International journal for quality in health care : journal of the International Society for Quality in Health Care最新文献

{"title":"Effect of an ERAS Nursing Protocol on Recovery After Minimally Invasive Lumbar Fusion: A Randomized Trial.","authors":"Yun Gao, Na Wang, Ling Zhang","doi":"10.1093/intqhc/mzag155","DOIUrl":"https://doi.org/10.1093/intqhc/mzag155","url":null,"abstract":"<p><strong>Background: </strong>Perioperative care for minimally invasive lumbar interbody fusion (MIS-LIF) is often suboptimal. Evidence for nurse-led Enhanced Recovery After Surgery (ERAS) protocols in this population is lacking. Our study was to evaluate the impact of a structured nursing management protocol based on ERAS principles on postoperative recovery outcomes in patients undergoing MIS-LIF for lumbar spinal stenosis.</p><p><strong>Methods: </strong>In a prospective randomized controlled trial, 70 patients scheduled for single-level MIS-LIF were randomly assigned to either an ERAS group (n = 35) or a conventional care group (n = 35). The ERAS group received a structured nursing protocol encompassing preoperative education, preemptive analgesia, intraoperative temperature and fluid management, postoperative multimodal analgesia, staged early mobilization, and complication prevention; the conventional care group received routine perioperative care based on standard orders. The protocol was implemented from admission to discharge. The primary outcome was time to first ambulation. Secondary outcomes included length of stay, pain scores (NRS at 6, 24, 48, 72 h), opioid consumption, complications, ODI (preoperative, discharge, 1 month), and patient satisfaction (at discharge).</p><p><strong>Results: </strong>The time to first ambulation was significantly earlier in the ERAS group (P < 0.001). The ERAS group also had a shorter hospital stay, lower pain scores, reduced opioid consumption (all P < 0.001), a lower overall complication rate (P = 0.002) with fewer episodes of nausea/vomiting (P = 0.016), superior functional improvement (ODI: 38.2±6.8 vs. 45.6±7.5, P < 0.001), and higher satisfaction at discharge (P < 0.001).</p><p><strong>Conclusion: </strong>A nurse-led ERAS protocol safely and effectively accelerates recovery, improves pain management, reduces complications, patient satisfaction after MIS-LIF.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Safety Science to Operational Reality: Competing Institutional Logics in the Translation of National Patient Safety Recommendations.","authors":"Mohammad Farhad Peerally, Elizabeth Sutton, Jane Ferguson, Kieran Walshe, Natalie Armstrong","doi":"10.1093/intqhc/mzag146","DOIUrl":"https://doi.org/10.1093/intqhc/mzag146","url":null,"abstract":"<p><strong>Background: </strong>National patient safety investigation bodies conduct system-level investigations and produce recommendations intended to drive improvement. Evidence that such recommendations translate into meaningful improvement is weak and the reasons for this are poorly understood. This paper examines how recommendations produced by the Health Services Safety Investigations Body (HSSIB), England's independent national patient safety investigation body, are produced by investigators and received by the national organisations to whom they are directed.</p><p><strong>Methods: </strong>A qualitative multi-method design was used including documentary analysis of 22 investigation reports produced by the Healthcare Safety Investigation Branch (HSIB), predecessor to HSSIB, two focus groups with HSSIB patient safety investigators (n = 12) and semi-structured interviews with 11 senior representatives of national organisations, recipients of HSSIB recommendations. Data were analysed using reflexive thematic analysis, guided by institutional logics.</p><p><strong>Results: </strong>Documentary analysis showed that HSIB recommendations were non-directive, clustering at the weakest level of the hierarchy of risk controls and favouring administrative measures. Two competing institutional logics were constructed using reflexive thematic analysis. HSSIB investigators deploy a safety science logic focusing on systems thinking, collaborative engagement and non-punitive learning, while recipient organisations enact a managerial-operational logic prioritising resource management and operational feasibility. Four consequences follow: i) recommendations are attenuated through nominal co-production; ii) recipients navigate priority thickets in which political salience, strategic fit and resource availability govern implementation; iii) accountability among recipients is diffuse; and iv) HSSIB's transparency carries limited traction within the managerial-operational logic.</p><p><strong>Conclusions: </strong>These conditions produce a paradox: HSSIB's structural separation from the organisations it investigates, while central to its legitimacy as a learning body, can distance it from the operational realities that govern whether recommendations are acted upon. Overcoming this paradox requires deliberate logic-building strategies that address how recommendations are framed, how accountability is constructed, and how the governance landscape is coordinated.