3 more , Gligor AM, Phull N, Pinto D
Int J Health Care Qual Assur · 2026 May · PMID 42170926 · Publisher ↗
PURPOSE: This paper is a practical guide for implementing metal screening devices (MSDs) as part of an enhanced patient safety protocol prior to magnetic resonance imaging (MRI) procedures. DESIGN/METHODOLOGY/APPROACH: S...
PURPOSE: This paper is a practical guide for implementing metal screening devices (MSDs) as part of an enhanced patient safety protocol prior to magnetic resonance imaging (MRI) procedures. DESIGN/METHODOLOGY/APPROACH: Six domains of quality are included: effectiveness, efficiency, appropriateness, acceptability, safety and sustainability. Improvement teams can use this guide, in whole or in part, to develop an implementation plan to meet their own clinical needs and operational requirements. The framework has three phases: pre-implementation, implementation and post-implementation, which can be conducted within 12 to 24 months. To determine if advanced screening reduces MRI-related preventable harm, regression analysis using Interrupted Time Series is described. Data on patient-reported harm is collected by a post-MRI survey delivered by telephone interview. Cost avoidance is estimated using burn injuries prevented, since burns are among the most common MRI-related injuries reported. FINDINGS: This framework was informed by a comprehensive literature review focused on identifying harm events related to MRI, root causes and innovations in safety for patients receiving MRI. A quality improvement approach is proposed because treatment and control experiments would not be recommended due to ethical considerations and feasibility/practicality for MRI departments. A comparison of pre- and post-implementation is an appropriate method for this purpose because it is applicable to small departments (i.e. single MRI units) and/or sites with low patient volumes. PRACTICAL IMPLICATIONS: Many MRI-related burns and other adverse events are preventable, yet these incidents continue to occur. Reducing or eliminating preventable harm improves patient experience, while providing assurance to health care providers that the diagnostic procedures do not result in preventable injuries or imaging failure, causing delays in diagnosis and treatment. The estimated value proposition suggests a typical investment would be cost neutral if only a single moderate harm event were prevented in one year of deploying MSD as part of an enhanced screening protocol. SOCIAL IMPLICATIONS: Technologies now exist to detect magnetic metal masses only or magnetic and non-magnetic metals at the same time. When accompanied by conventional screening procedures (patient-reported medical history, questioning and visual inspection), these devices show promise in reducing harm that might otherwise be considered unavoidable. ORIGINALITY/VALUE: The inspiration for this project came about through front-line clinicians unsatisfied with the status quo. While necessary, checklists and visual inspection alone inadequately protect patients from risk of injury. While solutions exist, widespread adoption of new technology and practices has not occurred in the clinical setting. This framework can be adapted or adopted, allowing improvement teams to evaluate cost, efficiency and effectiveness with the goal of eliminating preventable harm during MRI.
The strategy implementation fidelity gap in transitional healthcare systems.
Karibdzhanov C
Int J Health Care Qual Assur · 2026 May · PMID 42126048 · Publisher ↗
PURPOSE: Healthcare systems in transitional economies frequently fail to translate formally adopted strategies into consistent patient-centered care. This persistent disconnect between strategic intent and frontline exec...
