Risk Management and Healthcare Policy

IntroductionMedication errors (MEs) are common events in the hospital that compromises the patient safety. Despite high prevalence of MEs being reported, there is a limited information at the outpatient settings. MethodThis study assessed the prevalence and characteristics of MEs by analyzing the data of pharmacist-led interventions recorded between 1st November 2024 to 30th September 2025 at the outpatient department of pharmacy, Jigme Dorji Wangchuck National Referral Hospital (JDWNRH). ResultsOf the 90108 prescriptions dispensed, 2045 (2.27%) MEs were recorded during the study period. Among which, 90.81%, 8.70% and 0.49% accounted to prescribing error, packaging error and dispensing error, respectively. More than half of the prescribing error were attributed with antibiotics (39.3%) and antihypertensives (13.9%) combined. Dosing error (63.5%) was highly prevalent type of prescribing error, followed by wrong frequency (12.0%), no indication (10.0%) and omission (5.7%). The severity of harm related to with prescribing error were observed as; no harm (212, 11.42%), minor (233, 12.55%), moderate (1364, 73.45%) and serious (48, 12.58%). Pharmacist-led interventions has prevented more than 90% of the potential harm related to the prescribing error. ConclusionPrescribing error is the most common type of MEs at the outpatient settings in JDWNRH. Majority of the prescribing errors were found to be moderately severe. Pharmacists-led interventions should be effectively integrated in the disease management system to enhance the overall patient safety. Concerned prescribers should enhance their knowledge, particularly in therapeutic management of infectious disease and hypertension to minimize the prescribing errors.

BackgroundThe World Health Organization recommends rational drug usage to protect patient health and quality of life. Study assessed the quality of drug prescription and dispensing in a tertiary hospital. MethodsCross-sectional study with retrospective and prospective data collection underpinned by the WHO core prescribing indicators. A cluster sample of 10 clinical units and their attached pharmacies in the hospital. Six hundred prescriptions from the pharmacy over six months were randomly selected to evaluate the prescription indicators, 330 patient encounters observed for patient care indicators, and 48 randomly selected doctors to evaluate factors influencing their prescribing practices across the 10 clinics. Descriptive analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 25 and comparison done across all indicators of rational drug use. ResultsAverage drugs per encounter was 3.4 {+/-} 1.9 drugs. Antibiotics and injections were prescribed in 40.2% and 24.8% encounters respectively. Generic names were used in 43.6% and 97.1% of prescription were from the essential medicine list. Average time for consultation was 17.5 {+/-} 8.0 minutes, dispensing time was 7.7 {+/-} 3.8 minutes, 99.8% of medications were properly labelled, and 82% of patients understood the drug doses. The pharmacies stocked 93.3% of key drugs but no consultation room had the essential drug list. Only 43.7% of physicians demonstrated accurate understanding of rational drug use. ConclusionFindings on the WHO core drug indicators showed poor quality of drug prescription. Brand prescription, polypharmacy, and antibiotic overuse observed requires intensifying training and monitoring on rational drug use.

BackgroundPatient satisfaction and loyalty are key indicators of healthcare quality and are influenced by multiple service domains. Understanding which aspects of care drive these outcomes is essential for Health Insurance Organization (HIO) hospitals aiming to improve patient experience. MethodsAn analytical cross-sectional study was conducted across four hospitals in Alexandria, Egypt. A total of 983 patients were recruited using stratified random sampling from various hospital departments. Data was collected through structured face-to-face interviews using a validated Arabic National Patient Satisfaction Survey covering eight healthcare quality domains. Multivariate linear regression models were fitted to assess the impact of these domains on patient satisfaction and loyalty. Mediation analysis examined the indirect effect of satisfaction on the relationship between quality and loyalty. ResultsThe regression model significantly predicted patient satisfaction (Adjusted R{superscript 2} = 0.573, F(8, 974) = 165.93, p < 0.001), with Information, Empathy, and Organization emerging as the strongest predictors. All eight service quality dimensions contributed positively, and no multicollinearity issues were detected. The hierarchical model predicting loyalty was significant, explaining 52.5% of the variance in Model 1 and increasing to 64.8% after adding satisfaction (F(9, 973) = 198.59, p < 0.001). Patient satisfaction became the dominant predictor of loyalty, and the effect of Transition became non-significant once satisfaction was included, indicating full mediation. Overall, satisfaction mediated the relationship between service quality and loyalty, substantially strengthening predictive power. ConclusionEffective communication, clinical competency, organizational consistency, and responsive care are central drivers of patient satisfaction and loyalty in HIO hospitals. Enhancing these domains may improve patient retention and overall healthcare experiences. Study highlightsO_LIProvides actionable priorities for clinicians and managers, showing that improving communication, empathy, and care organization yields the largest gains in patient satisfaction. C_LIO_LIIdentifies system-level gaps (waiting times, discharge transition, payment processes) that hospital managers and policymakers can directly target for quality improvement. C_LIO_LIDemonstrates that patient satisfaction is the main driver of loyalty, informing policy decisions on where investments will have the greatest impact. C_LIO_LIUses a large, multicenter sample and validated tool, offering reliable, generalizable evidence to guide HIO performance monitoring and reform. C_LI

