International Journal Of Health Care Quality Assurance[JOURNAL]
Sun
200 papers
International medical services quality in Taiwan: gaps between international patients' expectations and perceptions of healthcare providers' practices.
Chen SY, Chen HW, Chen LC … +1 more , Tang WR
Int J Health Care Qual Assur · 2026 Feb · PMID 41730093 · Publisher ↗
PURPOSE: The globalization of medical services has emerged as a significant international trend, underscoring the importance of quality supervision in international medical services (IMS). Despite its growing relevance,...
PURPOSE: The globalization of medical services has emerged as a significant international trend, underscoring the importance of quality supervision in international medical services (IMS). Despite its growing relevance, the perceptions of international cancer patients regarding IMS quality remain underexplored. This study aims to assess gaps between international patients' expectations and their perceptions of healthcare providers' (HCPs') practices in IMS and explore predictors of these gaps to further improve IMS quality. DESIGN/METHODOLOGY/APPROACH: A quantitative comparative approach was used with 63 patients from a medical center in northern Taiwan. The SERVQUAL questionnaire, which assesses five dimensions-reliability, assurance, tangibles, empathy, and responsiveness-was employed to evaluate patients' expectations and perceptions of the quality of IMS. Data were collected at two time points: on the first day of treatment (patients' expectations) and the day before treatment completion (patients' perceptions). Paired t-tests and multiple regression were conducted for data analysis. FINDINGS: Although no significant differences were observed in the overall SERVQUAL scores between expectations and perceptions (t = -1.724, p = 0.090), significant gaps were identified in the reliability (t = -4.600, p < 0.001) and assurance (t = -2.504, p = 0.015) subscales. Self-reported health status was a significant predictor of expectation-perception gaps. Patients had higher expectations regarding the dependability, accuracy, knowledge, and courtesy of HCPs than their actual experiences. ORIGINALITY/VALUE: This study revealed notable expectation-perception gaps in IMS quality among international cancer patients, particularly in reliability and assurance. Strengthening oncology-specific IMS through dependable, reassuring, and patient-centered care can enhance satisfaction, build trust, and reinforce Taiwan's competitiveness in the regional medical tourism market.
Enhancing patient safety practices in Addis Ababa public hospitals: an explanatory sequential mixed methods study.
Abreham SD, Simangele S
Int J Health Care Qual Assur · 2026 Feb · PMID 41689309 · Publisher ↗
PURPOSE: The study aimed to identify strategies to improve patient safety practices in public hospitals in Addis Ababa. DESIGN/METHODOLOGY/APPROACH: A sequential, explanatory, mixed-methods study design guided by a pragm...
PURPOSE: The study aimed to identify strategies to improve patient safety practices in public hospitals in Addis Ababa. DESIGN/METHODOLOGY/APPROACH: A sequential, explanatory, mixed-methods study design guided by a pragmatic paradigm was employed. Heterogeneous stratified random selection and purposive sampling techniques were applied. A structured, self-administered questionnaire, a document review checklist and a Focus Group (FG) interview guide were used. Descriptive logistic regression and thematic analysis were conducted. FINDINGS: 365 clinicians and 289 nonclinical respondents participated. The response rate was 98.7%. The 150 FG participants were engaged in 15 FG interviews, and 54 documents were reviewed. The overall composite score for patient safety practices is 61.4%. 123 (33.6%) clinician respondents were unaware of patient safety guidelines, despite 269 (73.7%) indicating that they were available at their department. The non-clinician respondents working 40-54 h per week had 5.491 times higher odds of perceiving a good patient safety practice than those working 39 h (AOR = 5.491, 95% CI = 1.971-13.61, p < 0.05). Only 92 (25.2%) of the clinician respondents reported proper adverse event reporting and scoring practices in their working units. Inadequate teamwork, staff shortage, inadequate staff training and lack of essential medical supplies were identified as patient safety gaps. RESEARCH LIMITATIONS/IMPLICATIONS: The study may have the following limitations. Participants may have responded in socially acceptable ways to avoid judgment or repercussions, leading to overreporting of positive practices and distorting the study's findings. Additionally, reliance on participants' memory could introduce inaccuracies, especially for older or emotionally charged events, thereby affecting the reliability of self-reported data. Furthermore, the results may apply only to public hospitals in Addis Ababa and those operating under similar conditions. PRACTICAL IMPLICATIONS: The findings presented in this study aim to provide practical solutions to the patient safety challenges faced by the national health system. This research will serve as a valuable resource for the health system by presenting meaningful data that can be used as a framework for evidence-based practices in public hospitals. Additionally, universally applicable strategic interventions were developed to enhance patient safety across various healthcare settings, raise the standard of care and improve safety in hospitals. SOCIAL IMPLICATIONS: The proposed patient safety strategies can serve as a valuable resource for evidence-based practices, helping to create a national patient safety plan and guide national health policy. The study's recommendations focus on enhancing the quality of patient care and promoting safer practices across similar healthcare institutions. The validated patient safety strategies will inform national health policy and contribute to the development of a comprehensive national patient safety strategy. ORIGINALITY/VALUE: The developed strategies were based on the empirical study findings and presented to a panel of experts for validation and refinement.
