BMJ Open Quality最新文献

{"title":"Safe and effective genomic medicine implementation in hospitals: a scoping review.","authors":"Luisa Clucas, Cate Kelly, Trang Thu Do, Inez Beadell, Belinda Dawson-McClaren, Clara L Gaff","doi":"10.1136/bmjoq-2025-003359","DOIUrl":"10.1136/bmjoq-2025-003359","url":null,"abstract":"<p><strong>Background: </strong>Genomic medicine is rapidly changing routine clinical care in a range of specialties. Effective clinical governance is essential for safe implementation of emerging clinical practice, including genomic medicine. Frameworks exist for national implementation of genomics but lack the granularity needed by hospitals to guide local implementation of national policy.We aimed to identify if a framework suitable to support the safe, effective implementation and use of genomic medicine at a hospital level exists.</p><p><strong>Methods: </strong>A systematic search using scoping review methodology was performed, searching three databases (Medline, Embase and PubMed), from 2009 to 2022, to identify structured approaches to the clinical governance of genomics at a meso (hospital/hospital consortia) level.</p><p><strong>Results: </strong>No frameworks were identified that provided a holistic clinical governance approach to hospital-level implementation of genomics. Eight publications included components relevant to the implementation of genomics. While the clinical governance components included in the eight publications varied, all identified one or more of the following as important to effective implementation: optimal leadership of genomic care; ensuring an effective workforce; ensuring safe, effective clinical practice; the importance of quality metrics and the criticality of consumer partnerships. No publication explicitly discussed risk management, but all identified processes which would serve to minimise risk.</p><p><strong>Conclusions: </strong>Institutional-level change is essential for the implementation of genomic medicine throughout a health system. Yet, there is a lack of evidence-based frameworks to support integrated clinical governance of genomic medicine and its implementation by hospitals and their executive leaders. Our results can contribute to the design of an approach which supports hospital planning and decision-making by integrating all elements of clinical governance. Without this, implementation will be piecemeal, access to genomic medicine across a health system inequitable, and patients may receive inefficient, ineffective, slow and potentially unsafe care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124206","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":"Improving the detection and documentation of suspected cauda equina syndrome: a quality improvement project.","authors":"Maiar Elhariry, Tahir Khaleeq, Rachna Prem, Kanthan Theivendran","doi":"10.1136/bmjoq-2025-003450","DOIUrl":"10.1136/bmjoq-2025-003450","url":null,"abstract":"<p><strong>Background: </strong>Cauda equina syndrome (CES) is a rare but critical neurological emergency. Prompt diagnosis and accurate documentation are essential to avoid permanent neurological impairment. This quality improvement project aimed to improve the accuracy and completeness of neurological examination documentation for patients presenting with suspected CES.</p><p><strong>Methods: </strong>Using three Plan-Do-Study-Act (PDSA) cycles, a digitally prompted documentation tool '#CES' was developed and implemented in the electronic patient record system. The tool was designed in alignment with the 2019 GIRFT Spine Report and 2023 GIRFT National CES Pathway. It included red flag symptoms and neurological assessment criteria from the ASIA classification. A teaching session on its use was delivered in January before the second data collection period (19 September 2024-20 October 2024), and it was later incorporated into resident doctor induction in December before the third data collection period (5 January 2025-5 February 2025).</p><p><strong>Results: </strong>In the initial cycle (May-August 2024), documentation was inconsistent, particularly for sensory (0%) and reflex (4.9%) examination. Following implementation and a teaching session (September 2024), documentation improved in the second cycle (September-October 2024): sensation (81.3%), reflexes (57.1%), though tone and motor documentation declined. In the third cycle (January-February 2025), full template use rose to 80% (from 25%) and documentation further improved: sensation (94.1%), motor (64.7%), reflexes (64.7%), tone (64.7%), vascular (58.8%).</p><p><strong>Conclusions: </strong>A CES-specific, digitally prompted template significantly improved documentation quality. Integration of GIRFT red flags, clinician codesign and repeated education enhanced uptake and accuracy. Further PDSA cycles will focus on sustainability, time-to-diagnosis metrics and addressing clinician workload concerns.