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Research on accreditation has mostly focused on assessing its impact using large scale quantitative studies, yet little is known on how quality is improved in practice through an accreditation process. Using a case study of an acute teaching hospital in Portugal, the purpose of this paper is to explore the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided.

Data for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analyzed using a framework thematic analysis.

Interviewees felt that hospital accreditation contributed to the improvement of healthcare quality in general, and more specifically to patient safety, as it fostered staff reflection, a higher standardization of practices, and a greater focus on quality improvement. However, findings also suggest that the positive impact of accreditation resulted from the approach the hospital adopted in its implementation as well as the fact that several of the procedures and practices required by accreditation were already in place at the hospital, albeit often in an informal way.

The study was conducted in only one hospital. The design of an accreditation implementation plan tailored to the hospital’s context can significantly contribute to positive outcomes in terms of quality and patient safety improvements.

This study provides a better understanding of how accreditation can contribute to healthcare quality improvement. It offers important lessons on the factors and processes that potentiate quality improvements through accreditation.

This study aims to investigate how e-health system characteristics (information quality, system quality, perceived ease of use, perceived usefulness) contribute to the enhancement of medical staff performance, patient care, and doctor–patient relationships at UNRWA-Gaza healthcare centers. It aims at testing an integrative single model comprising Technology Acceptance Model (TAM), D&M model and e-health system utilization.

This study followed the quantitative methodology and the deductive research approach. Data were collected from 241 medical staff who use the system employed in 19 different healthcare centers across the Gaza Strip. Partial least square/structural equation modeling technique was used to analyze the collected data and to test study hypotheses.

Study concluded that information quality of the adopted Health Information System (HIS) has both direct and indirect positive impact on staff performance, only direct positive impact on patient care and only positive indirect impact on doctor–patient relationship. System quality, on the other hand, was found to have negative direct impact and positive indirect impact on staff performance and has both direct and indirect positive impact on both doctor-patient relationship and patient care.

Noteworthy that HIS has availability, speed and error detection and error prevention issues. It is recommended that these shortfalls be addressed together with improving user perception towards ease of use and usefulness of the system.

Management should also work to raise confidence in its medical staff to improve the effect of HIS on medical performance and patient care. It is also recommended that UNRWA should implement crowed management techniques such as queuing systems and on-phone booking to minimize patient waiting time.

The importance of the study stems from its context being conducted in a developing region (Gaza Strip-Palestine) which has a fragile economic, political and social environment with many other complexities. It is also conducted at United Nations Relief and Work Agency (UNRWA) healthcare centers, which provide medical services to Palestinian refugees. In addition, this study is among the few studies that address the impact of individual e-health success factors on both doctor-patient relationship and patient care constructs. Most previous studies concentrated on the impact of health system adoption as a whole on these two subject variables and one can hardly ever stop at studies that address effect of individual success factors on them. It also integrated both D&M system success model and TAM model with some additional amendments creating and tested a new model.

Against a backdrop of increased work intensification within maternity hospitals, the purpose of this paper is to examine the role of work engagement in the quality of care delivered to patients and in general health of the midwives delivering care, as reported by midwives and nurses.

Quantitative questionnaires consisting of standardised measures were distributed to midwives in two large maternity hospitals. These questionnaires assessed levels of work engagement, supervisor and colleague support, general health and quality of care.

Structural equation modelling analysis revealed a best‐fit model that demonstrated work engagement to be a significant partial mediator between organisational and supervisor support and quality of care, and as a significant predictor of self‐reported general health. Together, supervisor support, social support and organisational resources, mediated by work engagement, explained 38 per cent of the variance in quality of care at the unit level and 23 per cent of variance in general health among midwives (χ²(67)=113; p<0.01, CFI=0.961, RMSEA=0.06).

The study is limited in that it uses self‐report measures of quality of care and lacks objective indicators of patient outcomes. The cross‐sectional design also does not allow for causal inferences to be drawn from the data.

This study provides evidence for the links between individual levels of work engagement and both health and self‐reports of unit level quality of care. The results support the importance of health services organisations and managers deploying organisational resources to foster employee work engagement. The results also highlight the significant role of the immediate nurse manager and suggest training and development for such roles is a valuable investment.