BackgroundWith the continuous advancement of technology and rapid development of precision medicine, precision medical devices are increasingly being utilized in clinical diagnosis and treatment. These devices play a crucial role in clinical practice. However, improper use accelerates instrument wear and tear, increases hospital costs, and jeopardizes patient safety. In Mainland China, research on surgical instrument wear is limited. Healthcare institutions widely implement Lean Six Sigma (LSS) as a management tool to enhance medical quality and patient safety through process improvement. ObjectiveThis study aimed to reduce the wear rate of precision instruments using the LSS management method, thereby lowering medical costs and enhancing patient safety. It also seeks to provide recommendations to strengthen the quality management of hospitals. MethodsThe study applied five LSS phases (Define, Measure, Analyze, Improve, Control) to analyze instrument deterioration. The primary causes of instrument degradation were identified, and three major improvement plans were proposed: establishing an intelligent device traceability and sterile supply chain quality control management system, refining transportation management, and optimizing the instrument preprocessing position. This study compared the wear and tear rates of precision instruments before and after implementation of the LSS method from 2023 to 2024. ResultsThe wear rate decreased significantly from 17.63% to 6.54% (P<0.001), yielding direct cost savings of 769,000 Chinese Yuan (CNY),calculated from the reduced repair and replacement expenses. Furthermore, the satisfaction rates among surgeons and nurses rose from 83.33% to 95.83% and from 86.67% to 98.33%, respectively (P<0.05). ConclusionThe full lifecycle management of precision instruments based on LSS can effectively reduce the wear rate, lower hospital costs, and improve the satisfaction of surgeons and nurses in sterile supply departments. Data Access StatemenThe raw data used in this study are proprietary and cannot be shared publicly due to department confidentiality agreements.

IntroductionPrescribing medications plays a vital role in patient healthcare. The rational drug use is now a significant concern for public health due to incorrect medication prescribing. In promoting rational evidence-based prescribing, prescriptions will be screened and reviewed by pharmacists before medications are dispensed whereby pharmaceutical care intervention (PCI) will be conducted. MethodsThis study aimed to evaluate the prevalence and types of PCI detected at an inpatient pharmacy and to identify the stage of dispensing process where the PCI are frequently detected. The PCI that included was focusing on the prescribing errors. A cross-sectional observational study was conducted over a period of three months started from 1st March 2023 until 31st May 2023 where new medication orders using Pharmacy Information System (PhIS) of all patients warded screened by Inpatient Pharmacy Department were included. ResultsThe prevalence of PCI was 0.006%. The most common type of interventions performed were the prescribed frequency (31.5%) followed by dose (30.0%), drug (19.2%) and polypharmacy (10.8%). The drug category based on ATC classification with a high percentage of interventions was anti-infective for systemic use (34.6%) followed by nervous system (16.2%) and alimentary tract and metabolism (14.7%). Half of the PCIs were detected during screening stage (51.2%) whiles 36.0% were detected during counterchecking and the least detected is during medication filling (12.8%). The highest prescribing errors was from medical wards (50.7%), followed by surgical (24.1%) and orthopaedics (14.8%). ConclusionThe prescribers and clinical pharmacist and inpatient pharmacist are doing well in maintaining patient care. Prescriptions that involve drug category of anti-infective required more attentions especially on drug choice, dose, frequency, and polypharmacy.