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12458717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091090","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":"Decreasing blood culture contamination rates in a rural emergency department: a quality improvement initiative.","authors":"Priya Patel, Maria Johnson, Ashley Ayers, Makayla Ayres, Megan Andersen, Kathleen Spears, Scott Folk","doi":"10.1136/bmjoq-2024-003144","DOIUrl":"10.1136/bmjoq-2024-003144","url":null,"abstract":"<p><p>Blood culture contamination rates have been consistently above the national benchmark of 3% in the emergency department (ED) at Mosaic Life Care in St. Joseph, Missouri, USA. Contaminations contribute to negative patient outcomes including unnecessary antibiotic exposure, antibiotic resistance, prolonged hospital stays and delayed treatment plans. Reducing contamination rates is imperative to improving outcomes for both patients and the hospital. This study aimed to decrease blood culture contamination rates at a single, rural hospital institution in 7 months. Quality improvement frameworks guided the construction and implementation of the various countermeasures. Analysis of contamination data was conducted monthly and visualised in a run chart. Contamination rates decreased from 4.42%-3.51% (p<0.002) between September 2023 and October 2023 with Countermeasure 1. Rates fell to 2.9% in January 2024 through implementation of Countermeasure 2. Rates rose briefly to 3.5% in March 2024 but decreased to 2.8% in May 2024 following implementation of Countermeasure 3. Blood culture contamination rates in the ED declined significantly by increasing caregiver awareness via strategic environmental signage and renovating orientation education. The sustainability of this progress requires continued efforts. Maintenance of contamination rates below the national benchmark is targeted with continuous collaboration between clinical partners. This initiative demonstrated the importance of interdepartmental collaboration and communication with all stakeholders involved in quality improvement measures.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079678","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":"Evaluation of a tailored implementation strategy for audit-generated improvements in perinatal care.","authors":"Ien van der Woerdt-Eltink, Andrea Drost, Gera Welker, Ageeth Rosman, Jan Jaap Erwich, Esteriek de Miranda","doi":"10.1136/bmjoq-2025-003421","DOIUrl":"10.1136/bmjoq-2025-003421","url":null,"abstract":"<p><strong>Background: </strong>Perinatal audit identifies substandard factors in perinatal care for quality improvement of care. However, not all identified improvement objectives achieve effective implementation. The ACTion method, using a 7-step Plan-Do-Check-Act cycle, was developed for local perinatal care professionals to enhance tailored implementation by interactive learning, training and coaching of implementation and behaviour change principles.This study aimed to evaluate the efficacy of the ACTion method within all perinatal cooperation groups (PCGs) in the northern region of the Netherlands.</p><p><strong>Methods: </strong>A mixed-methods design was used for effect and process evaluation. Descriptive and inferential statistical methods were applied to analyse participants' knowledge; skills; motivation; and the number, nature and implementation stage of improvement objectives. Additionally, influencing factors were examined through inductive thematic analysis.</p><p><strong>Results: </strong>A multidisciplinary ACTion team was formed in all 11 PCGs. From the initially 93 participating ACTion team members, 86% completed the full training.Knowledge and skills after implementation of the ACTion method improved significantly, with mean scores increasing from 2.53 to 3.70 on a 1-5 Likert scale (p<0.001, r=0.9). ACTion teams addressed 3-19 improvement objectives, with implementation ranging from 14% to 67%, depending on time of start of the project and influencing factors. In total, 98 improvement objectives were addressed, of which 46 (47%) were fully implemented and secured. As emerged from interviews, a proactive key person and ongoing coaching during the follow-up phase were instrumental in driving these efforts. The multidisciplinary approach and collaborative efforts in regional obstetric care enhanced mutual understanding and cooperation across disciplines. Impeding factors included limited time, manpower and lack of commitment within the PCG.</p><p><strong>Conclusion: </strong>A locally tailored approach, involving interactive learning, training and coaching in the ACTion method, provides a valuable framework for implementing audit-driven improvement objectives in maternal and perinatal care, while simultaneously fostering interprofessional cooperation.