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expectation-perception gaps in healthcare service quality: A systematic review and meta-analysis toward service design-oriented healthcare evaluation.","authors":"Li-Yu Tseng, Kevin C Tseng","doi":"10.1093/intqhc/mzag151","DOIUrl":"https://doi.org/10.1093/intqhc/mzag151","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The SERVQUAL model is widely used to evaluate healthcare service quality; however, evidence regarding expectation-perception gaps remains fragmented across healthcare settings. Existing studies have primarily interpreted these gaps as indicators of patient dissatisfaction, potentially overlooking broader challenges in healthcare service delivery. This study aimed to quantify SERVQUAL expectation-perception gaps across healthcare settings and explore their implications for healthcare quality evaluation from a service design perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. Electronic databases were searched from inception to January 2026. Studies applying the SERVQUAL model in healthcare settings and reporting quantitative expectation-perception data were eligible. Twenty-five studies involving 9,640 participants were included. Random-effects meta-analysis using restricted maximum likelihood (REML) estimation was performed to calculate pooled mean differences (MDs) after scores were harmonized to a common five-point scale. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A statistically significant average negative expectation-perception gap was identified across healthcare settings (MD = -0.578; 95% confidence interval (CI), -0.781 to - 0.376; 95% prediction interval (PI), -1.662 to 0.505; p &lt; 0.001). Significant average negative gaps were observed across all five SERVQUAL dimensions. The largest pooled gaps were identified for Assurance (MD = -0.628), Reliability (MD = -0.627), and Responsiveness (MD = -0.616), followed by Empathy (MD = -0.534) and Tangibles (MD = -0.489). Regional subgroup analyses demonstrated substantial geographic variation in pooled expectation-perception gaps. Although substantial between-study heterogeneity was observed (I² = 99.74%), leave-one-out sensitivity analyses indicated that the direction and statistical significance of the pooled estimate were not materially altered by omission of any individual study. Funnel plot asymmetry was detected; however, this pattern may reflect both small-study effects and substantial between-study heterogeneity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;An average negative SERVQUAL expectation-perception gap was observed across the included studies, with the largest pooled mean gaps occurring in Assurance, Reliability, and Responsiveness. However, these findings should be interpreted cautiously because of the extreme between-study heterogeneity, prediction intervals crossing the null, and the predominance of cross-sectional evidence. The observed gaps may reflect context-dependent service delivery misalignments involving communication, coordination, responsiveness, and patient jo","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating regulatory pathways for access to innovative medicines in Tunisia.","authors":"Sarah Zerei, Meriem Guettari, Mariem Ben Toumia, Nour El Houda Ben Fatma, Soumaya Miled, Dora Cherif","doi":"10.1093/intqhc/mzag046","DOIUrl":"10.1093/intqhc/mzag046","url":null,"abstract":"<p><strong>Background: </strong>Recent years have witnessed a surge in the launch of breakthrough therapies, offering new hope to patients with severe or life-threatening conditions. However, access to these innovative medicines (IM) is often hindered by complex regulatory frameworks. This study aims to explore the regulatory environment shaping access to IM in Tunisia.</p><p><strong>Methods: </strong>A retrospective observational study was conducted using national data from January 2005 to December 2022, including all marketing authorization (MA) applications for human medicines. IM were defined according to the U.S. Food and Drug Administration (FDA) criteria. Data were extracted from the SIAMED® software managed by the Directorate of Pharmacy and Medicine (DPM).</p><p><strong>Results: </strong>A total of 8,377 MA applications were submitted, of which 424 (corresponding to 76 molecules) were classified as innovative. Oncology, including hematologic cancers, accounted for 83% of IM submissions. The average MA processing time was 1,169 days for IM (range: 38-3624) versus 650 days for non-innovative medicines (NIM). While 80% of IM were imported, 59% of NIM were locally manufactured. The number of IM applications increased twentyfold, from 34 in 2005-2010 to 300 in 2016-2022. MA approvals rose from 15 (2005-2010) to 74 (2016-2022). Between 2015 and 2021, IM accounted for approximately 10% of the national pharmaceutical budget. Additionally, 26 IMs were included in access program contracts, primarily for cancer, rheumatology, and multiple sclerosis.</p><p><strong>Conclusion: </strong>This study highlights the evolving regulatory landscape for IM in Tunisia. The growing number of applications signals a shift toward improved access, but further regulatory reforms are needed to accelerate patient access to innovation.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147648682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty, depression, and quality of life in acute care for elderly: a serial mediation and moderated mediation study in Taiwan.","authors":"Chau-Nee Chen, Tzu-Jung Fang, Cheng-Fang Hsieh, Chun-Chang Chen, Yu-Fu Chen, Hong-Yaw Chen, Pin-Yu Lai, Yu-Han Lu, Hon-Yi Shi","doi":"10.1093/intqhc/mzag122","DOIUrl":"10.1093/intqhc/mzag122","url":null,"abstract":"<p><strong>Background: </strong>Although the acute care for the elderly (ACE) model has been studied in relation to activities of daily living (ADL), depressive symptoms, and quality of life, the pathways linking frailty with post-discharge quality of life remain insufficiently understood. This study examined whether ADL and depressive symptoms sequentially mediated the association between frailty and quality of life among elderly patients receiving acute care.