PurposeTo achieve a positive safety culture, staff perception of safety must be frequently measured. There are several active and reactive methods to use to measure safety cultures such as near-miss occurrence, accidental data collection, measuring behavior, self-report method, and safety questionnaires. The safety attitudes questionnaire (SAQ) tool was used to measure safety culture. This tool is widely used in literature and among researchers and has been used and validated in middle eastern cultures. In addition, it has a validated Arabic version. MethodsA cross-sectional study was conducted using anonymous and random sampling. I surveyed all ICU staff working in all the adult ICUs in two of the major hospitals in the eastern province of Saudi Arabia. The short version of the Safety Attitudes Questionnaire was used to assess participants attitudes towards safety culture. The study involved all healthcare providers working in Adult ICU. ResultsThe study occurred over a three-week period in March 2019. A total of 82 completed questionnaires were returned which represented a response rate of 82%. On average, the domain that scored the highest number of positive responses was Job satisfaction with 68.5%, followed by teamwork climate 67.8%, then working conditions 60.1%, 57.1% safety climate, then preparation of management with 53.4%, and finally 46% in Stress recognition. A statistically significant difference was found between the mean SAQ score and the educational level of the participants. Participants with bachelors degrees scored a mean of 50.17 compared to participants hold diploma degrees who scored a mean of 68.81 (P=0.02). Moreover, a significant difference was found between the mean SAQ score and participants specialties. Attending/Staff Physician mean score was 36.40, Nurse Manager/Charge Nurse scored 39.78, and Respiratory therapist mean score was 47.88, compared to mean score of 62.27 for Registered Nurse, and Respiratory supervisor 67.0 (P=0.04). In addition, 79.2% of the respondents did not report any incidents in the last 12 months. ConclusionsThe result of the study shows an unsatisfying level of safety culture among healthcare staff in ICUs. The importance of this study is to establish a baseline for safety climate in these hospitals and specifically ICUs. In addition, by exposing the system weaknesses it helps the administration to strengthen and improve patient care. By decreasing workload and job stress, studies show they have a positive association with increasing job performance.

BackgroundHospital drug formularies function within Complex Adaptive Systems (CAS), where the alignment between drug supply and disease patterns is critical for patient care and cost-effectiveness. However, measuring this adaptability is challenging due to conflicting priorities among stakeholders and a lack of standardized assessment tools. ObjectivesThis study aims to analyze the perspectives of three key stakeholder groups-clinical providers, non-clinical service providers, and policymakers-to develop a consensus-based set of indicators for monitoring the adaptability of drug formularies in Vietnam. MethodsWe employed a modified Q-methodology approach involving 69 experts (20 non-clinical, 28 clinical, and 21 policymakers). A Q-set of 92 indicators across 9 criteria was developed. Participants evaluated these indicators using a 5-point Likert scale to determine levels of consensus and discordance, rather than a forced-distribution sort, to assess the absolute importance of adaptability metrics. ResultsThe analysis revealed high consensus across all groups regarding the importance of "Usage adaptation" and "Storage adaptation". However, significant discordance was observed in criteria related to "Ensuring drug availability," "Appropriate procurement" and "Outputs and outcomes". Notably, non-clinical providers prioritized proactive ordering, whereas clinical experts emphasized output results. ConclusionThe study proposes a management framework that monitors drug list adaptability across four levels: non-adaptive, passive, active, and advanced adaptive. Successful adaptability requires enhanced collaboration between specialized teams and a shift from efficiency-based to resilience-based performance metrics.

BackgroundCommunity pharmacies are vital for healthcare access in Ethiopias Sidama Region, yet patient satisfaction and perceptions of service quality remain understudied. This study evaluates patient satisfaction with pharmaceutical services in urban (Hawassa) and rural (Bensa, Aroresa) settings using a mixed-methods approach and an adapted SERVQUAL framework, incorporating six dimensions: reliability, responsiveness, assurance, empathy, tangibles, and accessibility. MethodsA cross-sectional survey of 400 patients and in-depth interviews with 20 participants were conducted in 2025. Quantitative data were analyzed using descriptive statistics and regression analysis, while qualitative data underwent thematic analysis. ResultsUrban patients reported higher satisfaction (M = 4.31, SD = 0.74) than rural patients (M = 3.12, SD = 0.88). Reliability ({beta} = 0.326, p < 0.001) and accessibility ({beta} = 0.244, p < 0.001) were significant predictors of satisfaction. Qualitative findings highlighted challenges such as medicine stockouts, language barriers, and gender-based discomfort, particularly in rural areas. A Sidama-specific SERVQUAL model was developed, emphasizing culturally and linguistically sensitive services. ConclusionsThe study reveals urban-rural disparities in pharmacy service satisfaction and underscores the need for targeted interventions to enhance medicine availability, cultural sensitivity, and accessibility in Sidama. The adapted SERVQUAL framework provides a robust tool for evaluating pharmacy services in similar low-resource settings.