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079734","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":"Enhancing senior physician-led multidisciplinary team rounds to improve patient care at Wallaga University Comprehensive Specialized Hospital, 2025.","authors":"Gedefa Bayisa, Dechassa Edessa, Meskerem Deyasa, Ganna Gobena, Dereje Obsa, Temesgen Tilahun, Tesfaye Shibiru, Amsalu Takele, Chala Abera, Etenat Tigabe","doi":"10.1136/bmjoq-2025-003429","DOIUrl":"10.1136/bmjoq-2025-003429","url":null,"abstract":"<p><strong>Background: </strong>The healthcare system is facing challenges due to insufficient multidisciplinary collaboration, leading to gaps in treatment, compromised patient safety and increased medical errors. Poor communication can cause misunderstandings, delays in critical decisions and cost escalation. Implementing multidisciplinary team (MDT) rounds, led by a senior physician, can improve communication, streamline decision-making and improve patient care.</p><p><strong>Methods: </strong>A multidimensional interventional study was conducted to address the identified problem. A fishbone diagram was used to identify the root causes of the problem. A driver diagram was developed to outline the key drivers and change concepts necessary for achieving the desired outcomes. Plan-Do-Study-Act cycles were implemented to test and refine interventions systematically.</p><p><strong>Intervention: </strong>A daily dashboard-based performance audit was implemented, which includes the status of MDT rounds recorded by unit heads and analysed by the Hospital SBFR Taskforce team. Both morning and evening round statuses from various service units are collected for review of the data and communication with department heads prior to morning sessions. The report is shared in a common Telegram group for accessibility among hospital leaders. Each service unit engages in discussions with their MDT every Friday, while a weekly SBFR forum takes place every Tuesday, attended by directors and representatives from service units to review weekly performance. On-site MDT supportive supervision is conducted as needed.</p><p><strong>Results: </strong>Senior physician engagement has significantly improved overall, as evidenced by the average score rising from 49% to 81%. Furthermore, 94% of participants agreed that senior-led MDT rounds were good for teamwork, professional development and discussion quality. Additionally, improvements in patient outcomes and decision-making were acknowledged by 80% of respondents and 97% of participants, respectively.</p><p><strong>Conclusions: </strong>The study indicates that senior-led MDT rounds enhance discussion quality, team collaboration, decision-making, patient outcomes and professional growth. To maintain MDT rounds, daily performance audits, clinical audits and continuous monitoring using common communication platforms are recommended.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079751","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":"Communication among health professionals using newborn technology for care: an exploratory scoping review.","authors":"Gloria Karungo Ngaiza, Dorothy Oluoch, Catherine Molyneux, Catherine Pope, Caroline Jones","doi":"10.1136/bmjoq-2025-003501","DOIUrl":"10.1136/bmjoq-2025-003501","url":null,"abstract":"<p><p>Neonatal technologies can significantly improve care quality and reduce newborn deaths. However, their successful implementation in complex health system contexts requires effective communication among health professionals. A comprehensive understanding of communication among professionals using newborn technologies is needed to inform technology implementation. We conducted a scoping review of the current literature. We searched the grey literature and online resources, including PubMed, Web of Science, Scopus, Embase, Cochrane Library and Google Scholar, for articles. We included English literature that discussed the use of technology in newborn care. 13 papers met the inclusion criteria. We analysed the findings using a thematic approach. 11 of the 13 papers included were based on research conducted in low-income and middle-income countries (LMICs), with continuous positive airway pressure being the most frequently covered technology. The communication information was limited, as these topics were just one of many themes in the papers. Most studies focused on nurses, encompassing aspects of communication such as knowledge sharing and interactions during patient management, monitoring and documentation. However, there was little detail on the nature of these interactions or where they occurred. Factors influencing communication included physical contexts such as infrastructure, socio-organisational contexts such as hierarchy and levels of skills, and technology-related factors such as perceived usefulness and ease of use. If and how these factors interacted with each other to shape technology-related communication was unclear. We highlight gaps in the literature on communication among health professionals using newborn technology for care. We stress the importance of carefully examining the physical and socio-organisational contextual factors and technology-specific attributes that shape communication in all settings, including LMICs. Research aiming to better understand the context of technology implementation will support the successful implementation of potentially life-saving technologies.