Quality Management in Health Care最新文献

{"title":"A Cohort Retrospective Observational Study of Hospital Accreditation Influence on Medication Safety in Saudi Hospitals.","authors":"Asaad A Abduljawad","doi":"10.1097/QMH.0000000000000589","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000589","url":null,"abstract":"<p><strong>Background and objectives: </strong>Medication errors remain a leading cause of adverse events globally and in Saudi Arabia, accounting for up to 45% of reported medical errors. Despite accreditation programs aiming to improve patient safety, evidence of their impact on medication management (MM) standards is limited. This study addresses this gap by evaluating MM compliance in Saudi hospitals from 2016 to 2023, post-implementation of the Central Board for Accreditation of Healthcare Institutions' Essential Safety Requirements (ESR).</p><p><strong>Methods: </strong>This retrospective cohort study analyzed ESR survey data from 454 hospitals nationwide. Of these, 161 hospitals met the inclusion criteria by completing all 6 annual ESR surveys (2016-2019, 2022-2023); 293 hospitals were excluded due to incomplete longitudinal data. Scores for 3 MM standards: MM5 (high-alert medication safety), MM6 (look-alike and sound-alike medication safety), and MM41 (medication error monitoring) were extracted. Statistical analysis included descriptive statistics, repeated measures analysis of variance, and independent t tests comparing 2016-2019 and 2022-2023 periods. MM compliance was not reported during the COVID pandemic period (2020-2021).</p><p><strong>Results: </strong>Significant improvements were observed across all MM standards over time. Mean MM5 scores increased from 69.56 in 2016 to 95.66 in 2023, MM6 from 40.79 to 96.10, and MM41 from 61.13 to 93.27 (all P < .001). Independent t tests confirmed substantial gains: MM5 rose from 70.06 to 92.28 (t = -14.50, P < .001), MM6 from 71.59 to 95.63 (t = -15.41, P < .001), and MM41 from 64.98 to 88.17 (t = -14.63, P < .001). Ownership type showed no significant effect (P > .05), and hospital bed size had no meaningful impact on MM5 and MM6, with a minor trend for MM41 (P = .001 but not statistically significant).</p><p><strong>Conclusions: </strong>The period after implementation of the Central Board for Accreditation of Healthcare Institutions ESR standards saw significantly improved medication safety compliance in Saudi hospitals, suggesting the effectiveness of accreditation in promoting patient safety. Policymakers should sustain these efforts to maintain progress. Future research should evaluate patient outcomes, cost-effectiveness, and adopt mixed-methods approaches to explore contextual factors influencing compliance.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement Is Not Yet Change: Making Effective Practice the Norm.","authors":"Mohammed As'ad","doi":"10.1097/QMH.0000000000000602","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000602","url":null,"abstract":"<p><p>Quality improvement processes seek to establish effective practices as everyday habits. In other words, they aim to make evidence-based practices the norm. There are several barriers to consider. First, there is a tendency to conflate measured change with embedded practice. For example, hand hygiene initiatives benefit from a Hawthorne effect. People may change their behavior when they know they are being observed. And some observation tactics and settings are more noticeable than others. Second, measurements are often made at the project's peak of attention rather than during routine practice after the intervention. Factors that may distinguish initial engagement from sustained integration include attenuation over time, variation between implementation sites, and variation by observation conditions. Effective quality improvement projects will anticipate and measure these factors, report the conditions under which data were collected, and continue evaluation beyond the active project phase. Sustained change also depends on organizational conditions that support routine practice. Improvement is not change until it no longer depends on being watched.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Infusion Scheduling Decision Support Tool to Manage Resource Utilization.","authors":"Yu-Li Huang, Deb K Anderson, Lauren A Moore, Jennifer J Larsen","doi":"10.1097/QMH.0000000000000596","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000596","url":null,"abstract":"<p><strong>Background and objectives: </strong>As demand for infusion therapy increases due to an aging population and growing rates of chronic illness, effective resource management in scheduling becomes more critical to serve patients in ambulatory infusion centers. The wide range of treatment types, lengths, and nursing requirements, as well as capacity constraints, makes infusion scheduling challenging to effectively manage patient flow and resource utilization. Despite efforts to improve scheduling efficiency, the lack of practice implication and feasibility remains. This study aims to develop a tool that delivers data- and algorithm-driven recommendations for appointment scheduling decisions to improve resource management.</p><p><strong>Methods: </strong>We introduce a real-time decision support tool that simultaneously accounts for (1) existing nursing workload and space utilization and (2) the nursing time and infusion chairs required for upcoming patients. The tool interface is presented, and the functions of each element are described. The appointment time selection algorithm was developed to provide schedulers with options for scheduling, constrained by nursing and chair availability. The tool also provides schedulers with the flexibility to deviate from recommendations and receive dynamic feedback on patient volume and nursing needs based on their decisions.