An Assessment of Quality Management Systems and Practices in General Hospitals in Kingdom of Saudi Arabia (KSA): Towards Initiating a Holistic Framework

Alanazi, B. M (2021) An Assessment of Quality Management Systems and Practices in General Hospitals in Kingdom of Saudi Arabia (KSA): Towards Initiating a Holistic Framework. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

There have been a few attempts to address different understandings of quality management systems in healthcare organisations. Nevertheless, there are still misconceptions about how the matter of quality management systems can be linked to practice to ensure the establishment of a holistic quality system. In general hospitals, although the quality related practices are universally rooted on the international standardisations such as ISO 9000 and ISO 9001, it is still problematic that standardisations generated by quality control agencies especially in economically developing countries such as Saudi Arabia did not appear to allow better practices to control the service quality in general hospitals. This research is following the pragmatism philosophy. It aims to: assesses and examines the perspectives and opinions of key stakeholders – namely nurses, patients, and middle managers (heads of department) – with the goal of initiating a framework to improve the practices of quality management systems in general hospitals in KSA. The research went into two phases: at the first phase: 252 questionnaires were distributed to nurses, and 237 questionnaires were distributed to patients. While, in the second phase, seven semi-structured interviews were conducted with heads of department in one of the general hospitals under investigation. The findings of the patients’ questionnaire demonstrated that patients were satisfied with the information provided to them and the level of communication. However, they showed a lack of satisfaction in relation to staff clinical skills, family involvement, as well as the current level of caring. Conversely, the findings from the nurses’ questionnaire showed that nurses claimed to understand the healthcare policy and that their hospitals achieved the required level of QM. Nevertheless, they complained about a lack of education, training, culture of learning and a poor recognition and reward system. the findings from the interviews agreed to a limited extent with and support the questionnaires with three different sets of themes (global, organising, and basic themes), which represent the role of hospital middle management in quality assurance and the important influence of different organisational cultural aspects such as structure, policy, and management style on shaping the role and responsibilities of the management in establishing a culture of quality. In addition, the findings of the interviews helped illuminate the role CBAHI has played in supporting hospitals’ mission to set a QMS that responds to patients’ needs. The outcome of the interviews revealed that although CBAHI is promoted in general hospitals’ QMS related practices such as patient record systems, CBAHI has so far failed to establish a culture of quality where quality practices can be secured. The implications of approaching the aim are varied: firstly, better understanding to the future steps the decision and policy makers should take to improve the clarity of the concept of QMS. In addition, for the successful implementation of QMS, the hospital management requires assuring that quality of care for patients is secured. Second, the research has implications on training and education of the nurses. The outcomes of the patients’ questionnaire suggest that staff did not meet patients’ expectations regarding not only the level of care, but also the level of clinical skills (practice). In fact, on some occasions in the questionnaire, several nurses demonstrated a lack of understanding of CBAHI standardizations. This suggests that the research should have implications on the development of CBAHI and its standardisation This research is undertaken principally due to a paucity of research that examines quality management systems and practices in the Saudi’s general hospital context. This, paired with significant changes within the health context in Saudi Arabia, meant that an opportunity existed to develop the practices of quality management through examining the perspectives of different stakeholders. Understanding the practices of quality management systems and the barriers as well as the challenges that hinder their implementation and use in general hospitals will help set guidelines to improve the practices of quality management system in the future of general hospitals in Saudi This research has contributed to the knowledge theoretically through addressing the issues and perceptions of different stakeholders, especially in Saudi Arabia, as the King intends to pursue his Vision 2030 where quality and equality is at the core, which will have a considerable impact on the development of quality management system practices in Saudi. In addition, it proposes new additions to the research Onion model utilised to master this research which is considered as another angle of contribution to the theory of research in nursing. Into practice, the findings of this research and the initiated framework are hoped to lead to better engagement and communication with the stakeholders at different levels – from top management to end users – to enhance the practices of QMS in general hospitals. As the findings illuminated different challenges including a lack of professional training, and a lack of understanding of both the culture of quality and culture of patient safety. The framework, thus, suggests a new net of collaborations and involvement of accreditation agencies such as CBAHI and MoH to build a holistic quality culture where everyone in the hospital should be engaged in developing the policy of quality and equality that support the implementation of QMS and its practices. The implication of such collaboration should lead to bettering the commitment of the nurses and middle managers to standardisations developed by CBAHI.