Quality of care in university hospitals in Saudi Arabia: a systematic review

Patient-centered care and satisfaction of patients with diabetes: insights from a survey among patients at primary healthcare centers in Saudi Arabia

BACKGROUND AND OBJECTIVE

Patient-centered care (PCC) and patient satisfaction are pivotal in healthcare provision for patients with diabetes. This study investigates the link between perceived PCC and satisfaction with care among patients with diabetes in Saudi Arabia.

METHODS

A cross-sectional study was conducted at 47 primary healthcare centers affiliated with general hospitals, including King Abdullah Medical Complex, King Abdulaziz Hospital, East Jeddah Hospital, King Fahd General Hospital, and Al Thagr General Hospital, operated by the Ministry of Health in Jeddah City, Saudi Arabia, between July and August 2023. Over 800 patients with diabetes were approached through a random sampling technique at the reception areas of these centers. These patients were directed to designated private rooms for further engagement, where they completed a face-to-face questionnaire administered by an interviewer. Data analysis was conducted using the software package SPSS version 28 and AMOS version 28.

RESULTS

Of the 594 patients who participated in the study (response rate 73.4%), the results indicated that the perceived level of PCC, including physical comfort (β = 0.200, p = 0.000), continuity in care transition (β = 0.114, p = 0.031), access to care (β = 0.203, p = 0.000), information and education (β = 0.169, p = 0.001), and family and friends involvement (β = 0.082, p = 0.023), were significantly related to patient satisfaction. However, other perceived PCC components, like patient preferences (β = 0.052, p = 0.233), care coordination (β = 0.078, p = 0.123), and emotional support (β=-0.080, p = 0.066), did not appear to have a significant relationship with patient satisfaction. Income and level of education substantially impacted the perception of PCC and satisfaction with care. One notable finding was that the perceived level of PCC had a strong positive relationship with patient satisfaction (β = 0.762, p = 0.002).

CONCLUSION

This study highlights the significant positive relationship between PCC and patient satisfaction in diabetes care in Saudi Arabia. It emphasizes the need for healthcare tailored to individual needs and demographic factors. This provide advocates the broader integration of PCC principles in health systems, particularly in Saudi Arabia, to improve patient experience and satisfaction. Policymakers should integrate patient-centered care into healthcare policies to improve service quality and health outcomes.

Patient satisfaction among Saudi academic hospitals: a systematic review

PURPOSE

To systematically review the patient's satisfaction (PS) levels within academic hospitals in Saudi Arabia from January 2012 to the end of October 2022.

DATA SOURCES

Articles were gathered from PubMed, ProQuest, Google Scholar and Web of Science.

STUDY SELECTION/DATA EXTRACTION

This review identified studies that assessed PS in Saudi Arabian university hospitals. Articles published before January 2012, as well as commentary letters, conference papers, theses and dissertations, were excluded. The study employed the five domains of PS as outlined by Boquiren et al. Two independent reviewers independently identified qualifying studies, used the Joanna Briggs Institute tools to evaluate the quality of each study and extracted essential data from each article.

RESULTS

Out of the 327 studies identified during the search phase, 11 met the project's objectives and criteria. Six studies reported overall PS rates ranging from 78% to 95.2%, with only one study indicating lower PS levels in emergency departments. Most studies demonstrated that technical skill is the primary domain influencing PS in academic hospitals.

CONCLUSION

There is a need for further investigation to explore the factors influencing PS using standardised survey instruments suitable for Saudi culture. Contradictory results regarding PS are clearly evident in the literature; therefore, it is advisable to standardise the assessment process to reduce discrepancies within the academic hospital setting in Saudi Arabia.