</p><p><strong>Results: </strong>The implementation results show a significant reduction in distributing nurses' workload in terms of time mismatching between patients' needs and nursing availability by 45.5%, P < .001, while the chair utilization remained consistent. The feedback from both the scheduling team and nurses was positive, which provided strong evidence for how this tool addressed and targeted their scheduling needs. In addition, key practice behaviors and implementation challenges that impact operations efficiency are discussed for further improvement.</p><p><strong>Conclusions: </strong>The proposed tool offers a streamlined, interactive, and adaptable scheduling approach for better resource utilization and ultimately reduces the time schedulers spend on making manual decisions.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chinese Patients' Attitudes Toward the WHO Surgical Safety Checklist.","authors":"Yuzhang Wang, Yanhe Wang, Ngwayi James Reeves Mbori, Yujie Chen, Siwei Li, Bingtao Hu, Jie Tan, Daniel Edward Porter","doi":"10.1097/QMH.0000000000000567","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000567","url":null,"abstract":"<p><strong>Background and objectives: </strong>Strategies to reduce adverse events have mainly focused on systems of care and professional behavior despite a growing interest in involving patients in safety initiatives. Only some studies were published in developing countries. This study sought to clarify the patients' views on the surgical safety checklist in China.</p><p><strong>Methods: </strong>We developed a research-based patient questionnaire and delivered it through a ubiquitous social media platform. The survey was sent to patients over 12 weeks from May to July 2020. Responses were accepted up to the end of July 2020. This survey was conducted at 5 Level 3 hospitals in 4 provinces (Beijing, Shandong, Liaoning, and Henan). Descriptive statistics (frequencies and percentages) were calculated to demonstrate the overall quality of checklist use. Multivariate linear regression was utilized to assess the predictive factors for respondents' views on the risk of an adverse event. Multivariate ordinal logistic regression, with respondents' characteristics as covariates, predicted attitude toward the WHO Surgical Safety Checklist. Adjusted odds ratios with 95% confidence intervals were calculated.</p><p><strong>Results: </strong>A total of 475 patients at 5 centers responded. Previous adverse medical events occurred more (26.7%) than generally reported. For surgical patients, the estimates of adverse-event risk in the hospital were almost entirely due to the perceived risks of surgery itself. Lower risk estimates were generated by patients who had experienced more surgery before (adjusted odds ratio = -0.429, 95% confidence interval: -0.752 to 0.107, P < .01). Compared with other studies, the proportion of patients with a positive perception of the checklist was lower. However, more than half (53.3%) thought the checklist would improve communication between staff. More patients than elsewhere were anxious about hearing repetitive confirmation before surgery. In keeping with more rigid role expectations in China, more patients preferred a doctor taking charge of the checklist (37.3%). Chinese patients had a more positive view of the patient's role in surgical safety improvement.</p><p><strong>Conclusions: </strong>Less than half of Chinese patients hold positive views on implementing the surgical safety checklist despite a higher perception of the risk of adverse surgical events than elsewhere. Patients would like to become more actively involved in surgical safety improvement. We suggest greater patient involvement during the implementation of the WHO Surgical Checklist, fostering a more supportive and collaborative environment in the future.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial Waste is Patient Harm: Reducing Wasteful Healthcare Spending Increases Safety and Health.","authors":"Andrew Doy, Jason Tibbels","doi":"10.1097/QMH.0000000000000587","DOIUrl":"https://doi.org/10.1097/QMH.0000000000000587","url":null,"abstract":"<p><p>Wasteful healthcare spending has more than economic costs-there are clinical costs as well. Waste increases out-of-pocket costs, delays necessary care, and worsens outcomes. We argue that, while most quality frameworks do not consider this patient harm, they should. Financial waste is clinically on par with medical errors and adverse events, as overtreatment and low-value care injure patients, care coordination failures lead to preventable complications and death, pricing failures cause delayed and complicated care, and low-value procedures cause complications. We reviewed the literature to tie financial waste, toxicity, and pollution to patient harm across 4 domains: care delivery, care coordination, overtreatment or low-value care, and pricing failure. Even with insurance, healthcare is unaffordable for most Americans, leading to delayed care and lower quality of life. Solutions exist, and specialty care platforms have successfully employed strategies to offset patient harm. Including financial harm in quality frameworks increases the urgency to address financial waste.