BackgroundProfessionals are defined in the context of a particular body of knowledge which is obtained through formal education, expanded level of skills, type of certification proving their entry into the profession; a set of behavioral norms called professionalism and attitudes representing high levels of commitment to and identification with a specific profession. Several factor affecting the development of the nursing profession. Recognizing and determining such factors can be the first step to move towards the professionalization of nursing. The objective of this study was to assess professionalism in nursing and factors associated among nurses working in Arsi zone, Public Hospitals, Oromia, Ethiopia 2018. MethodsThis study used an Institutional based cross sectional study design. Self-administered structured questionnaire adapted from RNAO (Registered Nurses association of Ontario) guideline, was used to measure the level of professionalism. The sample was 420 nurses from the six Public Hospitals of Arsi Zone, Oromia, Ethiopia. Data was analyzed using SPSS 20.0. Both bivariate and multivariate analysis were carried out to identify associations. Odds ratio was calculated for related factors with 95% confidence interval (CI). A p-value < 0.05 was considered to be statistically significant. ResultOut of 420 Nurses working in six public Hospitals, 380 responded to the questionnaire, making the response rate of 90.5%. In current study level of professionalism was high among nurses (n=380) with highest percentages on accountability, advocacy, and ethics. Gender (AOR=2.489, 95% CI=1.540-4.023), nursing is indispensable (AOR=1.760, 95% CI=1.104-2.806), job satisfaction (AOR= 1.844, 95% CI = 1.143-2.975) and having up to dated training (AOR= 1.809, 95%CI=1.071-3.055 were significantly associated with overall professionalism level. ConclusionNurses working in public hospitals of Arsi zone have relatively had better professionalism level. Gender, nursing is indispensable, job satisfaction, presence of up-to-dated trainings were found significantly associated with professionalism in nursing. Human resource personnel and CEOs of respective hospitals should develop various training programs for nurses and provide encouraging environments for obtaining better qualities in attributes of professionalism.

BackgroundImproving healthcare quality is fundamental to building patient trust, strengthening continuity of care, and improving service delivery. Within Egypts Health Insurance Organization (HIO), patient satisfaction and loyalty serve as critical performance indicators, particularly as the country transitions toward Universal Health Insurance (UHI). MethodsA cross-sectional analytical study was conducted among 983 HIO beneficiaries from four hospitals in Alexandria. A validated questionnaire measured eight domains of healthcare quality along with patient satisfaction and loyalty. Construct validity was assessed through confirmatory factor analysis (CFA), and structural equation modelling (SEM) was used to examine the direct effects of healthcare quality on satisfaction and loyalty. ResultsCFA demonstrated strong model fit (CFI = 0.943; TLI = 0.940; RMSEA = 0.031), with all constructs showing high reliability (Cronbachs > 0.70). Healthcare quality had a substantial direct effect on patient satisfaction ({beta} = 0.607) and a modest but significant direct effect on patient loyalty ({beta} = 0.263). Satisfaction, likewise, exerted a strong direct influence on loyalty ({beta} = 0.545), with all pathways reaching statistical significance. ConclusionsHealthcare quality is a pivotal determinant of patient satisfaction and loyalty within HIO hospitals. Targeted improvements, particularly in communication, staff competence, responsiveness, and transitional care, can enhance patient-centered outcomes and support the successful implementation of Egypts UHI reforms. What is Already Known on This TopicPatient satisfaction and loyalty are widely used indicators of healthcare performance. Perceived healthcare quality consistently predicts satisfaction and loyalty across health systems. In Egypt--and particularly in Health Insurance Organization (HIO) hospitals--few studies have used structural equation modelling (SEM) to examine these relationships. What This Study AddsDelivers the first SEM-based assessment of healthcare quality, satisfaction, and loyalty among HIO beneficiaries in Alexandria. Shows that perceived healthcare quality strongly predicts satisfaction and directly enhances loyalty. Provides validated measurement models for eight quality domains within the Egyptian public insurance context. How This Study Might Affect Research, Practice, or Policy Identifies priority areas for quality improvement: communication, competence, responsiveness, and transition of care. Supports Universal Health Insurance (UHI) reforms by highlighting predictors of trust and loyalty in public services. Offers a validated framework for routine patient-experience monitoring across HIO hospitals.