Privatization of Medical Services and Revenue Development Project: A Cross-Sectional Survey of Staff Perceptions at the University of Jeddah Medical Center

This study aimed to assess the perceptions of staff working at the University of Jeddah (UJ) Medical Center on the possibility of finding new financing methods for the administration and privatization of the primary and specialized medical care services it provides. A questionnaire link was sent online targeting all staff at the UJ Medical Center (n = 141). The questionnaire comprised 17 items under the following sections: demographic information, staff perceptions about the current status of the services provided by the UJ Medical Center and the possibility of finding new financing methods and additional sources of revenue for the administration. Of the 101 questionnaires returned, the majority were filled by males (n = 71; 70.3%). One-third of the participants (n = 39; 38.6%) have between 5 and 9 years of working experience in Medical Administration, and most of them (n = 42; 41.6%) reported that they have a background in the concept of revenue development/privatization/self-resources/paid treatment. Most were satisfied with the current status of the services provided (average rating = 3.39/5). However, most participants (n = 72; 71.3%) reported that the UJ Medical Center is not ready for the Revenue Development Project of privatization. The survey respondents demonstrated satisfaction with the medical services provided by the UJ Medical Center and the potential application of the Revenue Development Project. However, streamlining the privatization process according to the governmental structures is crucial for it to be implemented properly at the UJ Medical Center.

Attitudes of medical students in Khartoum, Sudan towards the doctor-patient relationship: a cross-sectional study

Background/Objectives

The doctor-patient relationship is essential to the delivery of high-quality medical care. A strong doctor-patient relationship that improves patient outcomes and satisfaction depends on effective communication. The purpose of this study was to assess medical students' attitudes toward the doctor-patient relationship during their clinical years at the University of Khartoum. We also looked at how gender and study year affected patient-centeredness.

Participants/Setting

The study was conducted on medical students in their clinical years from December 2020 to March 2021. Students were selected from years 3 to 6. A total of 353 medical students constituted the study sample.

Design

The cross-sectional study utilized the Patient Practitioner Orientation Scale (PPOS) for the measurement of student attitudes towards the doctor-patient relationship. PPOS scores are calculated as a mean score that ranges from 1 (indicating doctor or disease-centered inclinations) to 6 (indicating patient-centered or egalitarian inclinations). Medical students' demographic data was collected, including their gender, age and study year.

Results

A total of 313 students completed the survey (response rate: 89%). The average total PPOS score and the scores for the caring and sharing subscales for the entire cohort were 4.08 ± 0.53, 4.43 ± 0.58, and 3.72 ± 0.72, respectively. Female gender was significantly associated with more patient-centered attitudes (p < 0.001). When compared to the start of their clinical curriculum, students' attitudes were significantly more patient-centered by the conclusion of their studies (p < 0.001).

Conclusion

A satisfactory level of patient-centeredness was demonstrated by medical students at the University of Khartoum, and gender had an impact on this quality. Additional consideration should be given to the finding that students' orientations were more patient-centered in the caring dimension and less so in the sharing one. Once addressed, improvements in that area could create an environment that enhances attitudes among students in the sharing domain, with great potential gains to patients.

Level of Patient Safety Culture Awareness Among Healthcare Workers

Background

Patient safety is a major concern at all levels of the healthcare system, with the primary objective of reducing patient hazards when providing care. The Kingdom of Saudi Arabia has made great progress in improving the health of its citizens over the last few decades, particularly in terms of patient safety. Currently, many health-care institutions throughout the world are interested in implementing a safety culture to lower the risk of harm and the number of accidents associated with routine treatment.

Purpose

This study aims to assess the level of awareness concerning patient safety culture among health-care providers in hospitals in Riyadh, Saudi Arabia.

Methods

This is a descriptive cross-sectional quantitative study that used the Agency for Healthcare Research and Quality's patient safety culture questionnaire. The survey was conducted online and was completed by 204 health-care employees from three distinct hospital settings in Riyadh, Saudi Arabia: government, quasi-government, and private hospitals.

Results

The results showed a low level of patient safety culture awareness among health-care workers in the 10 dimensions of patient safety. The mean score was 2.24 out of 5 and the standard deviation was 0.50. Participants assigned the highest mean scores to Organisational Learning and Continuous Improvement (Mean: 2.48, Standard deviation: 0.66), Communication About Error (Mean: 2.44, Standard deviation: 0.70), and Teamwork (Mean: 2.40, Standard deviation: 0.64). Interestingly, the scores for hospital supervisor and managerial positions are significant compared to other clinical positions (p-value = 0.047). Moreover, the patient safety rating and the number of reported events were significantly related to the overall level of awareness (p-value <0.001), (p-value = 0.042), respectively.