PURPOSE: Healthcare systems in transitional economies frequently fail to translate formally adopted strategies into consistent patient-centered care. This persistent disconnect between strategic intent and frontline execution is conceptualized in this study as the Strategic Implementation Fidelity Gap. This paper introduces the concept of whether differences in strategic implementation fidelity are associated with measurable variations in patient-perceived service quality in public healthcare organizations. DESIGN/METHODOLOGY/APPROACH: A comparative cross-sectional study was conducted in two state-owned healthcare institutions in Almaty, Kazakhstan: a hospital characterized by higher implementation fidelity and a polyclinic with lower fidelity. Service quality was assessed using the SERVQUAL model, reconceptualized here as a behavioral indicator of strategic execution. Non-parametric analysis was applied to compare service quality gaps across five dimensions. FINDINGS: The findings reveal significant negative service quality gaps in both institutions, with the largest deficiencies consistently observed in empathy and responsiveness. Crucially, the institution with higher implementation fidelity demonstrated a significantly smaller overall SERVQUAL gap (p = 0.003), indicating that differences in execution capacity translate directly into measurable differences in patient experience. RESEARCH LIMITATIONS/IMPLICATIONS: This study provides compelling evidence; however, its findings should be interpreted in light of the following limitations. Cross-Sectional Design: The study employed a cross-sectional design, collecting data at a single point in time. While this allows for statistical comparison between institutions, it limits the ability to establish definitive cause-and-effect relationships or track the dynamic evolution of the Strategic Implementation Fidelity Gap over time. Future research should utilize longitudinal designs to assess the impact of implemented managerial protocols. Perceptual Data Dependency: The research relies primarily on patient-perceived quality data (SERVQUAL), which is inherently subjective. Although this is a crucial measure of service quality, the scope does not include the perspectives of healthcare providers or objective clinical outcome data. Generalizability: The sample was restricted to two public healthcare institutions in a single large city (Almaty, Kazakhstan). Therefore, the generalizability of the results to diverse regional healthcare settings or other transitional economies should be approached with caution. PRACTICAL IMPLICATIONS: Strategic Resource Rebalancing: The results offer a clear rationale for healthcare decision-makers to strategically rebalance investments. Priorities must shift from sole reliance on structural assets to rigorous development and control of managerial and staff protocols, placing a specific focus on the identified areas of weakness: Empathy and Responsiveness. Management Monitoring Tool: The statistically significant differences between institutions demonstrate that the SERVQUAL gap score can serve as a quantifiable management monitoring tool for supervisory bodies to audit the quality of strategic execution and compliance. Applicability in Transitional Systems: The findings provide an actionable governance model for all transitional and emerging economies seeking to modernize their health systems, demonstrating that reform success is predicated on the quality of Behavioral Governance. SOCIAL IMPLICATIONS: Restoring Public Trust: The identified gaps in Empathy and Responsiveness are primary drivers of eroded public trust in the healthcare system and government-led reforms. Addressing the Strategic Implementation Fidelity Gap through mandatory behavioral governance directly contributes to restoring citizens' trust in public institutions. Promoting Social Equity: Inconsistent service quality (low Implementation Fidelity) creates barriers to equitable access to effective care. Ensuring every facility adheres to standardized protocols (especially in behavioral aspects) promotes social equity and guarantees consistent quality of service for all population segments. Enhancing Patient Well-being: Directly addressing failures in Empathy and Responsiveness not only improves the clinical experience but also significantly enhances the psychological and emotional well-being of patients, increasing their adherence to treatment plans and overall satisfaction with state interaction. ORIGINALITY/VALUE: The study provides the first empirical quantification of a Strategic Implementation Fidelity Gap in a transitional healthcare system and demonstrates that service quality deficits are not solely driven by resource constraints, but by failures in behavioral execution. By repositioning SERVQUAL as a diagnostic tool for strategic implementation, the study offers a novel framework for assessing how governance and execution shape frontline outcomes. The findings suggest that healthcare reforms should move beyond structural investment and prioritize behavioral governance, performance monitoring, and the standardization of frontline practices to ensure effective strategy implementation.
Medical students' intention to adopt electronic health records to improve the quality of healthcare.
Ibrahim GJP, Adomah-Afari A
Int J Health Care Qual Assur · 2026 May · PMID 42118725 · Publisher ↗
PURPOSE: While Ghana has a national digital health strategy, the readiness of its future healthcare workforce remains under-examined. This study assesses factors influencing the intention to adopt EHRs to improve the qua...
