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

{"title":"Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.","authors":"Georgia Bercades, Cecilia Vindrola-Padros, David Brealey, Isla Kuhn, Seo Yeon Yoon, Grainne Brady, John Welch, Katharina Kohler","doi":"10.1093/intqhc/mzag101","DOIUrl":"10.1093/intqhc/mzag101","url":null,"abstract":"<p><strong>Background: </strong>Hospital ward strain occurs when care demands exceed available staffing, beds, and resources, posing a significant threat to safe inpatient care. While emergency department and intensive care settings have been extensively studied, ward-level pressures have received less attention, particularly from the perspectives of patients and frontline staff. This review aimed to synthesize current evidence on how hospital ward strain is experienced by staff and patients, and its implications for care quality, safety, and workforce sustainability.</p><p><strong>Methods: </strong>A mixed methods systematic review was conducted on patient and staff perspectives on hospital ward strain. MEDLINE, CINAHL, PsycINFO, and HMIC were searched for empirical studies published from January 2000 to March 2025. Three reviewers screened titles and abstracts in pairs; full-text assessment was conducted by one reviewer with independent verification of a random 20% sample. The Mixed-Methods Appraisal Tool was used to assess methodological quality. Findings were analysed using Donabedian's Structure-Process-Outcome (SPO) model and Hollnagel's Resilience framework.</p><p><strong>Results: </strong>Of 9,943 studies identified, 16 observational and non-randomized studies met the inclusion criteria, representing diverse healthcare settings across multiple countries. Most studies (87.5%) focused exclusively on staff perspectives; only two included patient experiences. Structural pressures (inadequate staffing, bed capacity constraints) consistently led to process failures (care delays, missed care, coordination breakdowns), resulting in burnout, turnover, quality and safety trade-offs, and compromised patient safety. Ward resilience was mainly reactive: respond and monitor were evident, but anticipate and learn, were mostly absent. Patient acuity was inconsistently reported, limiting cross-study comparison.</p><p><strong>Conclusion: </strong>Ward strain is a systemic patient safety issue requiring structural solutions beyond staff resilience. Patient perspectives remain underrepresented and must be prioritized in future research. Policymakers should invest in anticipatory and learning resilience capacities through workforce planning, real-time monitoring, and formal learning mechanisms, to ensure sustainable, safe ward care.</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/PMC13455353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564472","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":"Assessing the quality of postnatal care in India: regional disparities, determinants, and insights from NFHS-5.","authors":"Mahashweta Chakrabarty","doi":"10.1093/intqhc/mzag115","DOIUrl":"10.1093/intqhc/mzag115","url":null,"abstract":"<p><strong>Background: </strong>Postnatal care (PNC) is essential for reducing maternal and neonatal morbidity and mortality, especially in countries like India, where healthcare inequities persist. This study investigates the use and determinants of quality postnatal care (QPNC) in India, using Andersen's Behavioral Model of Health Services Utilization. QPNC in this study refers to the receipt of recommended skilled, timely, and appropriate PNC components.</p><p><strong>Methods: </strong>The study used data from the National Family Health Survey (NFHS)-5, comprising 163893 mother-newborn pairs. QPNC was operationalized using three dimensions: skilled care by qualified providers, timely first postnatal check-up within 24 hours, and receipt of essential postnatal interventions (e.g., cord examination, breastfeeding counselling, and other essential interventions). Multivariable logistic regression was applied to identify determinants of QPNC uptake, and secondary analyses examined determinants of each individual QPNC dimension.</p><p><strong>Results: </strong>Only 49.8% of mother-newborn dyads received complete QPNC. Although 77.8% of mothers and 82.1% of newborns received timely postnatal check-ups, substantial gaps remained in essential care components such as cord examination (73.5%) and counselling on newborn danger signs (73.3%). Marked geographic disparities were observed, with Tamil Nadu (82.7%) and Andhra Pradesh (71.9%) reporting high QPNC utilization, whereas Nagaland (<9%), Bihar, Uttar Pradesh, and several northeastern states performed poorly. At the district level, 46 districts reported QPNC below 20%, mainly in Bihar and Nagaland. QPNC utilization was comparatively higher in private facilities and higher-tier public institutions. Maternal education (AOR = 1.08), wealth status (AOR = 1.20), health insurance (AOR = 1.24), media exposure (AOR = 1.25), ≥4 antenatal care visits (AOR = 1.79), and institutional delivery (AOR = 17.71) increased the likelihood of receiving QPNC. Larger household size (AOR = 0.93), healthcare access barriers (AOR = 0.92), and caesarean delivery were associated with lower QPNC utilization, while vaginal delivery was associated with higher odds of QPNC compared with caesarean delivery (AOR = 1.18).