Conclusion

In Riyadh hospitals, overall patient safety awareness is low, necessitating adequate attention and effective solutions such as encouraging reporting errors, implementing safety huddles and leadership walkarounds, and establishing a patient safety culture. Health-care executives and managers are encouraged to develop safety cultures that promote trust and justice, allowing employees to be candid about their mistakes and failings without retaliation. Moreover, this safety culture should be defined by the following qualities: a just culture, a learning culture, and a reporting culture.

Attitudes of Family Medicine Trainees Towards Patient-Centeredness Practice

Objective

The interaction between physicians and patients is essential in clinical practice. Patient-centered care (PCC) is becoming popular in healthcare and provides an approach to deliver high-quality healthcare to yield positive clinical outcomes. This study explores family medicine residents' attitudes toward the physician-patient relationship and patient-centered care and the possible influence of demographic characteristics, level of training, school of graduation, and previous training.

Methods

A cross-sectional study was conducted among family medicine residents in Riyadh. They were invited to enroll in a web-based survey that includes demographic data, training details, and the "Patient Practitioner Orientation Scale (PPOS).".

Results

A total of 114 family medicine residents completed the survey. There were 68 (59.6%) males and 46 (40.4%) female residents. The overall PPOS was 4.23 ± 0.53. The mean score for sharing domain was 3.97 ± 0.66. The caring domain scored 4.49 ± 0.57. No correlations were found between the residents' demographic data and other included variables, and the means of sharing domain, caring domain, and overall score.

Conclusion

Family medicine residents were found to have positive attitudes toward patient-centeredness. Integrating patient-centered training early in the curriculum can improve healthcare students' and trainees' attitudes toward patient-centered care. Future research can explore the possible interventions in systematic assessment and training programs that can improve PCP.

Experiences and Satisfaction of Patients with Non-Communicable Diseases with Current Care in Primary Health Care Centres in Saudi Arabia

Primary healthcare centres (PHCs) play a pivotal role in chronic disease care and prevention and therefore in the experience and satisfaction of patients with non-communicable diseases (NCDs). This survey examined the experiences and satisfaction of 315 Patients with NCDs receiving care from PHCs. Participants were from attendees at Ministry of Health PHCs in Riyadh, Saudi Arabia. Findings indicate that most patients were satisfied with the care they received and confirmed the importance of providers' and physicians' communication skills in this. There was a lack of evidence of managed care, including patient involvement in disease management suggesting that steps are needed to empower patients to take a greater role in disease management. This study emphasises the important role of physicians in providing patients with information and empowering them to access community health facilities for self-managed care. This study also indicates a need to strengthen the primary health care system's focus on care beyond PHCs.

Attitudes and Perceptions of Health Leaders for the Quality Enhancement of Workforce in Saudi Arabia

BACKGROUND AND AIM

Besides the unique exposure and experience of health leaders in facing challenges and overcoming them, and the relatively fewer articles relating to the perception of health leaders in workforce quality enhancement, health leadership plays a crucial role in redirecting the workforce, increasing job satisfaction, professional development, and burnout prevention. Thus, this study aimed to understand the current healthcare workforce quality and future expectations from the attitudes and perceptions of health leaders.

METHODS

A qualitative research was carried out using semi-structured interviews consisting of 24 different questions. Participants of the study were healthcare leaders from different backgrounds and governmental institutions. All interviews were recorded, transcribed, and then analyzed using thematic analysis via the N-Vivo program.

RESULTS

Eleven participants were involved in the study, with one female and ten males. A thematic analysis and N-Vivo program yielded 5 main themes: (1) workforce competency, (2) health transformation, (3) leadership, (4) workforce planning, and (5) healthcare quality, with 22 emerging sub-themes. Moreover, participants responded with different attitudes and perceptions.