PURPOSE: While Ghana has a national digital health strategy, the readiness of its future healthcare workforce remains under-examined. This study assesses factors influencing the intention to adopt EHRs to improve the quality of healthcare among final-year students at the University of Ghana Medical School, a cohort representing the vanguard of this digital transition. DESIGN/METHODOLOGY/APPROACH: A quantitative cross-sectional survey was conducted among the entire cohort of 199 students. A structured questionnaire, based on the Technology Acceptance Model was used to collect data on socio-demographic characteristics, perceived usefulness perceived ease of use and intention to adopt Electronic Health Records Data were analysed using descriptive statistics, Chi-square tests, and multivariable logistic regression. The level of significance was accepted at p < 0.05 at a 95% Confidence Interval. FINDINGS: A response rate of 95.5% (190/199) was achieved. A substantial majority of students (89%) expressed a positive intention to adopt Electronic Health Records (EHRs). In bivariate analysis, significant factors associated with adoption intention included being male (cOR = 3.016, p = 0.039), awareness of EHR features (cOR = 4.194, p = 0.006), perceiving EHRs as extremely useful (cOR = 9.33, p = 0.008), and prior EHR-specific training (cOR = 3.82, p = 0.02). However, after multivariable adjustment, none of these associations retained statistical significance, and general digital literacy was not independently associated with adoption intention (p = 0.055). ORIGINALITY/VALUE: The findings suggest a need for continued research to foster universal Electronic Health Records (EHRs) adoption among healthcare providers to improve health care through technology.
Nursing care during the COVID-19 pandemic from the perspective of hospitalized children: a cross-sectional study.
Demir Acar M, Sarman A, Çiftçi Ünal Ş
Int J Health Care Qual Assur · 2026 May · PMID 42118723 · Publisher ↗
PURPOSE: This study aimed to understand how children experienced nursing care while staying in the hospital during the COVID-19 pandemic and to explore the feelings they had during this time. DESIGN/METHODOLOGY/APPROACH:...
PURPOSE: This study aimed to understand how children experienced nursing care while staying in the hospital during the COVID-19 pandemic and to explore the feelings they had during this time. DESIGN/METHODOLOGY/APPROACH: A descriptive study was conducted with children receiving inpatient care in pediatric units during the pandemic. Information was gathered through child-friendly interviews and questionnaires that focused on their experiences and perceptions of nursing care. FINDINGS: Children generally reported that their basic physical needs were well addressed. However, many felt that emotional support and opportunities to talk about their feelings were limited. A large proportion of children expressed worry and emotional distress related to being hospitalized during the pandemic. RESEARCH LIMITATIONS/IMPLICATIONS: The findings reflect children's experiences in a single healthcare setting and do not include the perspectives of nurses or family members. Future research could benefit from including multiple viewpoints and broader healthcare contexts. PRACTICAL IMPLICATIONS: The results highlight the importance of giving greater attention to children's emotional and psychological needs during hospitalization. Nurses may benefit from using simple communication strategies and supportive activities to help children express their feelings, especially during public health crises. SOCIAL IMPLICATIONS: By directly listening to children's voices, this study emphasizes the importance of respecting children's rights in healthcare settings and ensuring that their emotional well-being is considered alongside physical care. ORIGINALITY/VALUE: This study provides insight into children's own views of nursing care during an unprecedented global health crisis. By focusing on children's lived experiences, it offers valuable guidance for improving child-centered and holistic nursing care in challenging situations.
The economic burden of medical errors and policy solutions for patient safety: evidence from a mixed-methods study in Tehran.
Shafiei M, Nasiri T, Amiri-Ara M … +1 more , Zaboli R
Int J Health Care Qual Assur · 2026 May · PMID 42053503 · Publisher ↗
PURPOSE: This study aims to estimate the direct economic burden of major medical errors and identify feasible policy Solutions for improving patient safety in an Iranian tertiary hospital context. DESIGN/METHODOLOGY/APPR...