Accreditation has become an important benchmark for healthcare organisations, and accordingly, many government hospitals in Kerala got accredited with national level (NABH) and state level (KASH) accreditation programmes. This study examined the quality of public healthcare delivery in these accredited hospitals while having a comparison with the non-accredited hospitals. It also compared the impact of national and state-level accreditation programmes in Kerala public healthcare settings. This cross-sectional study conducted between July 2017 and July 2018, employing a positivist approach using stratified random sampling. In total, 621 samples were collected from in-patients of both accredited (NABH and KASH) (312) and nonaccredited (309) public healthcare institutions in Kerala. Nine constructs overarching the quality of healthcare delivery and patient satisfaction construct are used in the study. The study found that patient satisfaction is identical in both accredited and nonaccredited hospitals (M=4.28). Patient satisfaction in NABH accredited hospital (M=4.27{+/-}0.67874) is lower than that of KASH accredited hospital (M=4.30{+/-}1.25417). The mean score of six constructs of quality healthcare delivery of KASH accredited hospitals is higher than NABH accredited. Thus, the study concluded that accreditation, regardless of its type, has no impact on patient satisfaction even though the accreditation process slightly improved different dimensions of quality healthcare delivery.

BackgroundPharmaceutical care is a patient-centered practice model in which pharmacists assume responsibility for identifying, preventing, and resolving medication-related problems to optimize therapeutic outcomes. In Nigeria, pharmaceutical care activities within hospital settings have expanded over time; however, evidence describing the frequency of specific pharmacist intervention activities and the structural barriers influencing their delivery at the facility level remains limited. ObjectivesThis study aimed to (1) describe the types and frequency of pharmaceutical care intervention activities performed by pharmacists in a secondary-care facility in Nigeria, and (2) identify barriers limiting effective pharmaceutical care delivery in this setting. MethodsA descriptive cross-sectional survey was conducted among pharmacists at a 50-bed secondary-care facility in Ibadan, Nigeria. All pharmacists employed at the facility were invited to participate. Data was collected using a structured, self-administered questionnaire assessing pharmacist demographics, frequency of intervention activities, perceived barriers to pharmaceutical care delivery, and recommendations for improvement. Quantitative data was analyzed descriptively using frequencies and percentages. ResultsTwelve pharmacists participated in this study (response rate: 92.3%). Pharmacists reported frequent engagement in clinically meaningful interventions, including: therapeutic substitutions (87%), provision of drug information to prescribers (83%), prevention of duplicate therapy, and dosage adjustments. Less frequently reported activities included adverse drug reaction reporting and counseling on medication storage. Major barriers to pharmaceutical care delivery were primarily system-related, including: limited access to patient medical records (92%), inadequate privacy for patient consultations (88%), and inefficient documentation systems (83%). Staffing levels and clinical knowledge were not perceived as major barriers. ConclusionPharmacists in this secondary-care facility actively engaged in medication optimization and patient safety-oriented interventions; however, system-level constraints limited the delivery of comprehensive pharmaceutical care. Addressing infrastructural and documentation barriers is essential to strengthen pharmaceutical care practice in secondary-care hospital settings in Nigeria and similar low-and middle-income country (LMIC) contexts.

In the era of multidrug-resistant organisms and following the coronavirus disease 2019 (COVID-19) pandemic, the prevention of healthcare-associated infections (HAIs) has become one of the most critical global health concerns. The World Health Organization (WHO) developed the "My Five Moments for Hand Hygiene," encouraging healthcare professionals to improve adherence to hand hygiene (HH), thereby increasing compliance rates and emphasizing alcohol-based hand rubs as the preferred method. We investigated HH compliance and the use of alcohol-based formulations among healthcare professionals working in adult, pediatric, and neonatal intensive care units (ICUs), comparing the pre and post-pandemic periods. In the post-pandemic period, we analyzed HH compliance across ICUs as well as HH practices in each of the WHOs "Five Moments." A total of 2,789 HH opportunities were recorded (1,048 before the pandemic and 1,741 after). Overall compliance rates increased from 61% (640/1,048) before the pandemic to 66% (1,157/1,741) after, a statistically significant difference (p = 0.004). HH compliance is most critical in the moments before patient contact or aseptic procedures, especially in the Adult and Pediatric ICUs. The Neonatal ICU showed superior performance overall, including significantly higher performance during the two most critical periods. The results reinforce that the COVID-19 pandemic led to an increase in healthcare professionals HH compliance, although disparities persist between professional categories and hospital sectors. Furthermore, there was a drastic change in the pattern of selective hand sanitizer use, increasing the likelihood of alcohol use more than fourfold compared to the previous period (OR 4.30; 95% CI 3.32-5.58; p < 0.001).

