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Healthcare has undergone multiple phases in gaining understanding, accepting and implementing quality and safety, with the last 3 decades being crucial and decisive in making progress. During that time, safety has always been quoted along with quality, but the cost of error in healthcare (both in human lives and monetary cost) has been continuing to rise.

This article discusses the authors’ expert perspective in comparison to the industry’s research and practice outputs.

Healthcare has not yet defined quality and safety. This is allowing the misconception that already established quality management systems (QMSs) are fit for safety purposes as well. Even though aviation has acted as a paradigm for healthcare, further alignment in embedding safety management systems (SMS) has yet to be realised.

In this paper, the distinct nature of safety and its detachment of quality is being discussed, along with the need for clear and safety specific processes. Setting common language is the first step in establishing appropriate safety processes within SMSs, operating in tandem with QMSs, to promote patient safety successfully.

The healthcare sector relies on knowledge management systems to improve knowledge flows and effectively capture, leverage and share knowledge with several organizational stakeholders. However, knowledge as a resource represents a social construct that involves additional managerial complexities and challenges, including undesirable knowledge behaviours. The aim of the current study is to provide insight on how knowledge management systems, knowledge hoarding, knowledge hiding and task conflict shape the quality of care provided by hospitals. We propose and test an original revealing model.

We follow a quantitative approach to address the structural relationship between variables using a combination of factor analysis and multiple regression analysis. The model is tested adopting a structural equation modelling approach and using survey data conducted to 318 healthcare professionals working in Portuguese hospitals.

The main findings suggest that knowledge hiding is positively related to task conflict in hospitals, and task conflict negatively influences quality of care. Knowledge management systems directly and indirectly (via knowledge hoarding) promote quality of care. Moreover, knowledge management systems also mitigate the negative influence of task conflict over quality of care. We propose a final corollary on the relevant role of HRM as the backstage for the model.

Our research offers a novel insight into an overlap of organizational behaviour and healthcare management research. It provides an original framework on knowledge management systems, counterproductive knowledge behaviours and task conflict in hospital settings.

Our research offers a novel insight into an overlap of organizational behaviour and healthcare management research. It provides an original framework on knowledge management systems, counterproductive knowledge behaviours and task conflict in hospital settings.

Patient safety is a top priority globally. A robust healthcare system requires strategic collaboration between research and development. The author analysed over 300 cases from seven hospitals using the failure modes, effects, and criticality analysis (FMECA) tool to understand the underlying causes of medical errors.

The author studied seven hospitals and 300 cases using FMECA to prioritise activities. The findings showed that high-priority events occurred less frequently but had the potential to cause the most harm. Team members evaluated independently to ensure unbiased evaluations. This approach is useful for setting priorities or assessing difficulties.

Poor communication and lack of coordination among staff in a healthcare organisation caused misunderstandings, ineffective decision-making, delays in patient care, and medical errors. Implementation of effective communication and coordination protocols can help avoid these problems.

The study recommends using FMECA to identify and prioritise failures and conducting in-depth analyses to understand their root causes. It also highlights the importance of interdisciplinary knowledge and soft skills for healthcare staff.

This study reveals the significance of FMECA in healthcare risk management and benchmarking. FMECA helps identify system failures, develop prevention strategies, and evaluate effectiveness against industry benchmarks. It offers healthcare professionals a valuable tool to enhance patient safety and improve healthcare quality.

In this article, we outline our views on the appropriateness and utility of Return on Investment (ROI) for the evaluation of the value of healthcare quality improvement (QI) programmes.

Our recent research explored the ROI concept and became the genesis of our viewpoint. We reflect on our findings from an extensive research project on the concept of ROI, involving a multidisciplinary global systematic literature review, a qualitative and Delphi study with mental healthcare leaders from the United Kingdom National Health Service. Research participants included board members, clinical directors and QI leaders. Our findings led to our conclusions and interpretation of ROI against the broad QI governance. We discuss our views against the predominant governance frameworks and wider literature.

ROI is in-line with top-down control governance frameworks based in politics and economics. However, there is evidence that to be of better utility, a tool for the assessment of the value of QI benefits must include comprehensive benefits that reflect broad monetary and non-monetary benefits. This is in-line with bottom-up and collaborative governance approaches. ROI has several challenges that may limit it as a QI governance tool. This is supported by wider literature on ROI, QI as well as modern governance theories and models. As such, we question whether ROI is the appropriate tool for QI governance. A more pragmatic governance framework that accommodates various healthcare objectives is advised.

This article highlights some of the challenges in adopting ROI as a QI governance tool. We signal a need for the exploration of a suitable QI governance approach. Particularly, are healthcare leaders to be perceived as “agents”, “stewards” or both. The evidence from our research and wider literature indicates that both are crucial. Better QI governance through an appropriate value assessment tool could improve clarity on QI value, and thus investment allocation decision-making. Constructive discussion about the utility and appropriateness of ROI in the evaluation of healthcare QI programmes may help safeguard investment in effective and efficient health systems.