</p><p><strong>Conclusion: </strong>Substantial socioeconomic, institutional, and geographic disparities persist in QPNC utilization across India. Improving continuity and completeness of PNC requires strengthening maternal education, financial protection, healthcare infrastructure, and counselling support, particularly in underserved regions. Targeted district-level and facility-level interventions are essential to improve maternal and newborn health outcomes.</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":"148805371","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":"Improving stroke care and outcomes through AHA/ASA primary stroke certification: a pre-post study in Jordan.","authors":"Mohammad R Alosta, Elham H Othman, Tareq Afaneh, Fawzi Al-Hammouri, Sahar Al-Masri, Taher Janbek, Murad Rasheed, Hamzeh Odeh, Mohammad Azzouqa, Mohammad Alhammouri, Aseel Al-Najar, Loay Sahawneh, Farah Al-Qtaishat, Suha Al-Beshawi, Tasneem Alamoush, Julia Mora, Rami Khattar, Khaled Shkair, Mohammad Al-Mzayen","doi":"10.1093/intqhc/mzag088","DOIUrl":"10.1093/intqhc/mzag088","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke remains a major cause of disability and death worldwide. Delays in intervening in the early stages generally lead to longer recovery and negative functional outcomes. Stroke certification standards and evidence-based stroke guidelines, including those advocated by the American Heart Association/American Stroke Association (AHA/ASA), have led to significantly better stroke care and outcomes. However, their use is less applied in middle-income countries such as Jordan. Therefore, this study was conducted to examine the impact of implementing the AHA/ASA primary stroke certification standards on the delivery of stroke care services and patient outcomes in one private accredited hospital in Jordan.</p><p><strong>Methods: </strong>A quasi-experimental pre-post design with non-equivalent groups was used. The study sample included 62 stroke patients, 31 before and 31 after the hospital's certification. Key performance indicators (KPIs) for stroke care, such as timeliness of interventions, in-hospital care quality, secondary prevention, educational programs, early rehabilitation, and clinical outcomes, were compared among the groups using independent-samples t-tests and Chi-square tests.</p><p><strong>Results: </strong>Implementing certificate standards was associated with improvements across most care indicators. The mean time to CT scan decreased from 29.5 to 14.1 min, and the average time to CT report decreased by 68.3 min. The IV tPA administration for eligible patients with acute ischemic stroke arriving within 4.5 h from symptoms rose from 54.2% to 81.5%. The rate of early rehabilitation initiation increased from 48.4% to 93.5%, and the rate of providing educational materials to patients increased from 9.7% to 90.3%. Patients who achieved good functional outcome at 3 months improved significantly from 29% to 71% (P < .001), with no 30-day readmissions.</p><p><strong>Conclusion: </strong>Following the implementation of AHA/ASA primary stroke certification standards, we noticed improvements in the process and outcome of care in a small cohort of patients. Findings indicate the success of applying universal stroke protocol in resource-limited contexts and facilitate the scaling up of interventions in Jordanian hospitals to support timely, integrated, and evidence-based stroke care, which may have the potential to reduce costs and ensure sustainable long-term outcomes.</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":"148280794","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":"Observed quality of intrapartum care in Dire Dawa Administration, Eastern Ethiopia.","authors":"Moti Tolera Jalu, Yadeta Dessie, Tsinuel Girma, Margaret E Kruk, Bereket Yakob","doi":"10.1093/intqhc/mzag121","DOIUrl":"10.1093/intqhc/mzag121","url":null,"abstract":"<p><strong>Background: </strong>High-quality intrapartum care is essential for preventing avoidable maternal and neonatal morbidity and mortality. Although facility birth has expanded in Ethiopia, less is known about the observed content of care delivered during labour, birth, and the immediate postpartum period in the Dire Dawa Administration.</p><p><strong>Methods: </strong>This secondary cross-sectional analysis used direct-observation and provider-survey data from a parent facility-based maternity care study conducted in nine public health facilities in Dire Dawa Administration, Ethiopia. The facilities comprised two hospitals, five urban health centres, and two rural health centres. Eligible women undergoing spontaneous vaginal birth were observed continuously from admission through childbirth and up to 6 hours postpartum or discharge. A total of 811 observations and data from 84 intrapartum care providers were analyzed. The observed quality of intrapartum care was measured with a structured 28-item checklist adapted from MCHiP/SMGL tools and WHO recommendations. Multilevel linear regression was used because observations were hierarchically clustered within providers and facilities.