Translation, cross-cultural adaptation and validation of short-form patient satisfaction questionnaire (PSQ-18) in Bengali.
Sinha S, Islam MN, Hassan MM … +6 more , Karim MR, Khan AH, Kamruzzaman AKM, Buli J, Tabassum T, Hasan MJ
Int J Health Care Qual Assur · 2026 Feb · PMID 41645935 · Publisher ↗
PURPOSE: In the context of global healthcare, patient satisfaction is a core determinant of quality care. The Patient Satisfaction Questionnaire-18 (PSQ-18) is a comprehensive tool for measuring patient satisfaction. How...
PURPOSE: In the context of global healthcare, patient satisfaction is a core determinant of quality care. The Patient Satisfaction Questionnaire-18 (PSQ-18) is a comprehensive tool for measuring patient satisfaction. However, it was originally developed in English and has not been validated in Bangla. Therefore, this study aimed to culturally adapt and validate the PSQ-18 for Bangla-speaking people of Bangladesh. DESIGN/METHODOLOGY/APPROACH: This study was conducted in the Department of Rheumatology at Bangladesh Medical University over a period of 18 months. It comprised two phases: the first phase focused on the translation and cultural adaptation of the PSQ-18 into Bangla (PSQ-18 B), involving translation, back-translation, expert review and pretesting. The second phase assessed the psychometric properties of the PSQ-18 B, including internal consistency, test-retest reliability, content validity and construct validity. In this phase, the PSQ-18 B was administered to 130 patients through a self-administered questionnaire, followed by a retest after one week. FINDINGS: The study observed strong internal consistency (Cronbach's alpha near 0.99) and excellent test-retest reliability (Inter class correlation coefficient ranging from 0.90 to 0.99) across all 18 items of the tool. Content validity was tested by expert rheumatologists with item level content validation index of 1 and scale level content validation index of 1. Strong construct validity was indicated by significant positive correlations between the score of item 3 and overall total satisfaction score (rs = 0.97, p < 0.05). ORIGINALITY/VALUE: This study is the first to adapt and validate the PSQ-18 for the Bangla-speaking population. The findings confirm the PSQ-18 B as a reliable and relevant measure of patient satisfaction, and ready to be used as key assessment tool for Bangladeshi healthcare settings.
From quality to sustainability: the role of innovative culture: the case of public hospitals.
Tessema DH
Int J Health Care Qual Assur · 2026 Feb · PMID 41630406 · Publisher ↗
PURPOSE: The purpose of this research is to investigate the indirect effect of innovative culture (INVC) on the association between total quality management (TQM) and corporate sustainability (CS) in public hospitals in...
PURPOSE: The purpose of this research is to investigate the indirect effect of innovative culture (INVC) on the association between total quality management (TQM) and corporate sustainability (CS) in public hospitals in eastern Ethiopia. DESIGN/METHODOLOGY/APPROACH: The study is cross-sectional, and data were collected from 252 doctors and nurses of selected public hospitals in eastern Ethiopia using convenience sampling. The data was analyzed using Smart-PLS 4. FINDINGS: The findings indicate that innovative culture partially mediates the relationship between TQM and CS. Furthermore, TQM has a positive and significant influence on CS and INVC. The findings offer practical recommendations for implementing TQM principles in healthcare systems within emerging economies. PRACTICAL IMPLICATIONS: This study has substantial managerial implications for hospital administrators who may desire to evaluate and use the findings described in this paper when establishing strategic goals, policies and decision-making. Furthermore, the findings of this research add knowledge to the body of literature regarding the mediating role of INVC in the relationship between TQM and CS. ORIGINALITY/VALUE: The novelty of the study lies in examining the impact of innovative culture as a mediator in the association between TQM and CS in public hospitals.
Corrigendum: Building quality culture through accreditation: a PRECEDE-guided exploration of leadership in clinical units.
Int J Health Care Qual Assur · 2026 Feb · PMID 41618853 · Publisher ↗
Abstract loading — click title to view on PubMed.
Which aspects of "incident reporting culture" predict nurses' willingness to report errors?
Hajihosseini F, Mousazadeh N, Nazari R … +1 more , Sharif-Nia H
Int J Health Care Qual Assur · 2026 Feb · PMID 41618505 · Publisher ↗
PURPOSE: This study aimed to identify which aspects of incident reporting culture predict the willingness of nurses to report errors. DESIGN/METHODOLOGY/APPROACH: In this cross-sectional study (2021), a census sampling m...
PURPOSE: This study aimed to identify which aspects of incident reporting culture predict the willingness of nurses to report errors. DESIGN/METHODOLOGY/APPROACH: In this cross-sectional study (2021), a census sampling method was used to recruit 251 nurses with at least one year of experience in general wards across three hospitals in Northern Iran. Data were collected via a self-report questionnaire and analyzed using both descriptive and inferential statistics. FINDINGS: Two dimensions of incident reporting culture- "learning from errors" (ß = 0.234, 95% CI: 0.088 to 0.380) and "error management" (ß = 0.029, 95% CI: 0.013 to 0.235)-significantly predicted nurses' willingness to report errors. ORIGINALITY/VALUE: This study is among the first to identify specific dimensions of incident reporting culture that could enhance nurses' motivation to report errors.