CONCLUSION

Health leaders are satisfied with the current direction of workforce competency and planning, yet fragmentation of the system and poor accessibility may need further enhancement. Furthermore, misutilization of services and the uncertainty of the future and talent pool are potential barriers for capability building. Moreover, with the existing gap in the workforce, health leaders believe that privatization and corporatization may have a positive effect. Aside from that, Saudization with the current plan of having a minimum standard of accepting non-Saudis in certain areas might benefit in maintaining competition and enriching experience. However, catching up with further research in healthcare quality in Saudi Arabia is needed because of the ongoing health transformation.

Health Policy Development During COVID-19 in Saudi Arabia: Mixed Methods Analysis

Healthcare systems are increasingly required to utilize effective approaches, apply evidence-based practice, and consequently sustain successful strategic management. Document analysis provides insights into the effective management tools applied by agencies to respond to crises. This article provides a practical exploration of how the Saudi health authority applied effective measures to eventually reduce the administrative and clinical consequences while managing the COVID-19 pandemic. The conceptual descriptive framework was based on health policy triangle of Walt and Gilson. Official reports and supporting documents issued by the Saudi government toward COVID-19 were operationally analyzed. Moreover, five healthcare professional experts were invited in a semistructured interview to assess the strategic steps that have been utilized to minimize the health risk by conducting a healthcare risk analysis. Various documents showed that two major entities were responsible for managing regulations and medications of COVID-19 in addition to six other entities that were partially involved. Although each entity was approved to work independently, their efforts were cohesively associated with each other. Most documents were well-applied on personal, social, organizational, and national strata. However, it is unclear how lessons identified became affirmative, while the collaboration remains vague, especially under the emergence of a new entity such as the Public Health Authority. Healthcare professional experts also positively supported the effectiveness of such policies to confront COVID-19 through the following three domains: health guidelines, utilizing simulation (telehealth/telecommunication) services, and ensuring continuity of services.

Measuring and monitoring patient safety in hospitals in Saudi Arabia

Background

There is much variability in the measurement and monitoring of patient safety across healthcare organizations. With no recognized standardized approach, this study examines how the key components outlined in Vincent et al’s Measuring and Monitoring Safety (MMS) framework can be utilized to critically appraise a healthcare safety surveillance system. The aim of this study is to use the MMS framework to evaluate the Saudi Arabian healthcare safety surveillance system for hospital care.

Methods

This qualitative study consisted of two distinct phases. The first phase used document analysis to review national-level guidance relevant to measuring and monitoring safety in Saudi Arabia. The second phase consisted of semi-structured interviews with key stakeholders between May and August 2020 via a video conference call and focused on exploring their knowledge of how patient safety is measured and monitored in hospitals. The MMS framework was used to support data analysis.

Results

Three documents were included for analysis and 21 semi-structured interviews were conducted with key stakeholders working in the Saudi Arabian healthcare system. A total of 39 unique methods of MMS were identified, with one method of MMS addressing two dimensions. Of these MMS methods: 10 (25 %) were concerned with past harm; 14 (35 %) were concerned with the reliability of safety critical processes, 3 (7.5 %) were concerned with sensitivity to operations, 2 (5 %) were concerned with anticipation and preparedness, and 11 (27.5 %) were concerned with integration and learning.

Conclusions

The document analysis and interviews show an extensive system of MMS is in place in Saudi Arabian hospitals. The assessment of MMS offers a useful framework to help healthcare organizations and researchers to think critically about MMS, and how the data from different methods of MMS can be integrated in individual countries or health systems.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07228-z.

The association between hospital financial performance and the quality of care-a scoping review protocol

BACKGROUND

Hospitals operate under constant pressure to contain costs and improve the quality of care. The literature suggests that there is an association between health care providers' financial performance and the quality of care. On the one hand, providers that are financially more stable might have better capacity to maintain reliable systems and resources for quality improvement. On the other hand, providing better quality of care might lead to financial gains in the form of increased revenues or achieved savings and, in consequence, a higher profitability. The general objective of this scoping review is to identify and map the available evidence on the association between hospital financial performance and the quality of care. It aims to (1) provide a broad overview of the topic and (2) indicate a more precise research question for a future systematic review.