PURPOSE: This study aims to estimate the direct economic burden of major medical errors and identify feasible policy Solutions for improving patient safety in an Iranian tertiary hospital context. DESIGN/METHODOLOGY/APPROACH: A sequential explanatory mixed-methods design was adopted. In the quantitative phase, all medical errors reported between 2019 and 2023 were analyzed using the Ministry of Health's 29-item taxonomy. The three most frequent and cost-measurable categories - patient falls with severe injury, retained surgical items, and wrong-site surgery -were selected for micro-costing analysis. In the qualitative phase, two focus group discussions with eight safety experts were conducted, guided by the WHO Patient Safety Cost Framework. Data were analyzed using descriptive statistics and directed content analysis. FINDINGS: Patient falls generated the highest direct cost (USD 526 per case), followed by retained surgical items (USD 412) and wrong-site surgery (USD 71). The largest cost components were hospital stay, consumables, and therapeutic procedures. Qualitative findings highlighted systemic issues such as staff shortages, weak safety culture, poor checklist compliance, and a lack of digital monitoring technologies. PRACTICAL IMPLICATIONS: The study recommends strengthening human resource management, fostering a non-punitive safety culture, adopting RFID/barcode technologies for surgical tracking, implementing digital Time-Out monitoring, and investing in smart hospital infrastructure to prevent costly medical errors. ORIGINALITY/VALUE: This research provides the first comprehensive mixed-methods economic evaluation of medical errors in Iran, integrating financial data with policy-level analysis. The results offer evidence-based insights for healthcare administrators and policymakers seeking cost-effective Solutions to enhance patient safety and hospital efficiency.
Training effectiveness and health-worker performance: the roles of knowledge management and soft-skill competence.
Hasmin H, Nurung J
Int J Health Care Qual Assur · 2026 Apr · PMID 41958220 · Publisher ↗
PURPOSE: The study aims to test whether knowledge management (KM) and soft-skill competence (SSC) mediate the effect of training effectiveness (TE) on health-worker performance in Indonesian public healthcare organisatio...
PURPOSE: The study aims to test whether knowledge management (KM) and soft-skill competence (SSC) mediate the effect of training effectiveness (TE) on health-worker performance in Indonesian public healthcare organisations. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey of health workers in public healthcare organisations in Indonesia was analysed to test the proposed capability pathway linking training, KM, soft skills and performance. FINDINGS: TE was positively associated with KM (β = 0.756, p < 0.001), SSC (β = 0.213, p = 0.001) and health workforce performance (β = 0.296, p = 0.001). KM strongly predicted SSC (β = 0.799, p < 0.001), while SSC positively predicted health workforce performance (β = 0.638, p < 0.001). Bootstrapping showed that the indirect effect of TE on performance through KM and SSC was significant and stronger than the direct effect (indirect β = 0.522, BC 95% CI [0.372, 0.726], p < 0.001). RESEARCH LIMITATIONS/IMPLICATIONS: The study uses self-reported, cross-sectional data; causal inferences are therefore limited. Future research should incorporate longitudinal designs and objective quality indicators (e.g. adherence to clinical and administrative standards, safety-event reporting and patient experience measures). PRACTICAL IMPLICATIONS: Quality improvement leaders should prioritise training transfer. They can use simple KM routines, such as brief after-action reviews, SOP updates and peer learning. They should also reinforce soft skills through handover communication, teamwork practice and patient-centred interaction. SOCIAL IMPLICATIONS: Strengthening knowledge routines and soft skills can support more consistent and respectful care, especially in resource-constrained settings where service reliability and patient trust are critical. ORIGINALITY/VALUE: Rather than claiming the broad theoretical novelty, this study offers a context-specific empirical contribution by testing a serial capability pathway through which TE relates to health-worker performance in Indonesian public healthcare organisations. It shows that KM and SSC operate as two complementary and actionable mechanisms that help translate training into performance-relevant routines.
Efficiency improvement in the stroke care process based on the Lean Healthcare approach.
Cortés-Sevilla F, Sánchez-Barroso G, González-Domínguez J … +1 more , García Sanz-Calcedo J
Int J Health Care Qual Assur · 2026 Apr · PMID 41934094 · Publisher ↗
PURPOSE: Stroke care requires coordination among medical professionals and hospital management staff in a collaboratively developed process that must be continuously improved, as care time significantly reduces the patie...