Assessing emergency department service quality at Maragheh University Medical Centers (2024).
Alizadeh H, Hasanpoor E, Raoofi S … +1 more , Haghgoshayie E
Int J Health Care Qual Assur · 2026 Feb · PMID 41618499 · Publisher ↗
PURPOSE: Hospital emergency departments are critical healthcare units that manage urgent conditions and save lives. Service quality in emergency care is directly linked to patient satisfaction. This study aimed to assess...
PURPOSE: Hospital emergency departments are critical healthcare units that manage urgent conditions and save lives. Service quality in emergency care is directly linked to patient satisfaction. This study aimed to assess service quality in the emergency departments of teaching hospitals affiliated with Maragheh University of Medical Sciences, identifying strengths and weaknesses to inform strategies for improving performance. DESIGN/METHODOLOGY/APPROACH: This descriptive-analytical study was conducted in August-September 2024 with 420 convenience sampling patients from 3 emergency departments affiliated with Maragheh University of Medical Sciences. Inclusion criteria were being over 18 years old, presenting during the researcher's shift and consenting to participate. Service quality was measured using the 49-item SERVQUAL questionnaire, covering demographics, expectations and perceptions. Data from 304 complete questionnaires were analyzed using Excel and SPSS. FINDINGS: Analysis revealed most emergency department visitors were female (65.1%) and under 30 years old (31.9%). The highest satisfaction was with responsiveness (gap: 0.511), while reliability scored the lowest (gap: 1.779). Satisfaction levels correlated significantly with education and mode of arrival; patients with associate degrees reported the highest satisfaction, and those with doctoral degrees the lowest. Patients arriving by ambulance were most satisfied, while those arriving alone were least satisfied. ORIGINALITY/VALUE: This study extends SERVQUAL application to mid-sized, resource-constrained teaching hospitals in Iran. Unlike previous descriptive gap analyses, we identify specific operational determinants - including crowding patterns, staff allocation issues and physical capacity limitations - behind the significant reliability gap (-1.779). The findings provide hospital administrators with contextualized, actionable strategies for emergency care quality improvement in similar resource-limited settings worldwide.
The determinants of epidemics and pandemics preparedness in the least developed African countries: evidence from the global health security index.
Ait Soussane J
Int J Health Care Qual Assur · 2026 Jan · PMID 41496641 · Publisher ↗
PURPOSE: This study aims to investigate the determinants of pandemic and epidemic preparedness in the least developed African countries by applying a multidimensional framework that incorporates governance, health infras...
PURPOSE: This study aims to investigate the determinants of pandemic and epidemic preparedness in the least developed African countries by applying a multidimensional framework that incorporates governance, health infrastructure, socioeconomic vulnerability and institutional capacity. It addresses the lack of integrated empirical analyses tailored to Africa's complex socio-political and environmental context. DESIGN/METHODOLOGY/APPROACH: The study adopts a quantitative approach using cross-sectional data from 29 least developed African countries. The determinants are constructed across five dimensions: governance, institutional capacity, health infrastructure, socioeconomic conditions and social resilience. The robust weighted least squares method, using the Welsch loss function, is employed to address outlier sensitivity and provide stable parameter estimates for small sized samples. FINDINGS: Results show that higher immunization coverage and literacy significantly enhance pandemic preparedness, emphasizing the critical role of preventative health and education. Well-integrated social protection systems and effective governance are also strong positive contributors. In contrast, poorly supported community health workers, high poverty, informal employment and urban slums negatively affect preparedness. Environmental stressors such as air pollution and high population density further undermine resilience. Notably, nurses have a more positive impact on preparedness than physicians, highlighting the importance of strategic health workforce deployment over sheer numbers. ORIGINALITY/VALUE: This study is the first to empirically assess pandemic preparedness in the least developed African countries using an integrated, multidimensional framework and robust estimation techniques. It fills a significant research gap by localizing global theoretical models to the African context.
Challenges of accreditation in hospitals and their operational solutions.
Afshari M, Corani Bahador R, Alirezaei S
Int J Health Care Qual Assur · 2026 Jan · PMID 41492719 · Publisher ↗
PURPOSE: Monitoring and evaluation are crucial for healthcare quality assurance. This study systematically aims to explore the unique challenges encountered during the implementation of mandatory hospital accreditation i...