</p><p><strong>Results: </strong>The mean observed intrapartum-care quality index was 48% (SD 29). Quality varied by stage of care: initial assessment 45%, first stage of labour 56%, second stage 26%, third stage 65%, immediate neonatal care 35%, and early maternal postpartum care 42%. In adjusted analysis, health centres scored higher than hospitals [β = 5.50; 95% confidence interval (CI): 4.30-6.70], while rural facilities scored lower than urban facilities (β = -3.47; 95% CI: -5.49 to -1.44). Provider in-service training was positively associated with quality (β = 0.84; 95% CI: 0.34-1.34), whereas emergency or complication care was negatively associated with quality (β = -2.89; 95% CI: -4.42 to -1.36).</p><p><strong>Conclusion: </strong>Observed intrapartum care in public facilities in Dire Dawa Administration showed substantial quality gaps, particularly during the second stage of labour and immediate newborn and early postpartum care. The findings highlight uneven adherence to recommended clinical actions across facility type, facility location and care context.</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":"148851841","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":"Psychological safety is a quality-of-care issue, not merely a workforce wellbeing concern.","authors":"Raup Padillah, Stevi Becher Sengkey, Tellma Mona Tiwa, Marssel Michael Sengkey, Tesalonika Pondalos","doi":"10.1093/intqhc/mzag084","DOIUrl":"10.1093/intqhc/mzag084","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":"148255508","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 four main domains of the concept of return-on-investment from healthcare quality improvement programmes.","authors":"S'thembile Thusini, Tayana Soukup, Claire Henderson","doi":"10.1093/intqhc/mzag089","DOIUrl":"10.1093/intqhc/mzag089","url":null,"abstract":"<p><strong>Background: </strong>This paper synthesizes a series of four studies in the exploration of the concept of Return on Investment (ROI) in relation to healthcare Quality Improvement (QI) programmes (QI-ROI).</p><p><strong>Methods: </strong>We followed a multi-stage mixed-methods integration approach where four studies were first conducted and reported separately. The four study designs were linked to enable us to build a cohesive understanding of QI-ROI. Collective findings were then analysed and interpreted to identify the main QI-ROI concept domains. Two studies were based on an extensive global interdisciplinary systematic literature review N = 68; one a qualitative study N = 16, and last, a Delphi study N = 23. For the latter two studies, participants were from the UK National Health Service and included 24 board members, 15 service and clinical directors, and QI leaders.</p><p><strong>Results: </strong>Several benefits were seen to represent ROI from QI programmes. These encompassed internal (e.g. development) and external (e.g. service user socio-economic benefits), intervention outcomes (e.g. clinical benefits) and implementation outcomes (e.g. spread). Further, the benefits included lessons from 'failed' QI programmes. Together, these benefits encompass monetary and non-monetary value of QI along a programme's journey. We view these benefits as four main domains: development, improvement, savings, and sustainability or DISS.</p><p><strong>Conclusion: </strong>QI has several organizational and health system benefits contained within the DISS construct. These benefits support various organizational goals such as quality improvement, organizational development, performance and resilience. We posit that the collective findings are applicable to many organizations that provide interdisciplinary healthcare services globally.</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/PMC13342709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280714","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":"Learning from scale-up: a qualitative study of scaling-up interventions for people with multiple long-term conditions in primary care.","authors":"Sarah Chew, Natalie Armstrong, Gregory Maniatopoulos, Neil Perkins, Kamlesh Khunti, Richard Baker, Ash Routen, Janet Willars, Carolyn Tarrant","doi":"10.1093/intqhc/mzag117","DOIUrl":"10.1093/intqhc/mzag117","url":null,"abstract":"<p><strong>Background: </strong>Scaling innovations for people living with multiple long-term conditions (MLTCs or multimorbidity) remains challenging, particularly in primary care, where organisational capacity, infrastructure, and local contexts vary widely. There is limited empirical understanding of the implementation work needed to navigate these contextual influences when scaling complex innovations across diverse settings. This study aimed to identify and explain the contextual conditions and adaptive implementation strategies that enabled or constrained scale-up of interventions for people with MLTCs in English primary care.