METHODS

This scoping review will follow five stages: (1) defining the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) the consultation process and engagement of knowledge users. The following databases will be searched: MEDLINE via PubMed, (2) EMBASE, (3) Web of Science, (4) Scopus, (5) EconLit, (6) ABI/INFORM, and (7) Business Source Premier. The reference lists of relevant papers will be visually scanned with the aim of identifying further studies of interest. Also, a gray literature search will be conducted by screening the websites of diverse organizations dealing with hospital performance and/or quality of care. The review will not apply a publication date limit and will include both quantitative and qualitative empirical studies as well as theoretical papers, technical reports, books/chapters, and thesis. The reporting will utilize the PRISMA extension for a Scoping Review checklist.

DISCUSSION

This scoping review will provide an overview of the existing literature on the association between hospital financial performance and the quality of care. The review process will apply a rigorous methodological approach while broad inclusion criteria should assure comprehensive coverage of the available literature. The main limitation of the review is related to the general limitation of scoping reviews, i.e., the lack of a systematic quality and risk of bias assessment of included studies. In addition, the review will include only publications in English.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework osf.io/z25ag.

Person-Centered Care in a Tertiary Hospital Through Patient's Eyes: A Cross-Sectional Study

BACKGROUND

The current trend in healthcare systems around the world is moving towards a person (or patient)-centered care (PCC) model. While some healthcare organizations have only recently embraced the PCC approach, there is no evidence of person-centered care in Saudi hospitals. This study aimed to assess patients' perspectives on the climate of person-centered care and its associated factors in a tertiary hospital in Saudi Arabia.

METHODS

A cross-sectional study design was conducted in 16 inpatient departments at a tertiary hospital in Riyadh, Saudi Arabia. The validated version of the Person-centered Climate Questionnaire-Patient (PCQ-P) was distributed to 300 adult patients admitted to the hospital for more than 48 hours. The patients were interviewed face-to-face, using the PCQ-P. Descriptive and inferential statistical analysis were performed using SPSS (version 22; IBM, NY, USA).

RESULTS

A total of 300 questionnaires were completed. More than half (53%) were females; 39.7% aged 21-40 years; 72.7% married; 49% hold a high school diploma; and 67.4% unemployed. For route of admission into hospital, 39.8% of the respondents were admitted as elective or outpatient appointments, and 45% had been admitted for less than a week. Most patients (84.3%) reported that they preferred to be treated in a governmental hospital. Inpatients' overall mean PCQ-P score was 73 ± 9.988 out of 85. Results suggested significant associations between patient characteristics and their perspectives on person-centered care, such as age (P=0.005), gender (P<0.001), nationality (P=0.026), area of residency (P=0.001), route to admission (P=0.002), length of stay (P=0.003), and hospital preference (P=0.010).

CONCLUSION

Overall, patients' perspective on person-centered care seems positive. Patient and hospital characteristics could play an important role in shaping patients' perceptions of the climate of person-centered care domains.

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

PURPOSE OF REVIEW

Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results.

RECENT FINDINGS

DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results.

The experiences of foreign doctors in Saudi Arabia: A qualitative study of the challenges and retention motives

Background

The Saudi healthcare system is mainly staffed by foreign doctors who constitute about 73% of the total medical workforce. But, the high rate of turnover among these foreigners had deposited an additional unbearable cost and threatens the stability of the provided healthcare services in the country.

Objectives

This study was conducted to explore the professional and personal challenges that were experienced by foreign medical doctors while working in one of the major governmental tertiary-care hospitals in Riyadh city. The study also seeks to explore the factors that could influence or motivate their retention.

Methods

A qualitative study based on semi-structured interviews was conducted on January 2018. A total of 16 foreign doctors were recruited purposefully using a maximum variation sampling strategy. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis technique.

Results

Three primary themes have been emerged based on the data analysis: (1) Work-related challenges such as; communication and discrimination challenges. (2) Living-related challenges such as; supportive services and restricted movement challenges. (3) Factor motivating retention such as providing good children education, offering flexible traveling regulations, and providing professional development opportunities.