PURPOSE: Monitoring and evaluation are crucial for healthcare quality assurance. This study systematically aims to explore the unique challenges encountered during the implementation of mandatory hospital accreditation in a centralized healthcare context and develops a set of operationally sound solutions. DESIGN/METHODOLOGY/APPROACH: A qualitative methodology was utilized, with semi-structured interviews conducted with 17 hospital managers, supervisors and accreditation officials in Iranian hospitals in 2024. Participants were selected through purposive sampling with maximum variation, and interviews continued until theoretical saturation. Lincoln and Guba's criteria were applied to ensure the data's trustworthiness. The data were analyzed using the content analysis technique with MAXQDA 10 software. FINDINGS: Twenty-two challenges were identified in the themes of leadership and strategic management; human capital development and engagement and contextual coordination and adaptation. In total, 26 practical solutions were also identified for implementing the accreditation program in hospitals. RESEARCH LIMITATIONS/IMPLICATIONS: This study provides a comprehensive examination of the experiences of specialists and experts regarding the challenges of hospital accreditation and practical solutions for addressing these challenges. In fact, this research offers multi-dimensional, actionable recommendations for policymakers, accreditation management bodies and service providers, moving beyond mere compliance to leverage accreditation for genuine competitive advantage and public accountability. PRACTICAL IMPLICATIONS: While this research provides essential data for administrative decision-makers overseeing the accreditation process, we recognize that a purely administrative focus is inherently one-sided. Therefore, to fully realize the social and political value of our findings, this section translates the results into multi-dimensional, actionable recommendations for various key groups: For policymakers/governmental bodies (establish a cross-sectoral review board composed of representatives from patient advocacy groups, insurance providers and regulatory agencies to periodically review and validate accreditation criteria against current societal expectations, ensuring relevance and public accountability), accreditation management bodies and industry/service providers (service providers must move beyond mere compliance by utilizing the findings of this study to proactively map internal processes against the high-implementability factors identified). This involves viewing accreditation not as a hurdle, but as a roadmap for competitive advantage through demonstrable quality assurance that directly influences patient trust and market share. SOCIAL IMPLICATIONS: This study yields significant implications across several domains, capitalizing on the crucial role of accreditation in enhancing quality, ensuring patient safety and promoting stakeholder satisfaction. ORIGINALITY/VALUE: Despite the implementation of accreditation requirements in hospitals and continuous monitoring, we still observe shortcomings and deficiencies in some cases, which are addressed in hospital accreditation standards. By identifying the challenges faced by hospitals in this area locally and providing practical solutions, as well as implementing corrective interventions, positive steps can be taken towards the effective implementation of accreditation in hospitals. Previous studies largely focus on challenges within voluntary accreditation models (e.g. JCI and ACS), where commitment is market-driven. This study, conversely, investigates these challenges within the nationally mandated, highly centralized and culturally hierarchical Iranian healthcare context. This shift in mandatory governance creates unique friction points, such as the intense impact of frequent management changes and political influence on resource allocation, which are absent or minimized in voluntary systems. The identification of challenges directly linked to international sanctions (e.g. resource shortages and outdated technology) is a novel contribution that connects quality improvement literature with geopolitical realities. This link is vital for understanding accreditation barriers in sanctioned or developing economies and has not been adequately addressed in the existing global literature. While generalizability across all countries is limited, the findings serve as a crucial benchmark for the wider set of Middle Eastern, highly centralized, and developing economies facing similar governance and resource constraints. The 22 challenges and 26 solutions identified offer a localized framework that is highly applicable to systems operating under similar resource pressures.
Sustainability challenges in Uganda's health and sanitation projects: an institutional perspective.
Kyambade M, Mwesigwa R, Alinda K … +1 more , Tumwine S
Int J Health Care Qual Assur · 2026 Jan · PMID 41469856 · Publisher ↗
PURPOSE: This study examines why health and sanitation projects in Uganda struggle to achieve sustainability despite substantial investments, supportive policies, and global commitments. DESIGN/METHODOLOGY/APPROACH: Guid...
PURPOSE: This study examines why health and sanitation projects in Uganda struggle to achieve sustainability despite substantial investments, supportive policies, and global commitments. DESIGN/METHODOLOGY/APPROACH: Guided by Institutional Theory, the study adopts a qualitative design involving 21 semi-structured interviews with project managers, government officials, NGO staff, health inspectors, and community mobilizers. Data were thematically analyzed using Nvivo. FINDINGS: Results show that fragmented governance, weak policy coherence, and short-term donor cycles constrain institutional alignment. Low community ownership, weak feedback systems, and donor-local power imbalances undermine accountability, while leadership gaps, corruption, and limited technical capacity further weaken resilience. Together, these factors explain why sustainability remains difficult to institutionalize in Uganda's health and sanitation sector. PRACTICAL IMPLICATIONS: The study calls for integrating interventions within national institutional frameworks, strengthening local accountability, and enhancing ethical and technical leadership. Donors and policymakers should support long-term learning, participatory design, and sustainable local financing. ORIGINALITY/VALUE: This study provides one of the few empirical analyses of sustainability challenges in Uganda's health and sanitation projects. By applying Institutional Theory, it offers a systemic view of how governance, leadership, and community legitimacy shape project continuity and resilience.
Financial management behavior among Brazilian physicians: evidence for financial education and policy development.
