Prevalence of pressure injury on the medical wards of public general hospitals in Kuwait: a national cross-sectional study.

BACKGROUND: Pressure injury is a severe problem that can significantly impact a patient's health, quality of life, and healthcare expenses. The prevalence of pressure injuries is a widely used clinical indicator of patient safety and quality of care. This study aims to address the research gap that exists on this topic in Kuwait by investigating the prevalence of pressure injuries and preventive measures on the medical wards of the country's public general hospitals. METHODS: A cross-sectional research design was adopted to measure the point prevalence of pressure injuries on 54 medical wards in the public general hospitals. Data, including variables pertaining to hospitals, patients, pressure injuries and preventive practices, were collected using an online form. The data were processed and analysed using Microsoft Excel and SPSS 23 (α level = 0.05). Analysis provided an overview of patient, pressure injury characteristics and preventive measures, and the relationships between the patient and pressure injury characteristics and the prevalence of pressure injuries. A model for predicting the determinants of pressure injury prevalence was constructed from a linear regression analysis. RESULTS: The mean national prevalence of pressure injury was 17.6% (95% CI: 11.3-23.8). Purely community-acquired pressure injuries represent the majority of pressure injuries nationally (58.1%). Regarding preventive measures, "pressure injury assessment on admission" has been provided to 65.5% of patients. Correlation analysis revealed that the only statistically significant correlation with the prevalence of hospital-acquired pressure injury was "pressure injury assessment on admission", which was strongly negative (ρ = -0.857). Therefore, this was the only variable included in the regression analysis as a predictor of pressure injury prevalence (Beta = 0.839). The results showed many statistically significant differences between hospitals with respect to the variables studied. CONCLUSIONS: The national pressure injury prevalence is high compared to the global rate. The higher percentage of purely community-acquired pressure injuries requires particular attention. Many risk factors for the development of pressure injuries are public health concerns, and effective mitigating strategies are needed. Further research is required to assess the knowledge, attitude, and behaviour of nurses with respect to pressure injuries, and to evaluate preventive and management practices.

The Association Between Patient Safety Culture and Accreditation at Primary Care Centers in Kuwait: A Country-Wide Multi-Method Study.

Purpose: A culture of patient safety is essential for the continual improvement of service and reducing errors. This study aims to examine how the scores of patient safety culture items impact accreditation compliance percentages in primary care settings in Kuwait. Methods: A cross-sectional and a retrospective quantitative approaches were used on 5288 employees at 75 primary healthcare centers across Kuwait. Patient safety culture questionnaires were distributed to clinical and administrative staff with at least one year of experience. We also examined the percentages of compliance with accreditation standards by the studied centers. Participant socio-demographic and setting demographic data were studied using univariate (means, standard deviations, frequencies, percentages) and bivariate (Student's t-tests, ANOVA F-tests, Mann-Whitney U-test, Kruskal-Wallis H-test, Spearman correlation) analyses to examine how trends in the patient safety culture items and accreditation compliance differ across the primary healthcare center demographic groups. The relationship between patient safety culture composites and percentages of accreditation compliance was investigated. To predict the factors for accreditation compliance, we used multivariate regression analysis. Results: The responses of 5288 employees (response rate= 76.5%) from 75 centers were included. Our analysis revealed that the demographics of the setting affected the accreditation compliance percentage more than the percentages of patient safety culture positive ratings. Furthermore, the composites "Patient Care Tracking/Follow-up", "Communication about Error", "Organizational Learning" and "Overall Perceptions of Patient Safety & Quality" had statistically significant weak-to-moderate positive correlations (r = 0.272-0.373) with percentage scores for compliance with various accreditation standards. Regression analysis indicated that the patient safety culture items accounted for 35% to 38% of the variability in accreditation compliance scores. Conclusion: The safety practices adopted by a primary healthcare center reflect its culture, and this has an impact on its accreditation performance. Our interpretation of the findings is expected to help healthcare leaders to better understand the relationship between safety culture and performance and to develop realistic reform strategies.

Baseline assessment of staff perception of critical value practices in government hospitals in Kuwait.

BACKGROUND: Notification of laboratory-determined critical values is key for effective clinical decision making and is thus a consequential step in a patient's health care and safety. This study presents an overview of staff reporting policies and procedures concerning critical values in Kuwaiti governmental hospitals. METHODS: A cross-sectional descriptive study design was adopted. Study subjects were affiliated with laboratories from five government hospitals (four general and one sub-specialty hospital). All laboratory staff in every hospital were included. The Statistical Package for the Social Sciences (version 23) was used to analyse the collected data at a significance level of ≤ 0.05. Quantitative data analysis included univariate descriptive (means, medians, standard deviations, frequencies, percentages) and bivariate (chi-squared, ANOVA and Kruskal-Wallis tests) analyses. These analyses provided associations between participating hospitals and staff perceptions towards the policies and procedures surrounding critical values. RESULTS: 559 questionnaires were returned, a total response of 30.5% after those of 79 phlebotomists were excluded (eligible sample size n = 1833). The notification of critical values differs between participated laboratories in delivering protocol and time duration. Linked protocols between laboratories did not exist regarding policies and guidelines for applying the same procedures for critical value notification. There are differences in critical value limits among the participating laboratories. CONCLUSION: This study is the first to survey laboratory staff perceptions of critical value practices in Kuwaiti government hospitals. Enhancing critical value reporting and policy is crucial for improving patient safety and to develop high-quality health services. The findings of this study can help policy makers implement future intervention studies to enhance laboratory practices in the area of critical values and improve patient safety and the quality of government hospital systems.