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upper Extremity Specialist Puzzlement and Misdiagnosis Are More Likely When Patients Interpret Rather Than Describe Their Symptoms.","authors":"Tom J Crijns, Amelia E Mercado, David Ring, Gregg A Vagner, Lee M Reichel","doi":"10.1097/QMH.0000000000000514","DOIUrl":"10.1097/QMH.0000000000000514","url":null,"abstract":"<p><strong>Background and objective: </strong>Diagnosis of upper limb illness by upper extremity specialists may be more straightforward when patients relate matter-of-fact descriptions more so than interpretation of symptoms, which can be inaccurate and misleading. This study investigated the accuracy of diagnosis when specialists are presented with interpretations compared to descriptions of symptoms.</p><p><strong>Methods: </strong>Upper extremity specialists reviewed 4-sentence descriptions of symptoms of 7 nontraumatic upper limb diseases in typical American spoken English. Text for the descriptions was sourced from a set of transcripts of audio and video recorded visits: half matter-of-fact descriptions of common symptoms, and half reflecting common misinterpretations of symptoms. The 4 sentences were randomly presented one at a time and the surgeons provided text descriptions of their guess at the diagnosis and rated the likelihood of symptom misinterpretations.</p><p><strong>Results: </strong>The number of sentences until correct diagnosis was significantly lower for the matter-of-fact descriptions (median 1 vs median \"unable to diagnose\") compared to the symptom interpretations. For the matter-of-fact descriptions, most surgeons (>80%) correctly guessed the diagnosis on the first sentence. Specialists detected symptom misinterpretation in the scenario language.</p><p><strong>Conclusion: </strong>These findings suggest that difficulty in diagnosis is associated with patient interpretation rather than description of symptoms. While interpretation of symptoms is an important part of illness, the pathophysiology may be best discerned when patients provide matter-of-fact descriptions rather than interpretation of their symptoms.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"215-222"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145542275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Evaluation of Prolonged Hospitalization in Japanese Hospitals: Analysis Based on a Risk-Adjusted Indicator for Pneumonia.","authors":"Ryo Onishi, Yosuke Hatakeyama, Kunichika Matsumoto, Koki Hirata, Kanako Seto, Ryosuke Hayashi, Takefumi Kitazawa, Tomonori Hasegawa","doi":"10.1097/QMH.0000000000000554","DOIUrl":"10.1097/QMH.0000000000000554","url":null,"abstract":"<p><strong>Background and objectives: </strong>Prolonged hospitalization (PH) increases the burden on patients and health care finances. In Japan, health policy initiatives have aimed to reduce the length of hospital stays (LOS). Previous studies have suggested that LOS is influenced by patient characteristics and the quality of hospital care. This retrospective observational study aimed to elucidate differences across hospitals in the extent to which prolonged hospitalization is controlled, through the calculation of a risk-adjusted indicator.</p><p><strong>Methods: </strong>This study included inpatients 15 years of age and older diagnosed with pneumonia from 2014 to 2022. Hospitalization exceeding the average duration was defined as PH. We developed an RPH ratio indicator using Japanese administrative claim data in 2014-2022 and each period (2014-2016, 2017-2019, 2020-2022). The RPH ratio was calculated by the actual number of PH patients and the expected number of PH patients. The expected number of PH patients was determined using logistic regression analysis with risk-adjusted variables.</p><p><strong>Results: </strong>A total of 36,417 patients with pneumonia from 39 hospitals were included. The mean LOS was 19.2 days. The PH rate was 41.7%. The mean (± standard deviation) RPH ratio was 100.5 ± 21.4, ranging from 47.9 to 153.3, indicating a 3.2-fold difference between the minimum and maximum ratios. We found a significant positive relationship between changes in the ratio for each consecutive period.</p><p><strong>Conclusion: </strong>This study revealed significant variations among hospitals in the quality of LOS management and identified a notable trend in RPH ratios. Hospitals with high RPH ratios were likely to yield similar results in subsequent periods, emphasizing the importance of supporting hospitals.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"270-276"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145966759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital Workforce Staffing and Work-Pace Safety Perceptions During the COVID-19 Pandemic: A Cross-Sectional Analysis.","authors":"Lauren Edelstein, Neil Sehgal, Debra Shapiro, Rebecca Gourevitch, Negin Fouladi, Luisa Franzini","doi":"10.1097/QMH.0000000000000588","DOIUrl":"10.1097/QMH.0000000000000588","url":null,"abstract":"<p><strong>Background and objectives: </strong>The COVID-19 pandemic placed unprecedented strain on US hospitals, creating conditions of high patient acuity, elevated mortality, and staffing shortages. These pressures threatened care quality and shaped how workers perceived their ability to provide safe care. This study examined national trends in hospital workers' staffing and work-pace safety perceptions (SWSP) during the pandemic and evaluated whether changes in hospital mortality rates were associated with worsening perceptions. We further assessed whether intensive care unit (ICU) staff experienced sharper declines in SWSP compared with non-ICU counterparts.</p><p><strong>Methods: </strong>We conducted a quantitative analysis using de-identified responses from the Hospital Survey on Patient Safety Culture, linked with mortality data from the Healthcare Cost and Utilization Project State Inpatient Databases. A total of 258 987 responses from more than 400 hospitals were included from the pandemic period (April 2020-July 2022). Staffing and work-pace safety perception was measured using a composite of 2 Hospital Survey on Patient Safety Culture items on staffing adequacy and work pace, dichotomized into negative/neutral versus positive perceptions. Logistic regression models assessed associations between monthly mortality rates and SWSP, adjusting for individual- and hospital-level covariates. Stratified analyses compared ICU and non-ICU settings.