Andrade E, Lopo Martinez A, Boa Sorte N … +5 more , Roberto Souza Sodré P, Lobato Gomes F, Antonio Venancio F, Pinho Cruz L, Sergio Lins Perazzo P
Int J Health Care Qual Assur · 2025 Dec · PMID 41423805 · Publisher ↗
PURPOSE: This study aims to identify the demographic, professional and regional determinants of financial management behavior among Brazilian physicians and discuss the implications for medical education and policy. DESI...
PURPOSE: This study aims to identify the demographic, professional and regional determinants of financial management behavior among Brazilian physicians and discuss the implications for medical education and policy. DESIGN/METHODOLOGY/APPROACH: A cross-sectional online survey (n = 422) was conducted using an adapted 15-item Financial Management Behavior Scale (FMBS). The internal consistency was satisfactory (Cronbach's α = 0.758; McDonald's ω = 0.783). Group differences across FMBS terciles were assessed with chi-square/Fisher and Kruskal-Wallis tests; associations were examined via logistic regressions contrasting middle and upper terciles with the lower terciles (reference). FINDINGS: Positive behaviors were more frequent among men, older physicians and those practicing in the Southeast. In multivariable models, women had lower odds of being in the high-performing tercile (OR˜0.53, 95% CI 0.31-0.91); physicians aged = 50 years had markedly higher odds (OR˜27.3, 2.36-315.8); practice in the Southeast was associated with ˜three three-fold higher odds versus Central West. The FMBS subscales increased monotonically across terciles, especially Savings/Investments and Insurance (p < 0.001). RESEARCH LIMITATIONS/IMPLICATIONS: This study is limited by its cross-sectional design, which prevents causal inference, and by the reliance on self-reported data, which may introduce response bias. The exclusion of incomplete surveys might also have reduced representativeness. Future research should employ longitudinal designs and intervention-based studies to assess the long-term impact of financial education programs on physicians' financial behavior. PRACTICAL IMPLICATIONS: The findings support targeted financial counseling for early careers and female physicians and the curricular integration of personal finance in medical training. SOCIAL IMPLICATIONS: Aligning physician-focused initiatives with national financial education efforts may reduce the gender and regional gaps. ORIGINALITY/VALUE: The first nationwide analysis of Brazilian physicians' financial management behaviors used a culturally adapted FMBS and linked regional disparities to actionable education and policy levers.
Barriers in utilization of dental service among people in Nalgonda district, Telangana.
Mitra R
Int J Health Care Qual Assur · 2025 Dec · PMID 41416574 · Publisher ↗
PURPOSE: Regular home care and yearly dental check-ups are essential for maintaining oral health. However, dental service use remains limited, often only sought during pain/emergency. This study aimed to explore whether...
PURPOSE: Regular home care and yearly dental check-ups are essential for maintaining oral health. However, dental service use remains limited, often only sought during pain/emergency. This study aimed to explore whether this underutilization is due to individual perception or lack of service availability. DESIGN/METHODOLOGY/APPROACH: A cross-sectional observational study was conducted among 280 individuals selected using multistage sampling. A self-structured, pre-tested, closed-ended questionnaire, comprising 25 questions was self-administered. The data was analysed using SPSS v.22 and Chi-square test was applied to assess significant associations between variables. FINDINGS: The most commonly cited reason for not utilising dental services (73.2%) was the belief that dental care is unnecessary unless there is pain. Fear/anxiety was a significant barrier, especially among females (p = 0.004). Significant associations were observed between age groups and understanding of the dentist's explanation (p = 0.04), and in the type of treatment undergone (p = 0.01). SOCIAL IMPLICATIONS: This study explores how structural and social determinants like lack of awareness, geographic accessibility and economic constraints serve as barriers to dental service utilization in rural Telangana, reflecting broader patterns of health inequity in underserved population. ORIGINALITY/VALUE: The study highlights the continued low perceived need for preventive dental care in rural populations, reinforced by misconceptions that dental issues are only necessary when painful. It emphasizes the importance of community-based interventions such as mobile dental clinics, dental camps and outreach programs to increase awareness, reduce fear and improve utilization of dental services.
Using blockchain to enhance transparency and security in the vaccine and serum supply chain.
Babaeimorad S, Beheshtiseresht N
Int J Health Care Qual Assur · 2025 Dec · PMID 41411106 · Publisher ↗
PURPOSE: This paper aims to explore how blockchain technology can enhance transparency and security in the vaccine and serum supply chain. Vaccines and serums are critical healthcare products that require strict storage...