</p><p><strong>Methods: </strong>We conducted a theory-informed qualitative evaluation of four national projects that aimed to scale evidence-based interventions to improve the care of people with MLTCs in primary care. Projects ran between 2021 and 2024. Data included longitudinal interviews with project teams, document analysis, and a stakeholder workshop. Analysis was informed by the Consolidated Framework for Implementation Research.</p><p><strong>Results: </strong>Four key themes were identified: (1) scaling requires relational infrastructure: relationships, trust, and relational continuity were central to gaining traction; (2) supporting organizations and networks facilitate spread; (3) engaging primary care practices depends on addressing uneven readiness for research and innovation; and (4) local intelligence supports implementation at scale.</p><p><strong>Conclusion: </strong>Scaling MLTC innovations in primary care is shaped by relational, organisational, and infrastructural factors, including uneven readiness for implementation. Scaling proven interventions requires technical support and investment in the people, relationships, and local infrastructures that support embedding across diverse primary care contexts.</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/PMC13552373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148804338","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":"Patient and family activated escalation systems: a systematic review.","authors":"Noémie Déom, John Welch, Cecilia Vindrola-Padros","doi":"10.1093/intqhc/mzag093","DOIUrl":"10.1093/intqhc/mzag093","url":null,"abstract":"<p><strong>Background: </strong>Patient and family activated escalation systems (PFAES) enable patients and families to escalate concerns about in-hospital deterioration and trigger urgent clinical review when standard escalation routes fail. Given limitations of prior reviews and the rollout of Martha's Rule in England, this systematic review synthesized evidence on PFAES up to 2025, including system types, implementation, stakeholder experiences, sustainability, and equity.</p><p><strong>Methods: </strong>The protocol was registered on PROSPERO (CRD420250651441) and reporting followed Preferred Reporting Items for Systematic reviews and Meta-Analyses. The databases MEDLINE, Embase, Scopus, CINAHL, and Web of Science were searched (June 2025), with expert input and backward citation searching. Screening was undertaken in Rayyan. Studies reporting empirical data on hospital-based PFAES were included and appraised for quality using the Mixed-Methods Appraisal Tool. Findings were synthesized narratively.</p><p><strong>Results: </strong>Searches initially identified 6129 papers. Thirty-five studies met the inclusion criteria. PFAES clustered into two activation routes: direct-to-response team models and proxy activation embedded in ward routines. Low awareness (16/35) and limited understanding (15/35) among patients and families were frequently reported and were linked to limited visibility, reliance on written materials, and inconsistent staff explanations under workload pressure. Patients and families commonly described anxiety about speaking up and fear of harming relationships with staff, alongside a preference for healthcare professionals-led escalation due to concerns about bypassing them, viewing activations as outside their patient role, or simply trusting their care team to perceive and escalate deteriorations. Sustainability was associated with governance support, champions, and ongoing promotion, while equity was inconsistently addressed despite language and communication barriers being recurrent.</p><p><strong>Conclusions: </strong>While only published studies were included in this review, its broader scope and up-to-date coverage identified additional studies and defined two activation models. Direct-to-response team escalation can be a safety net to interprofessional communication failures but often feels too risky or confrontational for patients and families to use. Proxy escalation appears more acceptable yet depends on traditional staff escalation systems, for which direct-to-response team PFAES models are a safeguard. Future research should examine stakeholder perceptions where both routes operate concurrently, such as Martha's Rule, and determine the organizational conditions that support effective implementation. Implementations should embed equity and cultural safety to ensure vulnerable groups can access and use PFAES.