Conclusions

The findings of this study have indicated that there are more important motivators than money for improving the retention of foreign doctors in the country. Several policy actions have been recommended to maintain their essential role. For example; implementing an ethical code to protect them from receiving deceptive hiring information, developing a specialized pocket dictionary to overcome language barriers, embracing "workforce diversity management" techniques to minimize discrimination at institutional level, and finally it is also recommended to include the foreign doctors' family needs and other living related challenges in any future retention strategies.

Influence of Parental Physical Activity and Screen Time on the BMI of Adult Offspring in a Saudi Population

Saudi Arabia is witnessing a drastic rise in adult obesity. Geographic limitations hamper somatic activities to counter this rise. Parental physical inactivity in the region has never been addressed. This study’s purpose is to determine the differences between parent and adult child (the subjects here) levels of physical activity (PA) and screen time (ST) between normal weight and obese adults in the Saudi Arabian population. Two hundred and forty adult subjects (18 to 35 years) were screened for their body mass index (BMI) values (18.5 ≤ 25 as normal and 25 ≤ 30) or above as overweight/obese), followed by their congregation into normal weight (N) (n = 150) and overweight/obese (Ov/Ob) (n = 90) groups. A self-reported questionnaire assessed parenting practices, while a physical activity record diary calculated existing levels of PA and ST. Statistical significance was determined by a chi-squared test (p < 0.01) and BMI correlation was found by Pearson’s correlation coefficient. Maternal age (87.8% ≤ 20 years in the Ov/Ob group (Gp) and consanguineous marriage (88.9% in the Ov/Ob Gp) showed significant differences. A high prevalence of inactivity was observed among families (father 53.3%, mother 53.3%, subject 80.0%) in the Ov/Ob Gp. Higher amounts of ST (76.7% ≥ 9 h/day) were found in the Ov/Ob Gp, which significantly differed. Differences in the parent and child levels of PA and ST exist between normal weight and obese Saudi Arabian adults. Physically active parents having adult children inspire them to develop healthy physical behaviors which counter the development of obesity. Consanguineous marriage and early maternal age may be associated with progressive adult obesity.

Satisfaction of Outpatient Service Consumers and Associated Factors Towards the Health Service Given at Jimma Medical Center, South West Ethiopia

BACKGROUND

Client satisfaction reflects the gap between the expected service and the experience of the services from the client's point of view. As patient satisfaction is considered to be a healthcare outcome and predictor of treatment utilization and adherence to the care and support, assessment of the level of patient satisfaction is vital.

OBJECTIVE

To assess satisfaction of outpatient service and its associated factors toward the health service given among outpatients at Jimma medical center, southern western Ethiopia, 2019.

METHODS

An institutional-based cross-sectional study design was employed at Jimma Medical center from May 1 to May 30, 2019 GC. The respondents were selected by systematic random sampling method. The data were cleaned, coded, interred into EPI data version 3.1 and transferred and analyzed using SPSS version 23. Descriptive statistics was used to summarize the data. Binary logistic regressions were used to analyze the association between dependent and independent variables. A P-value <0.05 was considered significant.

RESULTS

A total of 284 respondents were included in the study with a response rate of 96.6%, from which 174 (61.3%) were male and 183 (64.4%) were Oromo by ethnicity. The overall satisfaction was 79 (27.8%) (CI = 20.0-30.4). Satisfaction was high if the patients had kept their privacy (AOR = 13.332; 95% CI = 2.282-77.905) and understandability of the patient problem (AOR = 21.830; 95% CI = 0.054-77.500).

CONCLUSION

The overall satisfaction level of the patients is low, so this demands the hospital to take further action on the identified problems to improve the services delivered to the patients.

Gender differences on medical students' attitudes toward patient-centred care: a cross-sectional survey conducted in Heilongjiang, China

OBJECTIVES

Assessing medical students' attitudes toward patient-centred care is essential to bettering medical education. Based on doctor-patient relationships and the medical system in China, it is important to explore the impact of gender differences and other background factors on patient-centred attitudes and to provide references for medical education reform.