PURPOSE: This paper aims to explore how blockchain technology can enhance transparency and security in the vaccine and serum supply chain. Vaccines and serums are critical healthcare products that require strict storage and transportation conditions. Ensuring the authenticity, safety and traceability of these products throughout their production and distribution process is vital for public health. The study focuses on identifying how blockchain can address these needs by improving tracking, preventing fraud and maintaining the integrity of sensitive medical products. Ultimately, it seeks to provide innovative solutions to strengthen this complex and sensitive supply chain. DESIGN/METHODOLOGY/APPROACH: The study employed an analytical approach, reviewing blockchain technology's capabilities in precisely tracking products from origin to destination. It examined the use of smart contracts to automate processes and enforce compliance with strict protocols in vaccine supply chains. A mixed-methods design was adopted, including qualitative interviews with 12 experts and a quantitative survey of 100 participants from the vaccine and serum supply chain to ensure comprehensive analysis. FINDINGS: The findings revealed that blockchain technology could effectively resolve many issues faced by vaccine and serum supply chains. By providing unparalleled transparency and immutability, blockchain helped prevent fraud and ensured that products maintained proper storage conditions throughout the journey. This led to increased security and confidence among stakeholders and end consumers. Despite challenges such as cost and integration hurdles, the benefits of blockchain in enhancing traceability, automating processes via smart contracts and ensuring compliance outweighed the difficulties, offering a promising improvement to this critical industry. ORIGINALITY/VALUE: This paper contributes to the field by highlighting the innovative application of blockchain technology in the sensitive and complex vaccine and serum supply chain. Given the critical nature of these medical products, leveraging blockchain for improved security and transparency represents a significant advancement. The study provides practical insights into how blockchain can mitigate risks, enhance supply chain efficiency and support regulatory compliance. Its value lies in demonstrating blockchain's potential as a transformative tool that can lead to a more reliable and trustworthy vaccine distribution system, encouraging broader adoption in the healthcare industry.
Validation of the Sickness Presenteeism Scale-Nurse (SPS-N) among Indian nurses and its relationship with perceived stress.
Kumar D, Garg N
Int J Health Care Qual Assur · 2025 Dec · PMID 41403217 · Publisher ↗
PURPOSE: This study examined the reliability and validity of the Sickness Presenteeism Scale-Nurse (SPS-N) among Indian nurses. DESIGN/METHODOLOGY/APPROACH: Three independent studies were conducted to validate the SPS-N...
PURPOSE: This study examined the reliability and validity of the Sickness Presenteeism Scale-Nurse (SPS-N) among Indian nurses. DESIGN/METHODOLOGY/APPROACH: Three independent studies were conducted to validate the SPS-N in the Indian context. The first study evaluated the factorial structure of the scale using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The second study explored reliability and validity with the help of Cronbach's alpha, McDonald's omega and the Fornell and Larcker testing system. Besides, convergent and criterion validities were also assessed by examining the correlation between SPS-N, Stanford presenteeism and perceived stress scores. Lastly, test-retest reliability was evaluated in the third study. FINDINGS: EFA yielded a four-factor solution that explains 59.17% of the total variance. However, the two statements were part of different dimensions of the scale in comparison to the original SPS-N scale. CFA confirmed the factorial structure among Indian nurses. Also, acceptable values of Cronbach's alpha and McDonald's omega established the scale's reliability. Besides, a significant positive association of the SPS-N scores with Stanford presenteeism and perceived stress scores confirmed the scale's convergent and criterion validities. ORIGINALITY/VALUE: The SPS-N exhibited acceptable reliability and validity, with minor modifications. The scale could be used to investigate the impact of presenteeism among Indian nurses.
Assessing the hospital pharmacy preparedness to mass casualty incidents.
Mousli HM, Elmasry H, Mousa E … +3 more , Ouda M, Elsayed N, Mosly MM
Int J Health Care Qual Assur · 2025 Dec · PMID 41400066 · Publisher ↗
PURPOSE: This study aims to assess the current state of awareness and preparedness for Mass Casualty Incidents (MCIs) among hospital pharmacies in Egypt, focusing on the availability of disaster plans either for pharmacy...
PURPOSE: This study aims to assess the current state of awareness and preparedness for Mass Casualty Incidents (MCIs) among hospital pharmacies in Egypt, focusing on the availability of disaster plans either for pharmacy or for a hospital as a whole, participation in drills and the perceived adequacy of essential medication stocks. DESIGN/METHODOLOGY/APPROACH: A descriptive, cross-sectional study was conducted using a validated, self-administered questionnaire distributed to licensed pharmacists across various public, private, and university teaching hospitals, across different governorates in Egypt. FINDINGS: Our findings show significant gaps in preparedness and awareness of many aspects of the mass causality events' handling. While just over half of participants reported that they have a pharmacy-specific disaster plan, over a third (36.6%) were unaware of their hospital's overall disaster plan. A striking 75% of pharmacists had never participated in a disaster drill. Confidence in medication stocks was high for common drugs like analgesics (70.3% agreed adequate). 65.4% of pharmacists reporting that chemical weapon antidote stocks were insufficient. Larger, better-resourced hospitals were significantly more likely to have a formal disaster plan. ORIGINALITY/VALUE: This research is the first focused examination of hospital pharmacy preparedness for MCIs in Egypt, which fills a significant gap in the national and regional literature. The findings provide novel, practical evidence that goes beyond intuitive opinion to identify specific readiness gaps, offering a critical foundation for stakeholders to build on.
Impact of machine learning on spare parts availability for critical medical devices: a supervised machine learning perspective.
Dattu FHPA, Syed Shazali ST, Tanjong SJ … +2 more , Rosli N, Abdullah ARA
Int J Health Care Qual Assur · 2026 Jun · PMID 41392590 · Publisher ↗
PURPOSE: This paper seeks to improve the reliability and quality of operation of the critical medical equipment methods through the combination of failure mode and effects analysis (FMEA) and supervised machine learning...