These results are the first to link work engagement and performance in health care contexts and point to the value of work engagement for both unit performance and for individual employee well‐being in health organisations.

The purpose of this paper is to examine the empirical validity of transformational, transactional and laissez‐faire leadership and their sub‐scales among physician managers.

A nation‐wide, anonymous mail survey was carried out in the United States, requesting community health center executive directors to provide ratings of their medical director's leadership behaviors (34 items) and effectiveness (nine items), using the Multifactor Leadership Questionnaire 5X‐Short, on a five‐point Likert scale. The survey response rate was 40.9 percent, for a total 269 responses. Exploratory factor analysis was done, using principal factor extraction, followed by promax rotation).

The data yielded a three‐factor structure, generally aligned with Bass and Avolio's constructs of transformational, transactional and laissez‐faire leadership. Data do not support the factorial independence of their subscales (idealized influence, inspirational motivation, individualized consideration, and intellectual stimulation under transformational leadership; contingent reward, management‐by‐exception active, and management‐by‐exception passive under transactional leadership). Two contingent reward items loaded on transformational leadership, and all items of management‐by‐exception passive loaded on laissez‐faire.

A key limitation is that supervisors were surveyed for ratings of the medical directors' leadership style. Although past research in other fields has shown that supervisor ratings are strongly correlated with subordinate ratings, further research is needed to validate the findings by surveying physician and other clinical subordinates. Such research will also help to develop appropriate content of leadership training for clinical leaders.

This study represents an important step towards establishing the empirical evidence for the full range of leadership constructs among physician leaders.

The purpose of this study is to determine the impact of knowledge sharing (KS) at work place on the individual work performance (IWP) of nurses.

A cross-sectional quantitative approach based on a survey questionnaire was used to collect data from currently working 256 nurses in 6 general public sector hospitals of Lahore, Pakistan. Equal sized convenient sampling technique was used to select the sample from the intended population. Multiple regression was applied to test the research hypotheses.

The results indicated that the elements of IWP (task and contextual performance) were positively correlated with and influenced by two facets of KS (KS propensity and KS behavior). A cohesive sharing culture among nurses must be established at their respective work places to foster the delivery of quality care services and to improve their performance.

The study findings suggest that health-care institutes must consider the importance of KS to boost up the sharing culture among all levels (s) of employees by establishing an interconnected learning environment for improved work performance.

KS plays a vital role in the learning and development of employees by enhancing their work performance. The extant literature showed that there was a dearth of studies that determined the impact of KS at work place on the IWP of nurses. As KS has unique and challenging factors in Pakistan, therefore, the investigation of its impact on nurses’ work performance would be worthy.

The purpose of the paper is to develop an integrated framework for performance management of healthcare services.

This study develops a performance management framework for healthcare services using a combined analytic hierarchy process (AHP) and logical framework (LOGFRAME). The framework is then applied to the intensive care units of three different hospitals in developing nations. Numerous focus group discussions were undertaken, involving experts from the specific area under investigation.

The study reveals that a combination of outcome, structure and process‐based critical success factors and a combined AHP and LOGFRAME‐based performance management framework helps manage performance of healthcare services.

The proposed framework could be practiced in hospital‐based healthcare services.

The conventional approaches to healthcare performance management are either outcome‐based or process‐based, which cannot reveal improvement measures appropriately in order to assure superior performance. Additionally, they lack planning, implementing and evaluating improvement projects that are identified from performance measurement. This study presents an integrated approach to performance measurement and implementing framework of improvement projects.

Since the early 1980s, breakaway training has been synonymous with many prevention and management of violence and aggression (PMVA) training programmes in social care and NHS settings. However, for almost three decades, this community has continued to accept a training approach that has been largely unsupported by a robust underpinning methodology or evidence base. The validity of this historical training approach will be examined in context with the available literature, and will seek to identify the fundamental flaws that have been inherent in the traditional system. This paper will conclude by making some practical suggestions on how the efficacy of personal protective training may be improved, based on the emerging findings from other scientific fields.