IntroductionPatient safety is crucial in healthcare. However, medical errors still occur and can harm patients. When healthcare workers experience adverse events, they can become "second victims" and experience emotional turmoil. Symptoms can persist for months and include hypervigilance and doubts regarding clinical skills. We conducted a study among staff at Kijabe Hospital to examine the second victim experience (SVE) and develop support strategies. MethodsWe conducted an online survey using the Second Victim Experience and Support Tool in May 2023. ResultsOf 900 healthcare workers,121 (13.4%) participated in the survey. The respondents consisted of various cadres including 31 students, 24 nurses, 18 clinical officers, 13 allied health workers, 12 consultants, 10 residents, and 13 from other cadres. Overall, 67.2% of the participants reported an SVE. Among these, 89.7% occurred within the past 12 months of these study. Of these participants, 49.6% provided hands-on or direct patient care, and 38.0% provided both direct and indirect patient care. The psychosocial symptoms reported included depressed mood (27.3%), guilt and frustration (27.3%), feelings of inadequacy and loneliness (24.0%), irritability (20.7%), and recurrent intrusive thoughts or images (19.8%). The physical symptoms reported included fatigue (24.0%), headaches (14.9%), and sleep disturbances (11.6%). Forty-five percent of SVs received support from someone at the hospital, while 27.3% received support from a colleague or a peer. In addition, 22.3% received support from close friends or family members, 6.7% received support from hospital administration or management and 0.8% received support from a pastor and an external counselor. ConclusionsTwo-thirds of healthcare workers had a second victim experience, reporting fatigue, depressed mood, guilt, and frustration. Counseling and psychological support were preferred by staff. Hospital management needs to prioritize staff support and acknowledge this experience to ensure patient safety.

ObjectiveThere is no validated questionnaire in Japan to measure the culture of safety in ambulatory care clinics. Therefore, we developed the Japanese version of the Medical Office Survey on Patient Safety Culture (MOSPSC) of the Agency of Healthcare Research and Quality (AHRQ) in the United States with the aim to establish a tool for evaluating and benchmarking the safety culture of outpatient clinics in Japan. Materials and methodsThis research uses both qualitative and quantitative approaches to translate, adapt and validate the MOSPSC questionnaire which consists of 62 questions. The process involved seven steps such as translation by two independent bilingual physicians, drafting and reviewing, backtranslation by two separate translation companies, semantic equivalence assessment by AHRQ and revision, pretest, focused discussion, and finalizing the questionnaire after expert review and proofreading. An actual safety culture survey was conducted with mainly online and paper versions at four clinics in Tokyo. The survey results were then evaluated for patient safety dimensions, reliability and construct validity. ResultsEfforts are made to select appropriate terminology during tool adaptation processes due to different language and medical system between Japan and the United States. The response rate in the actual survey was 66.4% (242/364). Confirmatory factor analysis showed that factor loading and goodness of fit indices were better when 3 items were removed from the original 10-composite model with 38 items. The Cronbachs alpha coefficients of composite measures ranged from 0.62 to 0.78 in the original model and 0.62 to 0.85 in the new model, indicating good internal consistencies. ConclusionsConsidering the differences in medical systems, culture, and language between the United States and Japan, the instrumented was adapted with a satisfactory content validity and reliability.