PURPOSE: This paper seeks to improve the reliability and quality of operation of the critical medical equipment methods through the combination of failure mode and effects analysis (FMEA) and supervised machine learning (ML) approaches to predictive spare parts management. The paper aims to reduce downtime, optimise the maintenance planning and increase the quality of healthcare services in general by advanced decision support. DESIGN/METHODOLOGY/APPROACH: A dataset comprising 2,800 maintenance records from six hospitals, covering 10 categories of medical devices including ventilators, dialysis machines, infusion pumps and computed tomography scanners, was analysed. The FMEA was initially used to calculate risk priority numbers (RPNs) to indicate the criticality of devices and their probability of failure. These RPNs were used as input features to three supervised ML models, which are the random forest (RF), the artificial neural network (ANN) and the support vector machine (SVM). Each model underwent grid-search hyperparameter tuning and five-fold stratified cross-validation to ensure reproducibility. The accuracy, precision, recall, F1-score and area under the curve were used to evaluate the models. FINDINGS: The accuracy of the RF model and ANN was 1.00 with an F1-score of 0.90 and SVM had the highest recall of 0.94, implying that it is more sensitive in identifying actual spare parts replacement requirements. The combined failure mode and effects analysis-machine learning model enhanced the availability of spare parts by an estimated 12-15% in all hospital locations. The strength and discriminative performance of the proposed models were tested with the help of visual analysis through confusion matrices and receiver operating characteristic curves. These outcomes demonstrate how predictive analytics can strengthen maintenance traceability and ensure continuity of patient-care equipment. RESEARCH LIMITATIONS/IMPLICATIONS: The suggested hybrid structure assists in data-based maintenance planning within the biomedical engineering departments of hospitals. It helps minimise the downtime, promote patient safety and increase the adherence to the healthcare quality standards, including International Organization for Standardization 13485 and Joint Commission International accreditation, by predicting replacement requirements and aligning them with inventory management. The model is also consistent with United Nations Sustainable Development Goals (SDGs) (SDG 3: Good Health and Well-Being and SDG 12: Responsible Consumption and Production). PRACTICAL IMPLICATIONS: Hospitals can optimise inventory planning and preventive maintenance scheduling. SOCIAL IMPLICATIONS: Improved equipment availability supports better patient care and healthcare reliability. ORIGINALITY/VALUE: This study is one of the pioneering studies that combine FMEA-based criticality measures and supervised ML models (RF, ANN and SVM) to optimise hospital maintenance. It offers a clear and understandable system that connects traditional reliability engineering and intelligent decision-support systems, which gives quantifiable gains in both healthcare quality assurance and sustainability performance.
Expression of concern: Role of a hospital accreditation program in developing a process management system: a qualitative study.
Int J Health Care Qual Assur · 2026 May · PMID 41367258 · Publisher ↗
Abstract loading — click title to view on PubMed.
Using a person-centred model of Lean Six Sigma to support process improvement within a paediatric primary eye care clinic.
Bourke C, Mullaniff A, Tang B … +2 more , Waya O, Teeling SP
Int J Health Care Qual Assur · 2025 Dec · PMID 41362228 · Publisher ↗
PURPOSE: Process improvement methodologies such as Lean Six Sigma are increasingly being deployed to address inefficiencies in healthcare. Simultaneously, global policy and strategy development stress the value of person...
PURPOSE: Process improvement methodologies such as Lean Six Sigma are increasingly being deployed to address inefficiencies in healthcare. Simultaneously, global policy and strategy development stress the value of person-centredness in healthcare. This paper examines the application of a Person-Centred Lean Six Sigma Model (PCLSSM) to improve processes in a paediatric eye care clinic, specifically focusing on streamlining the referral system and optimising the clinic environment. DESIGN/METHODOLOGY/APPROACH: A quasi-experimental, single-site, pretest-posttest study was conducted over nine months using the Lean Six Sigma define, measure, analyse, improve and control (DMAIC) framework. Data were gathered through Voice of the Customer (VOC) sessions, Gemba observations, process mapping and referral letter audits. Key stakeholders, including clinicians, administrative staff and parents, co-designed the interventions to enhance efficiency and patient experience. FINDINGS: The application of the PCLSSM resulted in a 46% increase in right-first-time referral accuracy, a 20% reduction in referral processing time, a 13% increase in staff confidence in the referral system, a 158% improvement in staff satisfaction with workload and a 104% rise in child and parent satisfaction with their clinic experience. The implementation of an electronic referral system and an improved clinic environment contributed to these improvements. ORIGINALITY/VALUE: This study is the first to integrate a person-centred approach with Lean Six Sigma in paediatric ophthalmology. The findings demonstrate the potential of combining process improvement methodologies with person-centred principles to enhance operational efficiency and stakeholder satisfaction. This approach can serve as a model for similar outpatient settings seeking to improve service delivery and patient experience.
Overcoming barriers to AI implementation in dentistry: a comprehensive ISM model analysis.