PURPOSE: Stroke care requires coordination among medical professionals and hospital management staff in a collaboratively developed process that must be continuously improved, as care time significantly reduces the patient's capabilities after the intervention. This article aims to quantify the efficiency improvement in the stroke care process based on a comprehensive Lean Healthcare approach. DESIGN/METHODOLOGY/APPROACH: An ad-hoc, two-phase structured Lean intervention was validated by analysing nine years of data in a hospital as proof of concept. FINDINGS: Mean reductions of between 2 and 4 min in key in-hospital time-based metrics were achieved for both types of strokes under study, resulting in improvements of up to 11.1%. These benefits demonstrated a statistically significant difference in mean pre- and post-Lean metrics. PRACTICAL IMPLICATIONS: The group of patients analysed post-Lean was not only managed with tissue plasminogen activator or thrombectomy in less time but also had lower disability degrees at entry and after three months, with the jump from three levels pre-Lean to a single level according to the modified Rankin score decreasing. SOCIAL IMPLICATIONS: It was concluded that a patient-centric continuous flow design significantly increases the likelihood of patient recovery. ORIGINALITY/VALUE: This study offers new evidence that a patient-centric continuous flow design enhances recovery outcomes in hospital care. By applying Lean Healthcare principles to patient-centred process redesign, it links operational efficiency directly to clinical improvement. The findings provide a replicable framework for integrating process flow optimisation into quality assurance, positioning it as a driver of patient-centred excellence and overall performance.
Young adult building artisans' involvement in illicit substances: the implications for SDGs 3 and 8.
Ebekozien A, Ebekozien O, Ebekozien EO … +7 more , Hafez MA, Aigbavboa CO, Nwaole ANC, Samsurijan MS, Eremiokhale JI, Aigbe RO, Ghazali N
Int J Health Care Qual Assur · 2026 Mar · PMID 41889271 · Publisher ↗
PURPOSE: The health and well-being of young adult building artisans are germane because of their critical role in infrastructure development. There is a perceived increase and paucity of studies regarding young adult bui...
PURPOSE: The health and well-being of young adult building artisans are germane because of their critical role in infrastructure development. There is a perceived increase and paucity of studies regarding young adult building artisans' involvement in illicit substances, which threatens the achievement of Sustainable Development Goals (SDGs) 3 and 8. This study investigated the underlying causes and recommended feasible measures to prevent or mitigate the use of illicit substances among young adult artisans on construction sites in Nigeria, and, by extension, to improve the achievement of Goals 3 and 8. DESIGN/METHODOLOGY/APPROACH: This research employs a face-to-face interview to collect data in Lagos and Abuja, Nigeria. FINDINGS: Findings reveal that there is a prevalent issue of increasing young adult building artisans' illicit substance intake on building sites. This poses a significant threat to occupational health (SDG 3) and workplace safety (SDG 8). Findings also identified 17 underlying causes, including a lack of awareness among artisans, a low educational background and lax safety and management policies. ORIGINALITY/VALUE: This research contributes to the existing literature on preventing or mitigating illicit substance use among young adult building artisans. It also recognises that preventive or mitigative measures can be useful for mental health stability and, by extension, for achieving the SDGs.
Exploring how information exchange issues mediate the influence of communication and administrative support on quality and patient safety.
Vijayasree S, Praveen Kumar P, Raja Shree KC
Int J Health Care Qual Assur · 2026 Mar · PMID 41852099 · Publisher ↗
PURPOSE: Patient safety and quality are crucial in hospital-based healthcare services. Information exchange is a dominating component in enhancing the safety and quality of patient care services. Therefore, this research...
