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With the exigencies of health-care service quality to actualize sustainable socio-economic and developmental aspirations, in both peripheral and core countries, this paper aims to provide empirical evidence on health-care service quality and its precursor – patients’ satisfaction, and continuous service utilization.

A total of 398 screened questionnaires were analyzed from selected hospitals of the Koforidua, Ghana. Findings from the structural equation modeling showed a significant association among perceived quality, patients’ satisfaction and tangibility. Contrary to the expectations, the results did not show a significant association among the constructs – perceived quality, safety and empathy. Again, the model fit indices collaboratively showed that the hypothesized model overwhelmingly “fit” the sample data, and further proved the predictive robustness of the model.

The results of the analysis demonstrate that patients were discontent with empathy and safety measures at the hospitals. However, tangible and perceived quality were identified as significant predictors of patients’ satisfaction.

There is a dearth of empirical investigations on the assessment of health-care service quality and patients’ satisfaction in developing economies such as Ghana. Therefore, the implication of the study will equip the top hierarchy of the Health System of Ghana in achieving their mission, and objectives in line with quality service delivery. In particular, MoH and GHS can embark on a routine exercise to audit the hospitals for re-accreditation, and provide CCT cameras to improve safety and security conditions at the hospitals, while enforcing the culture of receptive hospital environment to improve empathy.

The purpose of this paper is to present a description of the Irish national clinical governance development initiative and an evaluation of the initiative with the purpose of sharing the learning and proposing actions to activate structures and processes for quality and safety. The Quality and Patient Safety Division of the Health Service Executive established the initiative to counterbalance a possible focus on finances during the economic crisis in Ireland and bring attention to the quality of clinical care.

A clinical governance framework for quality in healthcare in Ireland was developed to clearly articulate the fundamentals of clinical governance. The project plan involved three overlapping phases. The first was designing resources for practice; the second testing the implementation of the national resources in practice; and the third phase focused on gathering feedback and learning.

Staff responded positively to the clinical governance framework. At a time when there are a lot of demands (measurement and scrutiny) the health services leads and responds well to focused support as they improve the quality and safety of services. Promoting the use of the term “governance for quality and safety” assisted in gaining an understanding of the more traditional term “clinical governance”. The experience and outcome of the initiative informed the identification of 12 key learning points and a series of recommendations

The initial evaluation was conducted at 24 months so at this stage it is not possible to assess the broader impact of the clinical governance framework beyond the action project hospitals.

The single most important obligation for any health system is patient safety and improving the quality of care. The easily accessible, practical resources assisted project teams to lead changes in structures and processes within their services. This paper describes the fundamentals of the clinical governance framework which might serve as a guide for more integrative research endeavours on governance for quality and safety.

Experience was gained in both the development of national guidance and their practical use in targeted action projects activating structures and processes that are a prerequisite to delivering safe quality services.

The purpose of this paper is to examine the relationship between patient safety culture and hospital performance using objective performance measures and secondary data on patient safety culture.

Patient safety culture is measured using data from the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture. Hospital performance is measured using objective patient safety and operational performance metrics collected by the Centers for Medicare and Medicaid Services (CMS). Control variables were obtained from the CMS Provider of Service database. The merged data included 154 US hospitals, with an average of 848 respondents per hospital providing culture data. Hierarchical linear regression analysis is used to test the proposed relationships.

The findings indicate that patient safety culture is positively associated with patient safety, process quality and patient satisfaction.

Hospital managers should focus on building a stronger patient safety culture due to its positive relationship with hospital performance.

This is the first study to test these relationships using several objective performance measures and a comprehensive patient safety culture data set that includes a substantial number of respondents per hospital. The study contributes to the literature by explicitly mapping high-reliability organization (HRO) theory to patient safety culture, thereby illustrating how HRO theory can be applied to safety culture in the hospital operations context.

To investigate the association between implementation of clinical governance and patient safety.

A pre-post study was conducted in an Australian health service following the implementation of clinical governance systems (CGS) in the inpatient wards in 2016. Health service audit data from 2017 on CGS implementation and the rate of adverse patient safety events (PSE) for 2015 (pre-implementation) and 2017 (post-implementation), across 45 wards in six hospitals were collected. CGS examined compliance with 108 variables, based on the Australian National Safety and Quality Health Service standards. Patient safety was measured as PSE per 100 bed days. Data were analysed using odds ratios to explore the association between patient safety and CGS percentage compliance score.