</p><p><strong>Methods: </strong>This retrospective cohort study with longitudinal follow-up included 11 231 elderly acute care patients from three large medical centers in Taiwan between 1 January 2020 and 30 June 2023. Frailty, ADL, depressive symptoms, and quality of life were assessed at admission and 1 year after discharge using the Clinical Frailty Scale, ADL scale, Geriatric Depression Scale, and EuroQol-5D, three-level questionnaire. Serial mediation and moderated mediation analyses were conducted using the PROCESS macro in SPSS version 23.0.</p><p><strong>Results: </strong>One-year ADL and depressive symptoms sequentially mediated the association between admission frailty and 1-year quality of life (indirect effect = 0.131, 95% confidence interval 0.038-0.231). Frailty scores significantly decreased, and ADL scores improved from admission to 1 year after discharge (P < .05). Moderated mediation analyses showed that body mass index, Charlson comorbidity index, alcohol use, nasogastric tube placement, and nutritional status modified specific mediation pathways (P < .001).</p><p><strong>Conclusion: </strong>Frailty among elderly patients receiving acute care was associated with post-discharge quality of life through pathways involving ADL and depressive symptoms. It supports comprehensive assessment and early post-discharge interventions targeting functional and psychological well-being, while recognizing that causal relationships cannot be established from observational data.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Also a feeling-how frontline health care professionals construct patient safety.","authors":"Axel Ros, Catarina Tingsvik, Johan Bergström","doi":"10.1093/intqhc/mzag085","DOIUrl":"10.1093/intqhc/mzag085","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing artificial intelligence to the front lines: PMcardio for detecting occlusive myocardial infarction in STEMI and STEMI-equivalent activations.","authors":"Mohamad Bahrou, Karthik Missula, Ted Amadi, Asad Cheema, Momin Siddique","doi":"10.1093/intqhc/mzag131","DOIUrl":"10.1093/intqhc/mzag131","url":null,"abstract":"","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148922507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient engagement and feasibility of a QR code-based digital information tool in the emergency department.","authors":"Akash Manes, Ivjot Samra, Ekaterina Fedosova, Joban Sran, Amir Behboudi","doi":"10.1093/intqhc/mzag100","DOIUrl":"10.1093/intqhc/mzag100","url":null,"abstract":"<p><strong>Background: </strong>Patients frequently seek guidance on non-urgent administrative and informational needs, such as sick notes, finding a family physician, and pharmacy access, during emergency department (ED) visits. Limited primary care availability contributes to these inquiries and may increase communication demands on clinical staff. This project aimed to assess the feasibility and patient engagement of a low-cost digital intervention using quick response (QR) codes.</p><p><strong>Methods: </strong>We conducted a prospective observational quality improvement study from June to December 2025 in a community ED. Twenty informational posters, containing four scannable QR codes, were placed in high-visibility public areas. Each QR code linked to a mobile-friendly resource: a virtual sick note, a tool to find a family doctor, directions to the nearest 24-hour pharmacy, and directions to the nearest pharmacy. Automated scan analytics were used to assess patient engagement and feasibility, defined by sustained use over time and absence of technical or workflow disruptions.</p><p><strong>Results: </strong>During the 6-month study period, the four QR codes were scanned 1,895 times. The virtual sick note (43.2%) and find a family doctor tool (30.3%) were the most frequently accessed resources, followed by the 24-hour pharmacy (20.4%) and local pharmacy (6.1%). Scan activity occurred daily throughout the study period, with no reported technical issues or disruptions to clinical workflow.</p><p><strong>Conclusion: </strong>QR code-based informational posters demonstrated consistent patient engagement and addressed common non-urgent informational needs without increasing staff workload. This low-cost, easily scalable digital tool was feasible to implement within routine ED operations and may support future patient-directed digital self-service initiatives.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148582089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring safer opioid use in hospitals: development of consensus-based safety and quality indicators-a modified Delphi study.","authors":"Abdullah Mutashar, Martin L Canning, Jodie Hillen, Magid Fahim, Nagham J Ailabouni, Christopher R Freeman","doi":"10.1093/intqhc/mzag112","DOIUrl":"10.1093/intqhc/mzag112","url":null,"abstract":"<p><strong>Background: </strong>A significant contributor to preventable medication-related harm is opioids. Within Australian hospitals, opioids have contributed to deaths, hospital admissions, and in-hospital related harm. Given these harms, there is a need to ensure opioids are used safely and that systems that support safe opioid use are in place and are effective. These should be monitored and when required, actions should be taken where a need for performance improvement is identified, or system change is warranted. Hence, the aim of this study was to develop a consensus-based suite of opioid-related safety and quality indicators (SQIs) that are evidence-informed, important and feasible for routine monitoring across an entire health service.