Sabir LB, Mohtashim F, Uddin SMF
Int J Health Care Qual Assur · 2025 Dec · PMID 41348553 · Publisher ↗
PURPOSE: Artificial intelligence (AI) in the present scenario stands at the forefront of innovation, offering transformative potential across all domains, including healthcare. Recognizing the need for a deeper understan...
PURPOSE: Artificial intelligence (AI) in the present scenario stands at the forefront of innovation, offering transformative potential across all domains, including healthcare. Recognizing the need for a deeper understanding of the barriers to AI implementation in dentistry, this study aims to explore and analyse the challenges hindering its widespread adoption. DESIGN/METHODOLOGY/APPROACH: The study employed a mixed-method approach. First, we conducted a detailed review of past studies to identify possible barriers. About 18 experts helped in finalizing the 17 important barriers. We used Interpretive Structural Modelling (ISM) to understand how these barriers are connected. Further, Matrice d'impacts croisés multiplication appliquée à un classement (MICMAC) analysis was operationalised to group the barriers and assess their effect on other barriers. FINDINGS: The study found several major barriers. These include fear of biasness, technology sophistication, firm size and structure, lack of trained staff, unavailability of data, privacy and security issues. Technological hurdles and lack of accountability are found to be the linkage variables linking the driver and dependent quadrants. ISM helped show how some barriers are more powerful and affect others. MICMAC analysis grouped the barriers into four types, namely independent, dependent, linkage and driving. RESEARCH LIMITATIONS/IMPLICATIONS: Dentists, technology makers and policymakers can use these results to build trust in AI systems and improve dental care. ORIGINALITY/VALUE: This is one of the initial attempts to use both ISM and MICMAC methods to study the role of AI in dentistry.
Enhancing accuracy in clinical laboratories: a study on error identification via delta check in high-volume settings.
Shaikh MS, Hashmi SB, Ahmed S … +1 more , Naureen F
Int J Health Care Qual Assur · 2025 Dec · PMID 41321004 · Publisher ↗
PURPOSE: Medical laboratories are integral to patient diagnosis, with approximately 70% of clinical decisions relying on laboratory results. Ensuring result accuracy requires robust quality assurance measures, including...
PURPOSE: Medical laboratories are integral to patient diagnosis, with approximately 70% of clinical decisions relying on laboratory results. Ensuring result accuracy requires robust quality assurance measures, including delta check alerts, which flag significant differences between consecutive test results within patients. This study aimed to assess the effectiveness of Delta Check alerts in identifying errors in mean corpuscular volume (MCV) within a high-volume tertiary care laboratory, thereby enhancing patient safety and diagnostic precision. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted at The Aga Khan University Hospital, Pakistan from January to March 2024. All inpatient complete blood count (CBC) samples were included. A delta check event was defined as a change in MCV exceeding 5 femtoliter (fL) within 24 h. These events were classified as valid or invalid based on clinical relevance, with valid errors further categorized into pre-analytical and analytical errors. Data were analyzed using Microsoft Excel 365, and categorical variables were reported as frequencies and percentages. FINDINGS: Among 149,286 inpatient CBC samples analyzed, 1,779 (1.19%) MCV delta check alerts were generated. Of these, 1,694 (95.2%) were invalid, primarily due to blood transfusions (n = 1,013, 59.7%). The remaining 85 valid errors included wrong patient labeling (n = 64, 75.2%), sample dilution (n = 19, 22.3%) and insufficient sample volume (2, 2.3%). These findings highlight the utility of delta check alerts in identifying pre-analytical errors that could otherwise compromise result accuracy. RESEARCH LIMITATIONS/IMPLICATIONS: This study underscores the value of delta check alerts in identifying pre-analytical issues, especially mislabeling and sample dilution, thereby strengthening laboratory quality assurance. Although many alerts were invalid, often due to transfusions, optimizing threshold settings may enhance system efficiency. Incorporating automated delta check processes into routine operations could provide an additional layer of protection against unnoticed errors. Future studies should examine the potential of machine learning to boost error detection while reducing false positives, ultimately improving both laboratory efficiency and diagnostic precision. PRACTICAL IMPLICATIONS: Implementing delta check alerts can enhance laboratory error detection, particularly in identifying pre-analytical issues such as mislabeling and sample dilution. Integrating automated alerts into routine workflows may improve result accuracy and reduce diagnostic errors. SOCIAL IMPLICATIONS: By improving laboratory quality assurance, delta check alerts contribute to enhanced patient safety, reduced diagnostic delays and improved healthcare outcomes. Strengthening error detection mechanisms supports public trust in laboratory testing and promotes better clinical decision-making. ORIGINALITY/VALUE: This study provides valuable insights into the application of delta check alerts as an additional quality assurance measure in high-volume hematology laboratories. While most alerts were clinically explainable and deemed invalid, a small but significant proportion identified critical pre-analytical errors, underscoring the importance of delta checks in enhancing laboratory quality assurance. By integrating delta check alerts into routine practice, laboratories can improve error detection, minimize misdiagnosis and enhance overall patient safety.
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