There was no change in PSE between 2015 and 2017 (MD 0.04 events/100 bed days, 95% CI -0.11 to 0.21). There were higher odds that wards with a CGS score >90% reported reduced PSE, compared to wards with lower compliance. The domains of leadership and culture, risk management and clinical practice had the strongest association with the reduction in PSE.

Given that wards with a CGS score >90% showed increased odds of reduced PSE health service boards need to put in place strategies that engage frontline managers and staff to facilitate full implementation of clinical governance systems for patient safety.

The findings provide evidence that implementation of all facets of CGS in a large public health service is associated with improved patient safety.

Early writings about teamwork in healthcare emphasized that healthcare providers needed to evolve from a team of experts into an expert team. This is no longer enough. As patients, accreditation bodies, and regulators increasingly demand that care is coordinated, safe, of high quality, and efficient, it is clear that healthcare organizations increasingly must function and learn not only as expert teams but also as expert multiteam systems (MTSs).

In this chapter, we offer a portrait of the robust, and albeit complex, multiteam structures that many healthcare systems are developing in order to adapt to rapid changes in regulatory and financial pressures while simultaneously improving patient safety, quality, and performance.

The notion of continuous improvement rooted in continuous learning has been embraced as a battle cry from the boardroom to the bedside, and the MTS concept offers a meaningful lens through which we can begin to understand, study, and improve these complex organizational systems dedicated to tackling some of the most important goals of our time.

Creating a culture of patient safety and developing a skilled workforce are major challenges for health managers. However, there is limited information to guide managers as to how patient safety culture can be improved. The purpose of this paper is to explore the concept of reflexivity and develop a model for magnifying the effect of patient safety culture and demonstrating a link to improved perceptions of quality of care.

This research employed a correlational case study design with empirical hypothesis testing of quantitative scores derived from validated survey items. Staff perceptions of patient safety, reflexivity and quality of patient care were obtained via a survey in 2015 and analysed using inferential statistics. The final sample included 227 health service staff from clinical and non-clinical designations working in a large Australian tertiary hospital and health service delivering acute and sub-acute health care.

Both patient safety culture and reflexivity are positively correlated with perceived quality of patient care at the p<0.01 level. The moderating role of reflexivity on the relationship between patient safety culture and quality of care outcomes was significant and positive at the p<0.005 level.

Improving reflexivity in a health workforce positively moderates the effect of patient safety culture on perceptions of patient quality of care. The role of reflexivity therefore has implications for future pre-professional curriculum content and post-graduate licencing and registration requirements.

Much has been published on reflection. This paper considers the role of reflexivity, a much less understood but equally important construct in the field of patient safety.

The authors compare perspectives on external evaluation of health service provision between Norway and the USA. External inspection and accreditation are examples of internationally wide-spread external evaluation methods used to assess the quality of care given to patients. Different countries have different national policy strategies and arrangements set up to do these evaluations. Although there is growing attention to the impact and effects on quality and safety from external evaluation, there is still a gap in knowledge to how structures and processes influence these outcomes. Accordingly, the purpose of this article is to describe the structures and processes in external evaluation designed to promote quality improvement in Norway and the USA with attention to comparison of enablers and barriers in external evaluation systems.

Data collection consisted of documentary evidence retrieved from governmental policies, and reviews of the Joint Commission (the US), international guidelines, recommendations and reports from the International Society for Quality in Health Care, and the World Health Organization, and policies and regulations related to Norwegian governmental bodies such as the Ministry of Health and Care Services, the Norwegian Directorate of Health, and the Norwegian Board of Health Supervision . Data were analyzed inspired by a deductive, direct content analytical framework.

The authors found that both accreditation and inspection are strategies put in place to ensure that healthcare providers have adequate quality systems as well as contributing to the wider risk and safety enhancing management and implementation processes in the organizations subjected to evaluation. The US and the Norwegian external regulatory landscapes are complex and include several policymaking and governing institutions. The Norwegian regulatory framework for inspection has replaced an individual blame logic with a model which “blames” the system for inadequate quality and patient harm. This contrasts with the US accreditation system, which focuses on accreditation visits. Although findings indicate an ongoing turning point in accreditation, findings also demonstrate that involving patients and next of kin directly in adverse event inspections is a bigger part of a change in external inspection culture and methods than in processes of accreditation.