</p><p><strong>Methods: </strong>A structured search of the academic and grey literature was undertaken to identify relevant SQIs. A 22-member hospital-based multidisciplinary clinical reference group (CRG) participated in a modified Delphi multi-round electronic survey. Participants rated the importance and feasibility of each SQI on a 9-point Likert scale. Between survey rounds, participants were provided with an individualized report and a virtual meeting was held to enable group discussion on views relating to non-consensus indicators. Consensus was defined as a median score rated as high (i.e. >6.5) and a lower interquartile range not <5.</p><p><strong>Results: </strong>In total, 121 articles were identified from the academic literature, seven within the grey literature and two procedures. After abstract and full-text review, nine articles/documents containing relevant SQIs were identified. There were 30 SQIs extracted and after rationalization, 23 SQIs were presented to participants. Survey round 1 participants proposed 11 additional indicators, resulting in a total of 34 indicators being considered by the CRG. There were 22 clinicians who expressed an interest in participating in the survey rounds and CRG meeting. Response rate for round 1 was 91% (n = 20), CRG meeting was 50% (n = 11) and survey round 2 was 77% (n = 17). In total, 17 indicators reached consensus for importance and feasibility.</p><p><strong>Conclusion: </strong>Consensus has been reached on 17 opioid-related SQIs which have been deemed important and feasible by a multidisciplinary CRG. Implementing these into practice will assist with monitoring and reporting of the effectiveness of opioid medication safety systems and identify improvement opportunities, ultimately enhancing patient safety.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The outcomes of Lean management in a large academic hospital in Finland in 2018-2023: a qualitative study.","authors":"Irmeli Hirvelä, Elina Reponen, Mervi Javanainen, Riikka Lämsä, Vesa Niskanen, Paulus Torkki","doi":"10.1093/intqhc/mzag079","DOIUrl":"10.1093/intqhc/mzag079","url":null,"abstract":"<p><strong>Background: </strong>Lean management (LM) has been implemented in healthcare organizations, promising efficient operations, rapid patient access to care, improved staff satisfaction, and lower costs. However, the use of LM is questioned because there is no strong evidence of its outcomes, so proof of long-term and organization-wide use is needed. The aim of the study is to increase understanding of the long-term effects of LM in healthcare.</p><p><strong>Methods: </strong>This is a case study done at the Helsinki University Hospital in Finland. A retrospective qualitative study was conducted in three sectors (A, B, and C) of the hospital. Fourteen healthcare leaders from three sectors participated in interviews by answering structured and open-ended questions. The interviews were used to evaluate the outcomes that are experienced by the leaders in the hospital setting over a 5-year period, and evaluate indicators that they used to assess these outcomes. The interviews were analyzed using qualitative and quantitative content analysis with ATLAS.ti analysis software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany).</p><p><strong>Results: </strong>The outcomes of LM can be grouped into three main categories (organization, patient, and staff) that are divided into six subcategories: experiential, care-related, work-related, economic, leadership and management, and image effects. The leaders experienced the greatest benefits on the organization level, as it enhanced the effectiveness of the organization's structure and operations, fostered continuous development, improved staff retention and attraction, and promoted patient-centredness. According to the leaders, the most important benefits for patients included improved access to care, better care flow, enhanced safety of care, and greater participation in improving operations. In addition, the leaders highlighted that the biggest benefits for staff were increased work satisfaction, work competence, work commitment, and ethical behaviour. We found that the use of LM also has disruptive and contradictory effects caused by the lack of organization-wide Lean commitment and structure, and the media have a bias towards negative portrayals of hospital efficiency.</p><p><strong>Conclusion: </strong>We found that six subcategories provide a comprehensive framework for qualitatively assessing organization-wide experienced outcomes of LM in the hospital. Our findings emphasize that the organization should be fully committed to the Lean method, and its structure should be clear so that the best benefits of LM can be achieved. We noticed that more qualitative LM research is needed to complement the Lean knowledge gained from quantitative research, develop more comprehensive and high-quality evaluation indicators, and increase evidence for its use in healthcare.</p>","PeriodicalId":520651,"journal":{"name":"International journal for quality in health care : journal of the International Society for Quality in Health Care","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13345745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}