PURPOSE: Patient safety and quality are crucial in hospital-based healthcare services. Information exchange is a dominating component in enhancing the safety and quality of patient care services. Therefore, this research explores the direct and indirect effects of communication and administrative support on quality and patient safety within multi-specialty hospitals. In connection with the indirect effects, the mediating role of information exchange issues in hospitals settings is examined. DESIGN/METHODOLOGY/APPROACH: Data were collected from 568 hospital healthcare professionals using a structured questionnaire. Data were analyzed using frequency analysis and structural equation modelling. FINDINGS: The outcomes of this study highlight the fact that communication and follow-up, as well as administrative support, directly and indirectly impact the quality and safety of patients through information exchange issues. PRACTICAL IMPLICATIONS: Hospitals should employ streamlined information exchange protocols to overcome challenges and optimize workflows. ORIGINALITY/VALUE: This research adds to the existing body of literature by presenting empirical insights on the mediating role of information exchange issues in the impact of communication and administrative support on hospital patient care outcomes.
Management of non-conformities in the pre-analytical phase of the medical analysis laboratory.
Kechkar H, Boukhaldi J, Sabri A … +5 more , Omari M, Morjan A, Elbakkouri J, Bousfiha AA, Kamal N
Int J Health Care Qual Assur · 2026 Mar · PMID 41846458 · Publisher ↗
PURPOSE: The pre-analytical phase is a critical step in medical biology analyses, encompassing all stages from test ordering to sample presentation on the analyzer. The aim of this study is to propose a quality managemen...
PURPOSE: The pre-analytical phase is a critical step in medical biology analyses, encompassing all stages from test ordering to sample presentation on the analyzer. The aim of this study is to propose a quality management approach for handling non-conformities in the pre-analytical phase of a medical analysis laboratory. DESIGN/METHODOLOGY/APPROACH: This study investigated various pre-analytical non-conformities in a medical biology laboratory in Casablanca over an 8-month period. To address the primary causes of these non-conformities, we employed several quality tools, including FMECA, Ishikawa diagram, Pareto diagram, and brainstorming. Our work was structured according to the Plan-Do-Check-Act cycle. Excel was used for data processing and diagram creation, while Zotero managed bibliographic references. FINDINGS: Two non-conformities were classified as high-criticality: the first concerned sampling errors (incorrect patient identification and non-compliant labeling), and the second involved non-compliant subcontracting samples. After determining the root causes of these two nonconformities, we implemented corrective actions and achieved a 46% improvement for the non-conforming during sampling and a 49% improvement for the non-conforming subcontracting samples. ORIGINALITY/VALUE: After the first PDCA cycle, we achieved a significant improvement in the two non-conformities studied. Using quality tools, we prioritized the most critical non-conformities for immediate action. In addition, other methods enabled us to identify all the potential causes of these two non-conformities, pinpointing those responsible for 80% of their occurrence. A second PDCA cycle will be implemented to further improve the results obtained in the first cycle.
Psychological distress and musculoskeletal problems among Malaysian adults.
Khan WQ, Tan ST, Tan SS … +3 more , Hariyono H, Kadir NABA, Tan CX
Int J Health Care Qual Assur · 2026 Mar · PMID 41843641 · Publisher ↗
PURPOSE: The growing prevalence of psychological distress in Malaysia highlights a significant mental health burden among the adult population. This study aimed to investigate the relationship between psychological distr...
PURPOSE: The growing prevalence of psychological distress in Malaysia highlights a significant mental health burden among the adult population. This study aimed to investigate the relationship between psychological distress and musculoskeletal problems among adults in Malaysia. DESIGN/METHODOLOGY/APPROACH: This cross-sectional study recruited a total of 391 Malaysian adults. The questionnaire consisted of a sociodemographic section, the depression, anxiety and stress|(DAS) Scale-21 (DASS-21), and the Nordic Musculoskeletal Questionnaire. FINDINGS: The prevalence of DAS were 36.3%, 45.0% and 22.5%, respectively. Notably, 44.3% of respondents reported at least one musculoskeletal problem in the past week, with the neck (18.2%), shoulder (17.1%), and lower back (17.1%) being the most commonly affected areas. Significant differences were observed between age (p < 0.001), marital status (p < 0.001), and educational level (p < 0.05) with DAS. There were significant differences between ethnicity and both depression and anxiety (p < 0.05). Regression analysis indicated that respondents with higher stress score (ß = 0.038, p = 0.046) were associated with a greater of musculoskeletal problems. PRACTICAL IMPLICATIONS: This study reveals a complex interplay between psychological distress and musculoskeletal problems. ORIGINALITY/VALUE: This study provides novel insights into the prevalence of DAS among adults, alongside musculoskeletal problems. The findings highlight key sociodemographic differences in psychological distress and reveal a significant association between stress levels and musculoskeletal problems. These results underscore the need for integrated mental and physical health interventions to address the co-occurring burden of psychological distress and musculoskeletal disorders.
