Management support for patient safety in two tertiary hospitals in Jamaica: A mixed methods study.

Abstract

Management support is important for implementation of policies and procedures, and to create an organizational culture for the delivery of safe patient care. This study sought to determine the culture for management and safety support at two tertiary hospitals in Jamaica, and to explore managers' involvement in quality and quality improvement activities. A mixed methods study was done among 328 doctors and nurses (quantitative arm) and 17 senior managers (qualitative arm) from two tertiary hospitals. Data on sociodemographic, work-related characteristics and management support for patient safety were collected and in-depth interviews collected explored managers' involvement in quality and quality improvement activities. The percentage positive score was determined for management support for patient safety and a logistic regression model identified independent predictors of positive scores. Thematic analysis identified themes and subthemes. Overall positive percent score for management support for patient safety was 51.57%. Independent predictors of positive scores were staff position, institution and primary area of work. Doctors were 72.4% less likely than nurses to have positive scores (OR=0.28, 95% CI: 0.14-0.55, p=<0.001). Participants from Institution B were 2.63 times as likely to have positive score compared to participants from Institution A (OR = 2.63, 95% CI: 1.40 - 4.96, p = 0.003). Compared to participants whose primary area of work was medicine, participants from accident and emergency and radiology/laboratory units were 3.15 (95% CI: 1.19-8.35, p = 0.021) and 5.18 (95% CI: 1.82-14.76, p = 0.002) times more likely to have positive scores respectively. Two themes (managers' role in quality assurance/improvement and challenges in quality assurance and improvement) and six subthemes emerged from in-depth interviews. Institutions should ensure that there is a clear strategy for quality and quality improvement and implement appropriate systems and structures to support quality-related activities. Boards of hospitals should make quality a key item for discussion and action, to ensure good patient outcomes.