The purpose of this paper is to evaluate the utility of clinical processes in healthcare institutions of different sizes. The implications of adoption rate of computerized physicians order entry (CPOE) and electronic medical/health records (EMRs/EHRs) in different sized healthcare institutions in the USA were studied in terms of understanding its impact on enhancement of quality of patient care.

This study has used secondary data to obtain insights on the processes and technologies used in hospitals of different sizes in the USA and enlighten those in the developing countries to adopt a strategy that would be most appropriate for them. The Dorenfest Institute for H.I.T. Research and Education Analytics database (The Dorenfest Institute, 2011) provided the data for 5,038 US hospitals. Logistic regression was performed to study the impact of the different types of processes and technologies on institutions of different sizes, classified based on the number of beds, physicians, and nurses.

The findings show that small sized hospitals had a positive relationship with drug dosing interactions process and nursing and clinician content process. On the contrary, medium sized hospitals had a negative relationship with the usage of CPOE for entering medical records, i.e. <25 percent (p<0.05). In order to be effective, these institutions should increase the usage of EMRs by more than 25 percent to get positive outcomes. Large hospitals showed a positive relationship with the usage of >75 percent of CPOE to enter medical records and usage of medical records >75 percent.

The authors demonstrate the need for an evaluation of utility of acute care hospitals based on hospital size in terms of number of physicians, and nurses, which have not been dealt earlier by the past studies. Moreover, there is also a need for an evaluation of utility of acute care hospitals for implementation of CPOEs and EMRs that are integrated with clinical decision support systems.

Although the data are US-centric, the insights provided by the results are very much relevant to the Indian scenario to support the improvement of the quality of care. The findings may help those implementing processes in healthcare institutions in India. No study has addressed the measurement of the positive and negative outcomes arising due to the implementation of different percentages of CPOEs and EMRs in different sized institutions. Further the number of physicians and nurses have not been considered earlier. Therefore, the authors have classified the hospitals based on physicians and nurses and studied their impact on the adoption of CPOEs, clinical decision support systems, and EMRs.

Designing and developing safe systems has been a persistent challenge in health care, and in surgical settings in particular. In efforts to promote safety, safety culture, i.e., shared values regarding safety management, is considered a key driver of high-quality, safe healthcare delivery. However, changing organizational culture so that it emphasizes and promotes safety is often an elusive goal. The Safe Surgery Checklist is an innovative tool for improving safety culture and surgical care safety, but evidence about Safe Surgery Checklist effectiveness is mixed. We examined the relationship between changes in management practices and changes in perceived safety culture during implementation of safe surgery checklists. Using a pre-posttest design and survey methods, we evaluated Safe Surgery Checklist implementation in a national sample of 42 general acute care hospitals in a leading hospital network. We measured perceived management practices among managers (n = 99) using the World Management Survey. We measured perceived preoperative safety and safety culture among clinical operating room personnel (N = 2,380 (2016); N = 1,433 (2017)) using the Safe Surgical Practice Survey. We collected data in two consecutive years. Multivariable linear regression analysis demonstrated a significant relationship between changes in management practices and overall safety culture and perceived teamwork following Safe Surgery Checklist implementation.

A key challenge facing pre‐registration nurse educators is to turn out students who are fit for practice by the end of their training (United Kingdom Central Council for Nursing, Midwifery and Health Visiting, 1999). This includes developing their understanding of professionalism (Department of Health, 2003; Nursing and Midwifery Council, 2004; 2007). This paper provides an evaluation of a special personal and professional development scheme for mental health student nurses implemented to improve the learning and development process. The scheme required that in addition to individual meetings with personal tutors, students would meet in small groups of 12‐15, every six weeks, facilitated by their personal tutor and a clinician. The meetings provided a space for students to discuss nursing topics, their clinical experiences and performance to improve their understanding of professional standards in their role transition.The outcome was that over 80% of the respondents were satisfied with the structure, facilitation methods, contents, group size and the time allocated for the meetings. They also reported an increase in knowledge and level of understanding, awareness of professional expectations, making better theory‐practice links of learning and becoming more self‐aware. The authors suggest that nurse training departments should collaborate with their clinical partners and adopt a similar framework to help bridge the theory‐practice gap and enhance the transition process from student to qualified practitioner.