</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/PMC13458593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414662","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":"Assessing the real-world value of hemophilia care: how suitable are patient-centered outcomes for hospital-level comparisons?","authors":"Diaz M Prameyllawati, Samantha C Gouw, Hester F Lingsma, Marjon H Cnossen, Floor C J I Heubel-Moenen, Frank W G Leebeek, Nick van Es, Johanna G van der Bom, Renske M T Ten Ham, Martijn A H Oude Voshaar","doi":"10.1093/intqhc/mzag105","DOIUrl":"10.1093/intqhc/mzag105","url":null,"abstract":"<p><strong>Background: </strong>Hospital-level comparisons of patient-centered outcomes play a central role in value-based healthcare. In hemophilia care, several standardized sets of patient-centered outcomes have been developed to foster the implementation of value-based healthcare; however, their suitability for hospital-level comparisons has not yet been assessed. Therefore, we evaluated the suitability of patient-centered outcomes for hospital-level comparisons in hemophilia care.</p><p><strong>Methods: </strong>We analyzed data from 807 adults with hemophilia enrolled in the 2019 HiN-6 study in the Netherlands. Twelve patient-centered outcomes were assessed. The suitability of these outcomes for hospital comparisons was evaluated using two criteria: (i) sensitivity to case mix, evaluated by Spearman's rank correlation between case-mix-adjusted and case-mix-unadjusted hospital-level scores and (ii) reliability of between-hospital differences, determined by rankability defined as the proportion of between-hospital variation not attributable to chance. High correlations indicate a minimal case-mix influence, while a high rankability reflects a high degree of reliability.</p><p><strong>Results: </strong>Most patient-centered outcomes were relatively insensitive to case mix (ρ > 0.70). Reliability of hospital differences was generally low (rankability <0.50). Only the annual bleeding rate and annual joint bleeding rate demonstrated moderate reliability with a rankability of 0.55 and 0.58, respectively.</p><p><strong>Conclusion: </strong>Most patient-centered outcomes assessed were not suitable for comparing hemophilia care at the hospital level because of low reliability. Among the outcomes evaluated, the annual bleeding rate and annual joint bleeding rate appeared relatively more suitable for such comparisons.</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/PMC13495108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671968","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":"Peer accountability in patient safety: an under-examined determinant of team performance.","authors":"Marcos Martínez","doi":"10.1093/intqhc/mzag134","DOIUrl":"10.1093/intqhc/mzag134","url":null,"abstract":"<p><strong>Background: </strong>Patient safety has been pursued largely through systems, protocols, and checklists, yet preventable harm remains common and effective interventions are often difficult to sustain or transfer between settings. A consistent observation is that the same intervention succeeds in one unit and fails in another, the difference lying less in the tool than in how the team functions. This review argues that an under-examined determinant of that difference is peer accountability: the lateral, reciprocal responsibility of team members to uphold shared standards and address departures from them. Distinct from vertical, blame-based accountability and related to but not identical with psychological safety and relational coordination, it is treated here as an integrative facet of team functioning rather than a wholly new construct.</p><p><strong>Methods: </strong>This is a narrative, non-systematic review. Literature in organizational science, human factors, team sport, and patient safety was identified through purposive searching of PubMed, Scopus, and Google Scholar up to 2025, with citation tracking; material was selected to develop the central argument rather than to provide exhaustive coverage.</p><p><strong>Results: </strong>Across several fields, the maintenance of shared standards by peers is associated with team performance, illustrated by analogy rather than direct evidence by small-group cohesion research and peer leadership in team sport. In healthcare, the same principle underlies crew resource management, the independent check, speaking-up behaviour, and high-reliability organizing. Two factors suppress peer accountability: steep authority gradients and a misreading of just culture as the absence of accountability. Acting earlier than disciplinary processes, peer accountability can interrupt the gradual normalization of unsafe practice, which neither punitive blame nor an undifferentiated no-blame stance prevents.</p><p><strong>Conclusion: </strong>Peer accountability complements rather than competes with systems thinking. Any hospital service can strengthen it through small, stable, mutually visible teams; institutionalized independent checking; a reduced gradient for raising concerns; and a just culture that retains individual and shared responsibility. These organizational rather than technological measures require explicit measurement and study before they can be recommended as established practice.</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":"148946526","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}