Date of Award

12-2024

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr Mairaj Shah

Second Advisor

Dr Maryam Huda

Third Advisor

Mr Iqbal Azam

Department

Community Health Sciences

Abstract

Abstract: Background and Problem Discussion: In the global landscape of healthcare, the concept of Quality Improvement (QI) has undergone a transformative shift, recognizing nurses as crucial contributors, who actively contribute to enhancing patient care outcomes via their integral involvement in the QI process. However, in some Low-Middle Income Countries (LMICs) like Pakistan, the concept of nurse’s involvement in the quality improvement process is still isolated, where the role of nurses is often visualized as confinement only to bedside care. This causes barriers to the utilization of nurses’ valuable insights and their experiences within the broader QI framework. Thus, posing a threat to the success and sustainability of QI measures, especially in the healthcare organization they work in.
Purpose: This study aims to understand nurses' perceptions of their role in quality improvement (QI) processes at private and public tertiary care hospitals in Karachi, Pakistan. It explores nurses' perceptions of their involvement in the QI decision-making process, the barriers and enablers they face in QI initiatives and compares the difference in perceptions across private and public tertiary care hospital. The findings and insights gained through this study will guide policymakers in creating evidence-based policies and strategies to enhance nurses' participation in QI process, to foster a collaborative culture in improving healthcare quality across institutions.
Methodology: The study in 1 private and 1 public tertiary care hospital, Karachi, Pakistan, employed a convergent parallel mixed method study design. The Systems Engineering Initiative for Patient Safety Model (SEIPS) 2.0, provided the conceptual framework to this study, to understand nurses' perception of their role in the quality improvement process of the hospital setting they work in. With SEIPS 2.0 framework, the Nursing Quality Improvement in Practice (NQuIP) tool has been strategically integrated for the formulation and generation of qualitative and quantitative data collection tool. The study participants were different for qualitative and quantitative data collection to confirm or contradict data findings of both qualitative and quantitative approaches.
Results: This study involved responses from 403 participant’s surveys and 20 in-depth interviews at private and public tertiary care hospitals in Karachi, Pakistan. Key themes that emerged from the SEIPS 2.0 work system framework included; RN knowledge, skills, and attitude - KSA, their accessibility to QI data, time constraints they faced to be involved in the QI process, understanding of QI policies, organizational culture and support, and work environment affecting nurses' participation in Quality Improvement (QI). The statistical analysis of 21 survey items of quantitative data was presented via its mean scores, and standard deviations and were ranked according to their level of agreement. The mean score of 21 items in a structured survey reported significantly higher empowerment in nurses of private hospital, with 51.5% agreeing on their role in QI compared to 16.8% in public hospitals (p < 0.001). Private settings also had higher mean scores for organizational support for nurse's knowledge and ongoing education strategies (mean = 4.38, SD = 0.68) than public hospitals, with notably lower scores (mean = 2.62, SD = 1.2). Thus, these results highlighted the disparities in empowerment and resources between private and public settings and underscored a need for stronger support in public hospitals to enhance QI participation.
Conclusion: The study findings indicated that nurses' engagement in QI is limited. Nurses' knowledge, skills, and attitudes appear to be inadequately low with structural and organizational barriers in public tertiary care hospitals as compared to private tertiary care hospitals. Therefore leaders must make efforts to increase nurse engagement to attain high-quality outcomes. Enhancing nurses KSA, with streamlined clinical responsibilities will add value to nurse’s autonomy to participate in QI process. Therefore hospital management and policymakers need to evaluate nurses' self-perceived QI competence and engagement, support the identification of target areas for improvement, and to develop effective strategies to overcome healthcare challenges

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