The article raises awareness of QI governance and encourages discussions about the challenges of using ROI as a tool for healthcare QI governance.

Effective teamwork is crucial for patient safety in healthcare. The TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) is a widely used tool for assessing teamwork perceptions. The T-TPQ has been adapted and validated for hospital setting use in several countries. This study aimed to translate and validate the T-TPQ into French for use among Tunisian healthcare professionals, enhancing teamwork assessment and patient safety initiatives.

A rigorous process ensured cultural and linguistic adaptation of the T-TPQ, including back-translation, expert panel review, and pilot testing. 459 healthcare professionals from four hospitals in Kairouan, Tunisia participated. Confirmatory factor analysis (CFA) compared the original five-factor structure with a revised structure based on exploratory factor analysis (EFA).

Both CFA models demonstrated good fit, with no significant difference between them (∆χ² = 22.51, p = 0.79). The original five-factor structure was retained due to its established theoretical foundation. The French T-TPQ exhibited strong internal consistency (α = 0.9). Two-way Random ICCs indicated fair to good test-retest reliability for all the five dimensions (0.633–0.848).

Several limitations should be acknowledged. The use of a questionnaire as a data collection tool is the source of a reporting bias, for fear of being identified or for reasons of “social desirability”. Nevertheless, this social desirability was minimal, as Baker et al. (2010) took steps to mitigate this during the instrument's development. Additionally, for assessing attitudes and perceptions, self-reported measures are deemed more effective, whereas objective measures are advocated for behavioral assessments. Furthermore, the participants were informed of the absence of good or bad answers, the importance of answering as closely as possible, and the confidentiality. Moreover, considering the data collection period, the COVID- 19 pandemic and its potential impact on recruitment, data collection, and participant responses. Although the sample size of 459 met the recommended criteria for conducting confirmatory factor analysis, as suggested by Bentler and Chou (1987) and (Floyd and Widaman, 1995), the COVID-19 pandemic presented challenges in recruitment. The increased workload and stress on healthcare professionals, coupled with staff redeployment and research restrictions within hospitals and care units, likely hindered achieving an even larger sample size. These circumstances also necessitated adjustments to data collection methods to ensure safety and adherence to pandemic protocols. This involved incorporating online surveys option with paper-based questionnaires and implementing stricter hygiene measures during in person data collection. Furthermore, the pandemic impacted the teamwork perceptions as significantly redefined the healthcare environment, placing immense pressure on professionals due to surging patient volumes, staff shortages, and the emotional burden of caring for critically ill individuals. This heightened stress and workload likely influenced teamwork dynamics, potentially fostering both positive adaptations, such as increased cohesion and support, as well as negative consequences like communication breakdowns and decreased morale (Terregino et al., 2023).

We outline significant practical implications for leaders in health care for improving teamwork and patient safety. Or, healthcare leaders can significantly enhance teamwork and patient safety by incorporating the validated French T-TPQ into their improvement strategies. This reliable tool enables the assessment of staff perceptions regarding teamwork strengths and weaknesses, specifically in areas like communication and leadership. By identifying these crucial areas, leaders can implement targeted training programs and interventions. In fact, the existing body of research consistently demonstrates the positive impact of team training interventions, on both teamwork processes and patient outcomes. These interventions have been shown to enhance teamwork skills (Baker et al., 2010; Thomas and Galla, 2013; Weaver et al., 2014). In areas such as communication, leadership, situation monitoring, and mutual support, leading to decreased mortality and morbidity rates (Weaver et al., 2014). Implementing team training programs fosters trust and collaboration around shared goals, contributing to a more effective and safer healthcare environment for both patients and professionals. Additionally, the culturally adapted T-TPQ not only benefits individual healthcare settings but also unlocks opportunities for broader research and collaboration on a global scale. By enabling cross-cultural comparisons and benchmarking, the T-TPQ can deepen our understanding of how teamwork dynamics vary across diverse healthcare environments and cultural contexts. This knowledge is invaluable for tailoring teamwork interventions and training programs to specific populations and settings, ensuring their effectiveness and cultural relevance. Moreover, integrating teamwork training into continuing professional development, interprofessional and medical education initiatives is crucial for cultivating collaborative competencies and building high-performing healthcare teams. Research has shown that interprofessional teamwork experiences significantly enhance collaborative competencies among nursing and medical students, emphasizing the importance of incorporating teamwork training early in healthcare education. This approach equips future healthcare professionals with the necessary skills to navigate complex team environments, ultimately improving patient care quality and mitigating workload issues that contribute to burnout (Simin et al., 2010; Ceylan, 2017; Fox et al., 2018).

The French version of the T-TPQ was semantically equivalent and culturally relevant with adequate test-retest reliability as compared to the English version, expanding its applicability and contributing to understanding teamwork perceptions in this context. The French T-TPQ offers a valuable tool for assessing teamwork, identifying areas for improvement, and implementing interventions to enhance teamwork and patient safety in Tunisia and potentially other French-speaking regions.