</p><p><strong>Results: </strong>Nationwide, SWSP declined steadily, decreasing by an average of 3.5 percentage points per year. Periods of heightened mortality, including the Delta and Omicron waves, coincided with sharper deterioration. A doubling of overall mortality was associated with a 38% increase in odds of negative/neutral SWSP (odds ratio [OR] = 1.38, standard error [SE] = 0.02, P < .01). Stratified analyses showed differences by setting: for non-ICU patients, a mortality doubling was linked to a 14% increase (OR = 1.14, SE = 0.02, P < .01), while for ICU patients, odds rose by 40% (OR = 1.40, SE = 0.12, P < .01).</p><p><strong>Conclusions: </strong>During the pandemic, healthcare workers' perceptions of staffing adequacy and work pace deteriorated, varying by position group and showing greater sensitivity to mortality surges among ICU staff than non-ICU peers. These findings indicate that SWSP represents an important dimension of safety culture that responds dynamically to systemic strain. For health system leaders, this underscores the value of complementing external performance measures with proactive monitoring of workforce perceptions. Attention to SWSP may provide early warning of stress, inform resource allocation, and support interventions to mitigate burnout, improve retention, and strengthen resilience in times of crisis.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"259-269"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of the COVID-19 Pandemic on Incidents of Workplace Violence Events as Reported in Patient Safety Event Reports.","authors":"Azade Tabaie, Vanessa B Hurley, Dae Hyun Kim, Allan Fong","doi":"10.1097/QMH.0000000000000558","DOIUrl":"10.1097/QMH.0000000000000558","url":null,"abstract":"<p><strong>Background and objectives: </strong>Workplace violence (WPV) committed against frontline health care workers is a worldwide concern but relatively little is known about relative rates of reported WPV events as identified through patient safety event (PSE) reports before and during the COVID-19 pandemic. This study sought to understand how the COVID-19 pandemic changed the rates and characteristics of reported WPV events committed by patients against health care workers, as captured in the PSE report system for a Mid-Atlantic health care system.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed voluntary self-reported PSE reports from March 1, 2018 to February 28, 2022. We analyzed reports in 2 equal periods-pre-pandemic (March 2018-February 2020) and during the pandemic (March 2020-February 2022) -focusing on WPV incidents. Data included event types, reporting locations, staff roles, and resolution strategies, comparing pre- and during-pandemic trends.</p><p><strong>Results: </strong>We identified differences in WPV PSE reports pre-pandemic versus during the pandemic. During the pandemic, there were more reports involving disorderly individuals and fewer incidents of physical and verbal abuse compared to the pre-pandemic period. Resolutions during the pandemic often involved medication, patient restraint, de-escalation, and security intervention, with fewer reports from providers and nurses but more from other health care staff like security officers.</p><p><strong>Conclusion: </strong>PSE reports contain valuable information pertaining to the identification of system hazards such as WPV events. Analyzing such data provides important insights into how the COVID-19 pandemic affected WPV incidents recorded in PSE system and may also provide a helpful orientation for ongoing monitoring of such events within other health care systems nationwide.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"277-283"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146047085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns About Patient Safety Related to Electronic Health Records: Scale Development.","authors":"Aya Al-Ali, Laila Akhu-Zaheya, Salam Bani Hani","doi":"10.1097/QMH.0000000000000570","DOIUrl":"10.1097/QMH.0000000000000570","url":null,"abstract":"<p><strong>Background and objectives: </strong>Electronic health record (EHR) implementation impacted patient safety since it has the potential to increase the standard and safety of medical care. This study aims to develop a scale for measuring EHR-related patient safety concerns and investigates differences in hospitals and participants in terms of these safety concerns.</p><p><strong>Methods: </strong>Nonexperimental, methodological design was used in this study. A mixed approach was used, including a qualitative focus group interview and a quantitative survey.</p><p><strong>Results: </strong>Five factors were retained, and they suggested 5 factors: clinical communication, EHR alert system, patient identification, the most recent data usage, and clinical documentation. The total number of participants who completed the questionnaires was 602 nurses and midwives, with a 67% response rate.</p><p><strong>Conclusion: </strong>Administrators are committed to creating a safety culture among users of EHR, and continuous evaluation and assessment of skills and competencies has great impact on patient safety.</p>","PeriodicalId":20986,"journal":{"name":"Quality Management in Health Care","volume":" ","pages":"234-248"},"PeriodicalIF":1.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}