Organizational Culture, Quality of Care and Leadership Style in Government General Hospitals in Kuwait: A Multimethod Study.

PURPOSE: To investigate the organizational culture, assess the quality of care, and measure their association with a transformational/transactional leadership style in six hospitals. MATERIALS AND METHODS: We used cross-sectional and retrospective quantitative approaches in government-sponsored secondary-care hospitals. A sample of 1626 was drawn from a frame of 9863 healthcare workers in six hospitals. Followers were surveyed using the Multifactor Leadership Questionnaire and the Organizational Description Questionnaire. We reviewed and analyzed one year (2012) of quarterly and annual quality indicators from the hospitals. Data were analyzed using suitable statistical analyses. RESULTS: We collected 1626 responses from six hospitals. 66.4% to 87.1% of participants in each hospital identified their hospital's organizational culture as transformational, whereas 41 out of 48 departments were identified as having a transformational culture. The percentage of participants at each hospital rating their leader and organizational culture as transformational ranged from 60.5% to 80.4%. The differences between leadership style and organizational culture were statistically significant for four of the hospitals. For most of the quality indicators, there was a positive, but nonsignificant, correlation with leadership style. CONCLUSION: Leaders define and influence organizational culture. The prevailing transformational leadership style creates and maintains a transformational organizational culture. The effect of transformational leadership on the quality of care delivered by the organization was measured in this study, and showed a positive and nonsignificant relationship between generic quality indicators and the transformational style.

Baseline assessment of patient safety culture in primary care centres in Kuwait: a national cross-sectional study.

BACKGROUND: Assessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes. This study investigated patient safety culture in Primary Health Care Centres in Kuwait, and benchmarked the findings against regional and international results. This study also examined the association between predictors and outcomes of patient safety culture in these settings. METHODS: This cross-sectional quantitative study used the Medical Office Survey on Patient Safety Culture. The study was targeted at staff of all the Primary Health Care Centres in Kuwait with at least one year of experience. Data were analysed using SPSS 23 at a significance level of ≤ .05. Univariate (means, standard deviations, frequencies, percentages) and bivariate (chi-squared tests, student t-tests, ANOVA F-tests, Kruskal-Wallis tests, Spearman's correlation) analyses provided an overview of participant socio-demographics and the association between patient safety culture composites and outcomes. We undertook a multivariate regression analysis to predict the determinants of patient safety culture. Results were benchmarked against similar local (Kuwait, 2014), regional (Yemen, 2015) and international (US, 2018) studies. RESULTS: The responses of 6602 employees from 94 centres were included in the study, with an overall response rate of 78.7%. The survey revealed Teamwork (87.8% positive ratings) and Organisational Learning (78.8%) as perceived areas of strength. Communication about Error (57.7%), Overall Perceptions of Patient Safety and Quality (57.4%), Communication Openness (54.4%), Owner/Managing Partner/Leadership Support for Patient Safety (53.8%) and Work Pressure and Pace (28.4%) were identified as areas requiring improvement. Benchmarking analysis revealed that Kuwait centres are performing at benchmark levels or better on four and six composites when compared to international and regional findings, respectively. Regression modelling highlighted significant predictions regarding patient safety outcomes and composites. CONCLUSIONS: This is the first major study addressing the culture of patient safety in public Primary Health Care Centres regionally. Improving patient safety culture is critical for these centres to improve the quality and safety of the healthcare services they provide. The findings of this study can guide country-level strategies to develop the systems that govern patient safety practices.

Exploring leadership styles in government hospitals in Kuwait.

PURPOSE: This paper aims to determine and assess leadership styles in six government general hospitals. DESIGN/METHODOLOGY/APPROACH: This is a cross-sectional study that uses a self-administered questionnaire to determine the leadership styles by self or followers' rating. The participants were 66 leaders and 1,626 followers. The data were analyzed using suitable statistical methods. FINDINGS: The prevailing leadership style of hospitals' leaders is the transformational style, where self-rating as transformational is higher than followers' rating. The demographic characteristics of leaders are statistically insignificant. RESEARCH LIMITATIONS/IMPLICATIONS: Other health-care settings were not included in the study. In addition, the study is designed to determine the relationship between variables, not to identify cause and effect. However, effective leadership has a substantial value and impact in health care. The paper confirms the existence of a transformational style effect on all organizational outcomes and represents a baseline for future studies in determining leadership styles and organizational culture types to highlight improvement areas. PRACTICAL IMPLICATIONS: The paper recommends designing training programs to improve transformational leadership behavior. Moreover, investment in research is needed to understand how to build transformational leaders. In addition, leaders' recruitment must be conditioned by obtaining a leadership certification. ORIGINALITY/VALUE: This topic is under-researched in Kuwait health-care system. The use of leadership style as an indicator for a health-care organization's performance is still not well known in Kuwait.