METHODS

A cross-sectional study was conducted on fourth-year medical undergraduate students from November 2017 to March 2018 in Heilongjiang Province, Northeast China. The Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS), which has been validated in previous research, was used to measure the medical students' attitudes. The medical students' demographic data was collected, including their gender, age, information on whether they have siblings, family residence location, doctor(s) for parents, year in which the student first experienced clinical practice, and student category.

RESULTS

A total of 513 students (91.12%) completed the survey. The Chinese medical students scored considerably higher for 'Caring' (including patients' preferences into the decision-making process) than for 'Sharing' (sharing information/responsibility with patients). These students tended to have patient-centred attitudes, as measured by an average overall CR-PPOS score of 3.63 (scores higher than 3.5 indicate patient-centred attitudes), which is higher than Malian (3.38) and Pakistani (3.40) medical students but lower than American (4.57) and Brazilian (4.66) students. Female students (P < 0.05) were significantly associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores. Student category (P < 0.05) was associated with 'Sharing' and 'Caring' scores. Clinical hospital students (P < 0.05) were associated with more patient-centred attitudes and with higher 'Sharing' and 'Caring' subscale scores, Students without siblings (p < 0.07) were associated with the higher 'Sharing' subscale scores.

CONCLUSIONS

In China, gender has a significant impact on medical students' patient-centred attitudes, which is similar to findings from other countries. If medical schools want to raise patient-centred attitudes across the board and bridge the gap between male and female patient-centred attitudes, gender, student category, and other factors should be incorporated into medical education.

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals

BACKGROUND

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation.

METHODS

A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals.

RESULTS AND DISCUSSION

The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi hospitals.

CONCLUSION

It appears that the most important contributing factors to the successful implementation of QI in Saudi hospitals are proper human resources utilization and effective quality management. Through careful planning, change management, proper utilization of human resources, supportive quality information systems, focus on processes and systems, structural support, and an organizational culture that is compatible with QI philosophy, Saudi hospitals will be more capable in achieving sustained measureable improvements in the quality and safety of patient care.

What Factors Affect Patient Satisfaction in Public Sector Hospitals: Evidence from an Emerging Economy

Patient satisfaction can identify specific areas of improvement in public sector hospitals. However, the Pakistani healthcare system, and quality of service delivery is rarely assessed through the perspective of patient satisfaction. Our study demonstrated the performance of public healthcare systems in Pakistan by interacting with physical services (tangible and environmental), doctor⁻patient communication, and pharmacy and laboratory services based on patient satisfaction. Primary data were collected from the patients by using a random sampling method. Patients who participated in the study were visitors of public hospitals' outpatient departments. A total of 554 questionnaires were circulated, and 445 were received. The confirmatory factor and multiple regression analyses were employed to analyze the collected data. The results revealed that laboratory, as well pharmacy services, had positive significant effects (p = 0.000) on patient satisfaction, while doctor⁻patient communication (p = 0.189) and physical facilities (p = 0.85) had an insignificant relationship with patient satisfaction. Therefore, it is suggested that a significant communication gap exists in the doctor⁻patient setting, and that Pakistan's healthcare system is deprived of physical facilities. Consequently, such services need further improvements.

Patient satisfaction with outpatient physical therapy in Saudi Arabia

Background

Patient satisfaction (PS) is a key measure of the quality and outcome of healthcare systems which reflects patients’ experiences. The purpose of this study was to assess overall PS with outpatient physical therapy (PT) care in Saudi Arabia and identify associated characteristics and components.

Methods

Four hundred patients who received PT treatment during 2017 were invited to participate in this study. The MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) was used to assess PS.

Results

The average age of 358 (90%) respondents was 38.1 (SD 12.7) years, and a majority (77%) of them were female. At least 76% respondents reported feeling better after PT treatment, while the mean global satisfaction score of all respondents as per the MRPS was 3.56, indicating high satisfaction.

Conclusion

PT is still at an early stage of development in Saudi Arabia and is an integral part of the healthcare sector. PS is the key to identify areas for improvement and provide high quality healthcare to the public.