Mapping Irish child and young people's health datasets and national policy frameworks: a scoping review protocol with a quantitative gap-analysis framework.
El Hadidi S, Barrett M, McGarvey C … +2 more , Hamilton K, Martin C
Int J Health Care Qual Assur · 2026 Mar · PMID 41814580 · Publisher ↗
PURPOSE: To systematically map Irish national health datasets and policy frameworks relevant to children and young people (0-24 years) and appraise their readiness for quality improvement, equity monitoring, and interope...
PURPOSE: To systematically map Irish national health datasets and policy frameworks relevant to children and young people (0-24 years) and appraise their readiness for quality improvement, equity monitoring, and interoperable reuse. DESIGN/METHODOLOGY/APPROACH: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute (JBI)-guided scoping review will synthesise peer-reviewed and grey literature. Datasets will be benchmarked using World Health Organization Data Quality Review (DQR) domains, Findable, Accessible, Interoperable, Reusable (FAIR) principles, European Medicines Agency registry guidance and PROGRESS-Plus equity stratifiers. Outputs will be synthesised into structured matrices (national catalogue, key quality indicators and availability-variability layer) and an equity heat map. FINDINGS: The review will characterise heterogeneity in coverage, coding, governance, equity stratification and linkage-readiness across perinatal, hospital, registry, surveillance and community datasets, identifying priority gaps for standardisation. RESEARCH LIMITATIONS/IMPLICATIONS: Within the context of healthcare quality assurance, the synthesis will enable evidence-informed benchmarking across clinical domains, from perinatal outcomes to chronic disease management. The integration of DQR and FAIR appraisals will allow Irish health agencies to identify datasets that meet international standards of reliability, completeness and accessibility. Simultaneously, mapping PROGRESS-Plus variables will reveal where data gaps perpetuate inequities, informing targeted data-collection reforms. The resultant framework will provide a replicable model for how nations can align data governance with the continuous quality-improvement cycle central to the International Journal of Pharmaceutical Quality Assurance's mission - linking structure (data quality), process (data use) and outcomes (policy and patient benefit). PRACTICAL IMPLICATIONS: This review will generate a decision-ready catalogue of Irish paediatric and young people's health datasets, highlighting strengths, gaps and opportunities for improvement. By appraising data quality, equity stratifiers and linkage readiness, it will provide actionable recommendations for standardisation and governance. Policymakers can use the outputs to align datasets with international best practice, clinicians can advocate for inclusion of outcome and patient-reported measures and researchers can identify priority areas for secondary analysis and linkage studies - supporting safer, fairer, and more effective child health services in Ireland. SOCIAL IMPLICATIONS: Strengthening child health data systems has direct societal benefits by enabling more equitable, transparent and evidence-based policy. By mapping available datasets and assessing equity stratifiers, this review will highlight gaps in capturing determinants such as ethnicity, deprivation and disability. Addressing these gaps will allow more accurate monitoring of health inequalities and ensure that vulnerable groups are not overlooked in service planning. The outputs will support a culture of accountability, inform public debate on data use and contribute to building a learning health system that promotes fairness, inclusivity and trust in healthcare for children and young people. ORIGINALITY/VALUE: This protocol delivers the first integrated, decision-ready framework to benchmark paediatric data ecosystems against international quality, equity and stewardship standards, enabling learning health systems and policy-relevant data governance in Ireland and comparable Organisation for Economic Co-operation and Development settings.