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079759","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":"Self-harm and Violence Presenting to Emergency Care Registry (SAVER) project: protocol for a mixed-methods study.","authors":"Emily Bebbington, Anne Krayer, Abigail Lea, Alberto Salmoiraghi, Claire Cotter, Deborah Job, Gemma Hobson, Geraint Farr, Gwennan Charlton, Jane Moore, Limssy Varghese, Meinir Evans, Ned Hartfiel, Non Evans, Rebecca Masters, Rhiannon Tudor Edwards, Robert Atenstaedt, Rob Poole, Rosalind Reilly, Catherine Robinson","doi":"10.1136/bmjoq-2025-003463","DOIUrl":"10.1136/bmjoq-2025-003463","url":null,"abstract":"<p><strong>Introduction: </strong>Intentional injuries can be broadly classified into those that are self-inflicted (eg, suicide, self-harm), and those that are inflicted by others (eg, homicide, assault). Many risk factors are the same for all intentional injuries. It is widely accepted that there needs to be a public health approach to self-harm and interpersonal violence prevention, including surveillance of presentations to emergency departments. Self-harm and interpersonal violence are important causes of morbidity and mortality in Wales. Interpersonal violence surveillance is already operationalised in Wales, but variables are limited and case ascertainment may not be complete. There is no self-harm register. The aim of this study is to understand the utility of existing systems in North Wales that collect data about self-harm and interpersonal violence, and how a registry could be implemented to address any unmet needs.</p><p><strong>Methods and analysis: </strong>The project consists of five work packages. First, process mapping will be used to understand the pathways by which patients access emergency care, and how data are collected about patients. Second, routinely collected data will be explored to understand the burden of disease, and the strengths and limitations of existing data collection systems. Third, semi-structured interviews will be completed with stakeholders to understand their needs and experiences. Fourth, semi-structured interviews with third sector organisations which work with people with lived experience of self-harm or interpersonal violence will explore the acceptability of data collection. Fifth, a method will be developed that would enable economic evaluation of a self-harm and interpersonal violence register.</p><p><strong>Ethics and dissemination: </strong>Results will be used to understand whether a self-harm and interpersonal violence registry is required in Wales. The results have the potential to influence local and national strategy on intentional injury prevention. Results will be disseminated to local services, regional and national programme teams, and published as a peer-reviewed journal article.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069019","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":"Informed consent: is it more than a formality? a quality improvement project in surgical practice.","authors":"Jawairia Altaf, Ahmed Hasan Ashfaq, Nida Riaz, Fatima Faraz","doi":"10.1136/bmjoq-2025-003523","DOIUrl":"10.1136/bmjoq-2025-003523","url":null,"abstract":"<p><p>Informed consent is a fundamental element of clinical practice. A well-structured and understandable consent form not only upholds patients' rights but also protects clinicians against medicolegal risks. This quality improvement project aimed to identify deficiencies in the consenting process for surgical procedures and implement changes to enhance patient care. The project was conducted in the Ear Nose Throat Department at Holy Family Hospital, Rawalpindi, a large tertiary care centre serving a predominantly low socioeconomic population in Pakistan. A total of 80 patients were included across two cycles (40 patients per cycle). Structured interviews and questionnaires were used to assess patient understanding of informed consent components. Key areas for improvement were identified. Educational sessions for doctors were organised and a new, detailed consent form was introduced. The project followed the Plan-Do-Study-Act methodology. Baseline measurements in cycle 1 showed that 15% (n=6) of consent forms were incomplete, reduced to 0% postintervention. A written explanation of the procedure was missing in 57.5% (n=23) of cases initially, improving to 10% (n=4) in cycle 2. Potential complications were not recorded in 37.5% (n=15) of cases at baseline, falling to 10% (n=4) after intervention. Verbal explanation of the procedure was omitted in 32.5% (n=13) of cases initially, reduced to 5% (n=2) postintervention. Documentation of the right to withdraw was absent in 12.5% (n=5) of cases in cycle 1, with full compliance achieved in cycle 2. This project demonstrates that targeted educational interventions and structured consent documentation can significantly improve the quality of the consenting process, promoting safer and more patient-centred care.