Measuring the preference towards patient-centred communication with the Chinese-revised Patient-Practitioner Orientation Scale: a cross-sectional study among physicians and patients in clinical settings in Shanghai, China

OBJECTIVES

To adapt the Patient-Practitioner Orientation Scale (PPOS), to a Chinese context, and explore the preference towards patient-centred communication among physicians and patients with the Chinese-revised Patient-Practitioner Orientation Scale (CR-PPOS).

DESIGN

A cross-sectional questionnaire-based study.

SETTING

Clinical settings from eight medical units, including four community hospitals and four general hospitals, in Shanghai, China.

PARTICIPANTS

1018 participants, including 187 physicians and 831 patients, completed this study in two successive stages.

OUTCOME MEASUREMENTS

Psychometric properties of the CR-PPOS and participants' score on the CR-PPOS.

RESULTS

Compared with the original PPOS, the 11-item CR-PPOS obtained better psychometric indices. Physicians and patients scored differently on both the total CR-PPOS and its two subscales. Compared with physicians, the scores of patients were more influenced by their personal characteristics, such as age and education.

CONCLUSIONS

The CR-PPOS is a better instrument in a Chinese context than the original translated version. The divergence in the extent to which patient-centred communication is preferred among Chinese physicians and patients should be noted. Adapting physicians' communication strategy to patients' preferences based on their personal characteristics can be a viable approach towards improving clinical efficiency.

Does adoption of electronic health records improve the quality of care management in France? Results from the French e-SI (PREPS-SIPS) study

BACKGROUND

Electronic health records (EHR) are increasingly being adopted by healthcare systems worldwide. In France, the "Hôpital numérique 2012-2017" program was implemented as part of a strategic plan to modernize health information technology (HIT), including the promotion of widespread EHR use. With significant upfront investment costs as well as ongoing operational expenses, it is important to assess this system in terms of its ability to result in improvements in hospital performances.

OBJECTIVE

The aim of this study was to evaluate the impact of EHR use on the quality of care management in acute care hospitals throughout France.

METHODS

This retrospective study was based on data derived from three national databases for the year 2011: IPAQSS (indicators of improvement in the quality and the management of healthcare, "IPAQSS"), Hospi-Diag (French hospital performance indicators), and the national accreditation database. Several multivariate models were used to examine the association between the use of EHRs and specific EHR features with four quality indicators: the quality of patient record, the delay in sending information at hospital discharge, the pain status evaluation, and the nutritional status evaluation, while also adjusting for hospital characteristics.

RESULTS

The models revealed a significant positive impact of EHR use on the four quality indicators. Additionally, they showed a differential impact according to the functionality of the element of the health record that was computerized. All four quality indicators were also impacted by the type of hospital, the geographical region, and the severity of the pathology.

CONCLUSION

These results suggest that, to improve the quality of care management in hospitals, EHR adoption represents an important lever. They complete previous work dealing with EHR and the organizational performance of hospital surgical units.

Financial hardship on the path to Universal Health Coverage in the Gulf States

BACKGROUND

Countries globally are pursuing universal health coverage to ensure better healthcare for their populations and prevent households from catastrophic expenditure. The countries of the Gulf Cooperation Council (GCC) have and continue to implement reforms to strengthen their health systems. A common theme between the countries is their pursuit of universal health coverage to provide access to necessary health care without exposing people to financial hardship.

METHODS

Using nationally representative data from the Global Findex study, we sought to analyze the hardship faced by individuals from four high-income countries in the GCC. We estimated the weighted proportion of individuals borrowing for medical reasons and those who are not able to obtain emergency funds. We further examined variations in these outcomes by key socioeconomic factors.

RESULTS

We found up to 11% of respondents borrowed money for medical purposes, double of that reported in other high-income countries. In contrast to affluent respondents, we found that respondents from deprived background were more likely to borrow money for medical purposes (adjusted odds ratio: 1.81, P<0.001) and expected to fail in obtaining emergency funds (adjusted odds ratio: 4.03, P<0.001).

CONCLUSION

In moving forward with their reforms, GCC countries should adopt a financing strategy that addresses the health needs of poorer groups in their pursuit of universal health coverage.