The effect of disability employment on firm performance: the moderating role of technological innovation.
Saif-Alyousfi AYH
Int J Health Care Qual Assur · 2026 Mar · PMID 41808372 · Publisher ↗
PURPOSE: This study aims to investigate the impact of disability employment on firm performance, highlighting the moderating role of technological innovation (TI). DESIGN/METHODOLOGY/APPROACH: Data from 93 firms listed o...
PURPOSE: This study aims to investigate the impact of disability employment on firm performance, highlighting the moderating role of technological innovation (TI). DESIGN/METHODOLOGY/APPROACH: Data from 93 firms listed on the Saudi Stock Exchange (Tadawul) from 2015 to 2023 were analyzed using a fixed-effects model to examine the effects of disability employment, TI and their interaction on performance measures, including return on assets, return on equity, Tobin's Q and stock price returns. FINDINGS: Disability employment positively affects firm performance, with stronger effects in firms adopting higher levels of TI. Technology-intensive sectors and larger firms benefit more, reflecting their greater capacity to implement inclusive employment and technological advancements. Robustness checks, including subsample analyses and alternative models (two-stage least squares and generalized method of moments), confirm the reliability of the results. PRACTICAL IMPLICATIONS: Integrating disability employment with TI can enhance firm performance and support sustainable growth. Policymakers and practitioners are encouraged to promote inclusive employment alongside technological development to maximize these benefits. ORIGINALITY/VALUE: This study offers novel insights into how disability employment and TI interact to shape firm performance, providing robust evidence from an emerging market context.
Understanding stakeholder engagement for improved sustainability performance of health and sanitation projects in Uganda: a qualitative inquiry.
Kyambade M, Alinda K, Mwesigwa R … +2 more , Tumwine S, Lwanga F
Int J Health Care Qual Assur · 2026 Mar · PMID 41787657 · Publisher ↗
PURPOSE: This study examines how stakeholder engagement influences the sustainability performance of health and sanitation projects in Uganda. It aims to uncover how engagement practices ranging from consultation to co-c...
PURPOSE: This study examines how stakeholder engagement influences the sustainability performance of health and sanitation projects in Uganda. It aims to uncover how engagement practices ranging from consultation to co-creation, shape economic, social, and environmental outcomes in a low-resource context. DESIGN/METHODOLOGY/APPROACH: A qualitative research design was adopted, using in-depth interviews, field observations, and document analysis with 21 participants. Participants were purposively selected for their strategic involvement in health and sanitation projects, and data collection continued until thematic saturation was achieved. Thematic analysis was applied, guided by Stakeholder Theory and Elkington's Triple Bottom Line (TBL) framework. FINDINGS: Five key themes emerged including community concerns, communication, governance approaches, project oversight, and ownership perceptions. Inclusive participation and transparent communication enhanced trust and community ownership; governance and oversight mechanisms strengthened accountability and resource efficiency; while capacity building and cost-sharing supported long-term project viability. These findings demonstrate that meaningful stakeholder engagement reinforces sustainability performance across economic, social, and environmental dimensions. PRACTICAL IMPLICATIONS: The study provides actionable insights for policymakers and practitioners by emphasizing the need to institutionalize inclusive participation, strengthen accountability frameworks, and promote shared ownership through co-financing and capacity development. Such measures can transform stakeholder engagement from a procedural formality into a strategic enabler of sustainable development. ORIGINALITY/VALUE: To the authors' knowledge, this is among the first empirical studies to advance the understanding of stakeholder engagement and sustainability performance within Uganda's health and sanitation sector. The study contributes to theory by extending the application of Stakeholder Theory and Elkington's TBL to a developing-country context, demonstrating how relational and procedural engagement mechanisms translate into tangible sustainability outcomes.
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