Efficiency standards, similar to industrial measures like overall equipment effectiveness (OEE), are being used in healthcare systems more and more. Performance indicator models applied to machines assume a constant completion time. However, for human resources, the completion time of a task may vary depending on the stress experienced. This study seeks to bridge this gap by integrating the human behavior of the physician into the performance evaluation.

The paper presents a new algorithm called PerfoBalance that is intended to distribute waiting-patient values among doctors. By maximizing each physician’s stress zones, this method helps to improve their performance as a whole. A thorough case study with medical professionals is carried out to confirm the effectiveness of the suggested methodology. The PerfoBalance algorithm is used in a variety of contexts to divide waiting-patient values among doctors and optimize stress zones.

Experimental results demonstrate a significant improvement in physician efficiency when implementing the PerfoBalance algorithm. The algorithm strategically selects stress zones that contribute to higher performance rates for physicians by optimizing waiting-patient values.

By addressing the undervaluation of human performance difficulties in current efficiency models used in the healthcare industry, this research constitutes a significant contribution to the field. With its launch, the PerfoBalance algorithm offers a fresh viewpoint on waiting-patient value allocation and stress zone management in healthcare settings, hence representing a powerful method for increasing physician productivity.

Community health centres (CHCs) play a vital role in healthcare service delivery in rural India and act as a crucial link between the primary and tertiary healthcare systems. The rural population in the union territory of Jammu and Kashmir primarily depends on CHCs for healthcare services due to the scarcity of private healthcare infrastructure and the lack of access to tertiary hospitals. The purpose of this study is to analyse the impact of management capability, staff competence, waiting time and patient satisfaction on revisit intention among patients visiting CHCs for care needs. It further examines the mediational role of patient satisfaction between antecedents of patient satisfaction and revisit intention.

A survey by questionnaire was used to collect data from 318 inpatients and outpatients visiting CHCs. Partial least square-structural equation modelling was performed with the help of SmartPLS 3 software to evaluate the causal relationships between variables.

The findings of the study ascertain that staff competence and waiting time are strong predictors of patient satisfaction while management capability was reported as an insignificant factor. Patient satisfaction significantly affects revisit intention and successfully mediates the impact of management capability, staff competence and waiting time on revisit intention.

CHCs play a significant role in bridging the gap between primary healthcare and tertiary healthcare and in delivering healthcare services to the vast rural population in India. This study necessitates the active participation of management to ensure the smooth functioning of CHCs. There is a need to provide adequate staff and necessary infrastructural facilities to reduce the treatment waiting time.

This paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.

In their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.

The authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.

The authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.

The purpose of this paper is to improve the understanding of the social contexts of sustainable Lean culture in healthcare by examining self-efficacy (SE) as a fundamental construct related to the value of perceived readiness, prior education of Lean and the importance of leadership’s system-level support.

A descriptive correlational study was conducted to identify the relationships between SE and Lean readiness factors, SE and prior Lean training, SE and clinical vs administrative roles and SE and perceived system-level support in a large health system.

There was a statistically significant difference in self-reported readiness to use Lean tools between individuals who had received Lean training during their academic education and those who had not; however, their level of education did not impact SE. Lastly, and perhaps most important, the learner who embodies SE also has system-level support.

Future directions of this research, in addition to assessing team readiness as other studies suggest, would be to evaluate individual team member readiness by gauging SE and addressing deficits prior to the deployment of process improvement (PI) projects to promote success and sustainability.

This contributes to the ongoing scholarship of Lean management systems, providing clinical and non-clinical leaders with a contextual understanding of their supportive role in the SE of teams.

This study demonstrates the value of understanding SE of individual team members and how it can contribute to overall improved team outcomes, directly impacting the sustainability of Lean change culture and its promotion of improved patient safety, cost efficiencies and access to care.

The process of performance measurement provides support to company management to achieve the objectives established in strategic planning. Through the definition of critical success factors and related key performance indicators, performance measurement verifies the gap between planned objectives and the results achieved, informing the responsible bodies to enable them to evaluate performance and, if necessary, implement improvement actions. Although many types of companies adopt performance measurement, this process is challenging when applied to national health services. This paper aims to identify the evolution of performance measurement and the critical success factors of national health services.

The authors conducted an explorative case study of a leading national health service to delineate the evolutionary path of performance measurement and the main critical success factors.

The results indicate a significant increase in the maturity of performance measurement of a national health service that has been motivated by international reforms and national regulations. This research highlights performance measurement features such as a balanced set of metrics, targets, and incentives linked to strategic objectives and regular and frequent performance reviews. Furthermore, it identifies the performance measurement model of a leading national health service.

The evolution of performance measurement and numerous critical success factors of national health services are described; the critical success factors cover a wide range of financial to operational aspects such as patient safety, organizational appropriateness, and clinical appropriateness.