The message of this paper is important for policymakers, and bodies of inspection and accreditation because knowledge retrieved from the comparative document study may contribute to better understanding of the implications from the different system designs and in turn contribute to improving external evaluations.

Although there is a growing attention to the impact and effects on quality and safety from external evaluation, the implications of different regulatory strategies and arrangements for evaluation on quality and safety remain unclear.

The purpose of this paper is to examine the usability and potential of incorporating quality costs into an electronic adverse incident recording system within a healthcare sector.

The paper is a general review and a discussion of an electronic adverse incident‐recording system into the potential benefits and restrictions was undertaken. Articles containing both information systems and quality costs were reviewed in order to explore the potential of linking information against patient safety issues.

The paper finds that quality costs is a valid and useful approach for measuring the impact of individual adverse incidents or trends in order to support managers and clinicians to develop appropriate action plans to reduce levels of patient harm and thereby improve patient safety. The paper also shows that quality costs can be used to support managers and clinicians and are commercially designed to improve the detection, investigation and action planning to improve service quality and patient safety.

Quality costs can be used as a driver for identifying potential high impact quality and patient safety projects within a healthcare setting.

This paper provides useful information for designers of electronic adverse incident‐reporting systems to support managers and clinicians to utilise the benefits of quality costing in order to strengthen and re‐focus patient safety issues in healthcare.

The purpose of this paper is to explain the patients’ views towards private healthcare service providers. The study focussed on hospital service quality and analysed the relative significance of quality measurements in anticipating the patients’ satisfaction and loyalty. The mediating role of patient satisfaction is assessed between quality of hospital healthcare services and patient loyalty.

A total 611 patients (both indoor and outdoor) participated in a questionnaire survey from the six private hospitals of capital city, Islamabad, Pakistan. Data were analysed through descriptive statistics, common method variance, reliability, correlation and regression in order to investigate customer perceived service quality and how the quality of services stimulates loyalty intentions towards private service suppliers.

Findings depict that private healthcare service providers are attempting to deliver well improved healthcare services to their customers. Results confirmed that better quality of healthcare services inclines to build satisfaction and loyalty among patients. The healthcare service quality aspects (i.e. physical environment, customer-friendly environment, responsiveness, communication, privacy and safety) are positively related with patient loyalty which is mediated through patient satisfaction.

Findings will help the hospital managers to articulate effective strategies in order to ensure superior quality of healthcare services to patients. The study will induce hospital management to deliver attentions towards the quality of private healthcare service systems and improvements towards the deficient healthcare services. Furthermore, the study will present a clear picture of patient’s behavioural attitudes; satisfaction and loyalty intentions towards the quality of healthcare services.

The study provides the views and perceptions of patients towards the quality of healthcare services. The healthcare service quality dimensions, i.e., physical environment, customer-friendly environment, responsiveness, communication, and privacy and safety were assessed. Hospital healthcare service quality was examined in order to find out its effect on patient satisfaction and patient loyalty.

High patient satisfaction is not simply a customer service goal; it is an important dimension of quality and part of financial incentives and public reporting requirements. However, patient experience is often siloed within health system organizational charts and considered separately from quality and safety initiatives, instead of being seen predominantly as a “customer service” initiative. Representatives from 52 health care systems across the United States completed an online survey to explore both the processes and infrastructure hospitals employ to improve patient experience, and the metrics hospitals use to assess the quality of patient experience beyond patient satisfaction survey data. When asked about performance metrics beyond satisfaction, most hospitals or systems noted other metrics of the entire patient experience such as the rate of complaints or grievances and direct feedback from patient and family advisors. Additionally, respondents suggested that a broader definition of “quality of the patient experience” may be appropriate to encompass measures of access, clinical processes, and quality of care and patient safety outcomes. Almost all respondents that we surveyed listed metrics from these less traditional categories, indicating that performance improvement within the patient experience domain in these organizations is linked with other areas of hospital performance that rely on the same metrics, such as clinical quality and patient safety.