BackgroundPharmacy value-added services (PVAS) have long been offered in public health institutions across Malaysia as an alternative to conventional counter services for prescription refills, with the aim to reduce the waiting time. ObjectiveTo assess the utilization of the PVAS in individual health institutions, and its association with the achievement of the key performance indicator (KPI) set for the pharmacy waiting time. MethodThis was a cross-sectional study based on the data contributed by 142 hospitals and 648 health clinics throughout 2018. The availability and uptake of the PVAS were summarized as percentages. The impacts of the PVAS uptake and the other institution-related factors on the KPI achievement were further explored using the logistic regression analysis. ResultsApproximately 2.9 million (17.1%) of the refill prescriptions were dispensed via the PVAS. The appointment-and-pickup services (42.7%) and the Integrated Drug Dispensing System (23.7%) emerged as the most commonly used types of PVAS. A higher PVAS uptake was associated with a better KPI achievement (OR=0.91, 95% CI: 0.84-0.98). In contrast, adding a new type of PVAS to the existing services yielded an opposite outcome (OR=1.48, 95% CI: 1.15-1.89). Both the prescription load and location of health institutions were also found have influenced the KPI achievement. ConclusionThe PVAS are generally well accepted in Malaysia and showed to have reduced the pharmacy waiting time. However, strategies to optimize the PVAS uptake are warranted.

BackgroundHealthcare quality is a key determinant of patient experience, satisfaction, and loyalty, yet the mechanisms linking quality to loyalty remain underexplored in Egypts Health Insurance Organization (HIO). This study examines the mediating role of patient satisfaction in the relationship between healthcare quality and patient loyalty among HIO beneficiaries. MethodsA cross-sectional study was conducted with 983 beneficiaries from four HIO hospitals in Alexandria. Data was collected using a validated questionnaire covering eight healthcare-quality domains, patient satisfaction, and loyalty. Confirmatory factor analysis (CFA) assessed construct validity, and structural equation modeling (SEM) tested direct and mediated pathways. Bootstrapping (5,000 samples) evaluated mediation significance. ResultsHealthcare quality significantly predicted patient satisfaction ({beta} = 0.607, p < 0.001), which in turn strongly influenced patient loyalty ({beta} = 0.545, p < 0.001). Direct effects of healthcare quality on loyalty were reduced and non-significant when satisfaction was included. The indirect effect via patient satisfaction was significant ({beta} = 0.331, 95% CI: 0.262-0.404), confirming partial mediation. Transition of Care, Empathy, and Responsiveness were the most influential quality domains. Model evaluation demonstrated a strong fit across all indices (CFI = 0.967, TLI = 0.960, RMSEA = 0.043). ConclusionPatient satisfaction is a key link between healthcare quality and loyalty. Enhancing communication, competence, responsiveness, and transitional care as satisfaction-driven domains can strengthen trust, continuity, and loyalty, supporting patient-centered reforms and Egypts Universal Health Insurance implementation. What is already known- Healthcare quality strongly influences patient satisfaction and loyalty. - Patient loyalty is critical for continuity of care, trust, and system sustainability. - Few Egyptian studies have applied structural equation modeling to explore mediation pathways between quality, satisfaction, and loyalty. What this study adds- Validation of a mediation model examining healthcare quality, patient satisfaction, and loyalty among HIO beneficiaries in Alexandria. - Patient satisfaction partially mediates the relationship between healthcare quality and loyalty. - Identifies key quality domains that drive satisfaction-related loyalty, providing actionable targets for improvement. How this study might affect research, practice, or policy- Supports integrating patient satisfaction as a core indicator in HIO performance monitoring. - Informs targeted quality-improvement interventions focusing on satisfaction-sensitive domains. - Provides a robust mediation framework to guide evidence-based UHI policy and implementation in Egypt.

BackgroundProlonged length of hospital stay is the most common indicator of poor quality of health care and inefficient utilization of hospital resources. Prolonged hospital stay associated with increased mortality, hospital-acquired infection, and unnecessary utilization of hospital bed and other resources. Predicting length of hospital stay facilitates resource designing and initiates quality improvement activities. However, data regarding the prolonged length of hospital stays, and associated factors were a scarce in Ethiopia. MethodsA hospital-based cross-sectional study was conducted on a sample of 316 adult patients from December 1 to January 10, 2022. A consecutive sampling technique was used during sampling procedure. A structured questionnaire was used to collect data regarding sociodemographic factors, clinical factors, medication factors, and behavioral factors through interview, medical record review and by using check list. The data was entered into the epidata4.6 version and exported to SPSS Version25 for binary logistic regression analysis. To identify factors associated with outcome variable, candidate variables (p<0.25) were fitted to multivariable analysis, and those with P-values<0.05 were considered as factors associated with prolonged length of hospital stay. Odds ratio with corresponding 95% CI was used to indicate the strength of association of variables with prolonged length of hospital stay. ResultOne fourth (24.7%) of the study participants experienced a prolonged length of stay at surgical ward. The odd of a prolonged length of hospital stay was high among patients who had comorbid condition [AOR=4.59, at 95% CI= (2.46-8.56)], who developed surgical site infection [AOR=5.02 at 95% CI= 1.97-12.80)], and who developed hospital acquired pneumonia during hospital stay [AOR= 3.43 at 95% CI= (1.36-8.64)]. Conclusion and recommendationNear to quarter of the study participants experienced prolonged length of hospital stays. Comorbid condition, surgical site infection, and hospital acquired pneumonia were factors associated with prolonged length of hospital stay at surgical ward. Quality of care could be improved by adjusting surgical ward environment to prevent hospital acquired infection and focus on managing complication after surgery. Health care provider should be educating surgical patient about the risk of comorbidity on wound healing and early diagnosis and prevention of comorbid condition.