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145051811","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":"Impact of adding an airway safety prompt to the A-F bundle on unplanned extubation in the intensive care unit.","authors":"Maged Tanios, Huan Mark Nguyen, John W Devlin, Hyunsoon Park, Michael Tanios, Meera Lakshmi Mahidhara, Jay Patel, Sasanapirath Vong, Jeff Cupino, Mark Cordia, Antonio Beltran","doi":"10.1136/bmjoq-2024-003196","DOIUrl":"10.1136/bmjoq-2024-003196","url":null,"abstract":"<p><strong>Objective: </strong>Endotracheal intubation is a life-saving intervention for adults with acute respiratory failure (ARF) but may result in unplanned extubation (UE). The success of UE prevention efforts has varied. We describe the development, implementation and impact of an airway safety quality improvement programme (ASQIP) embedded in an existing ABCDEF (A-F) bundle on UE occurrence.</p><p><strong>Design: </strong>Before-and-after evaluation of an ASQIP.</p><p><strong>Setting: </strong>42-bed mixed intensive care unit (ICU) at a university-affiliated teaching hospital.</p><p><strong>Patients: </strong>Consecutive adult patients, endotracheally intubated for ARF.</p><p><strong>Intervention: </strong>The ASQIP, developed from a literature review, the results of a national clinician survey, local clinician focus group input and root cause analyses of prior UE events, included interprofessional rounding scripts and was embedded into an existing A-F bundle. Multiple implementation strategies were employed, including didactic education to all ICU nurses (registered nurse, RN) and respiratory care therapists (RTs), the daily posting of signs of the ASQIP on the doors of rooms with a patient deemed to be at high risk for UE, and daily reminders from managers to bedside RTs and RNs.</p><p><strong>Measurements: </strong>ASQIP implementation was effective and was associated with a significantly lower incidence of UE per 100 MV days (before 0.43 vs after 0.29; p=0.04).</p><p><strong>Conclusions: </strong>A multidisciplinary quality improvement initiative that incorporates airway safety within the A-F bundle may help reduce UE rates in critically ill adults. Future research is needed to validate standardised communication and assess the long-term sustainability of such interventions.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039047","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":"Health systems responsiveness in low and middle-income countries (L&MICs): revisiting its scope.","authors":"Meesha Iqbal, Robert Morgan, Cici Bauer, Cecilia Ganduglia Cazaban, Sameen Siddiqi","doi":"10.1136/bmjoq-2025-003441","DOIUrl":"10.1136/bmjoq-2025-003441","url":null,"abstract":"<p><strong>Introduction: </strong>Health systems responsiveness (HSR) addresses the legitimate non-health expectations of the population and plays a vital role in strengthening health systems and enhancing population health. Identifying specific constructs or domains within HSR is particularly important in the context of low and middle-income countries (L&MICs) to facilitate targeted improvement. Following a comprehensive systematic review of the literature, we developed a conceptual framework for HSR. This study was designed to validate our proposed framework through a Delphi process.</p><p><strong>Methods: </strong>Global HSR experts were contacted via email to participate in the study, and a copy of the proposed framework (12 domains, 53 subdomains) was shared with them. Participants were asked to rate each subdomain on a scale of 1-5, with 5 being the highest score; based on scientific strength, relevance and feasibility. They also provided suggestions to merge, omit or add domains and subdomains. A subdomain was retained if it received a rating of 4 or 5 from at least 70% of participants for scientific strength and relevance, and 50% or more for feasibility. The final version of the framework was shared with all participants for approval.</p><p><strong>Results: </strong>Thirteen global health experts participated in the Delphi process. Final version of the HSR framework consisted of 10 domains: respect for dignity, autonomy and confidentiality of information; quality of basic amenities; access to social support networks during care; choice of provider; prompt access to care; attention, clarity of communication and guidance; consideration of financial protection; coordination and continuity of care and 31 subdomains. The overall Cronbach's alpha values were 0.94, 0.93 and 0.96 for the categories of scientific strength, relevance and feasibility of assessment, respectively, indicating very high internal consistency among the Delphi participants.</p><p><strong>Conclusion: </strong>We recommend using this framework to elaborate on HSR across L&MICs, after pretesting within specific contexts.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":"14 3","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038844","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}