BackgroundClinical audit is a vital quality improvement tool in healthcare that enables frontline workers to evaluate their care practices against established standards. This study assessed the knowledge, attitude, and practice of clinical audit among frontline healthcare workers in selected hospitals in Gusau, Zamfara State. MethodsA descriptive cross-sectional study was conducted between February to September 2024 among 410 frontline healthcare workers across four health facilities in Gusau, Zamfara State, using a quantitative method of data collection. Data was analyzed using SPSS version 20, with a CI of 95% and p-value of [&le;] 0.05 considered statistically significant. ResultsThe mean age of respondents was 36.6 +/- 7.3 years, with 180 (44%) aged 31-40 years. The overall level of knowledge of clinical audit was adjudged to be poor among 224 (54.6%) of participants. Doctorsdemonstrated marginally higher good knowledge scores compared to other cadres. Facility type was significantly associated with knowledge level (p=0.001), while age, gender, specialty, and years of experience showed no significant association. Respondents generally had positive attitudes toward clinical audit, but actual participation in audit practices was low across all cadres. ConclusionsThis study has demonstrated a suboptimal level of knowledge of clinical audit among frontline healthcare workers, with variation across facility types. While attitudes toward clinical audit were largely positive, practical engagement remains limited, highlighting the need for targeted training and institutional support to enhance clinical audit practice in similar settings.

Patient safety remains a global problem that affects both developed and developing countries. Healthcare organizations should focus on the need of assessing safety culture as that will provide basic understanding on safety related perceptions of their staffs. ObjectiveThis study was aimed to assess baseline level and mean score of every domain of the patient safety attitude among doctors and nurses in public hospitals in Selangor and to identify the determinants associated with patient safety attitude in all domains : teamwork, safety climate, working condition, job satisfaction, stress recognition and perception of management. MethodThis was a cross-sectional study utilizing the Safety Attitude Questionnaires (SAQ) involving 142 doctors and 231 nurses in three public hospitals in Selangor. The samples were selected through proportionate stratified random sampling. Data was analysed using descriptive, bivariate and multivariate analysis. ResultsThe response rate was 83% in which job satisfaction (73.78{+/-}20.54) and perception of management (58.98{+/-}16.28) received the highest and lowest mean score, respectively. The factors associated with positive patient safety attitude towards 1)teamwork were position (OR 1.99, p=0.03) and history of attending patient safety training (OR 3.228, p = 0.000); 2) safety climate were history of attending patient safety training (OR 7.283, p = 0.000); 3) job satisfaction were education level (OR 35.709, p=0.000), position (OR 10.598, p=0.000) and history of attending patient safety training (OR 2.883, p = 0.000); 4) perception of management were age (OR 2.084,p=0.021) and work area (OR 2.461,p=0.012); 5) working condition were age (OR2.200,p 0.003) and history of attending patient safety training (OR1.738, p 0.032). ConclusionRespondents with history of attending patient safety training have more positive attitude towards teamwork, safety climate, job satisfaction and working condition. Improving patient safety culture should be priorotized by the hospital management team to inculcate safety culture in healthcare providers. STRENGTHS AND LIMITATIONS OF THIS STUDYO_LIThis study reports the outcomes of patient safety attitude in public hospitals in Malaysia. C_LIO_LIThis study has a good response rate. C_LIO_LIThe study covers both types of hospitals in Malaysia (specialist and non-specialist hospitals). C_LIO_LIThe respondents were from 2 categories of healthcare professionals. C_LIO_LIThe factor of limited time and financial constraint limit the ability to include bigger sample into this study C_LI