Abstract Background and Purpose Fatigue, cognitive overload, and declining wellbeing remain pervasive threats to surgical performance. Existing interventions have focused on working-hour limits or reactive stress-management, with limited application of behaviour-change theory. This study tested the feasibility of a theoretically informed, two-phase intervention designed to enhance surgeons’ self-regulation and build sustainable performance. Methods A single-site feasibility and pilot study was conducted using the Medical Research Council Framework for Complex Interventions. Sixteen surgeons were invited; 10 participated. The intervention integrated an educational component on performance science and a coaching component using the GROW model. Behaviour Change Wheel and Theoretical Domains Framework principles guided design, with Self-Determination Theory underpinning motivational design. Feasibility outcomes included fidelity, dose, adaptation, and reach. Secondary outcomes assessed fatigue, thriving, psychological capital, and self-reported clinical performance using validated measures. Results Eighty percent of participants completed both phases. Fidelity and acceptability were high. Statistically significant changes were observed in fatigue (P = .046), recovery autonomy (P = .044), and sleep hours (P = .026). Thriving scores (learning subscale) increased (P = .014), alongside changes in hope and optimism within psychological capital. Participants valued the intervention’s professional relevance and identity-aligned framing. Conclusions A theoretically grounded behaviour-change intervention was feasible and acceptable for surgeons, showing preliminary signals in recovery and psychological resources. The study establishes proof-of-concept for embedding behavioural-science methods within surgical performance systems and provides a foundation for multi-site, multi-level evaluation.
Abstract Background Patient safety culture is a core dimension of health care quality, yet evidence from refugee-serving primary care settings remains limited. Objective This study assessed healthcare providers’ perceptions of patient safety culture in United Nations Relief and Works Agency for Palestine Refugees in the Near East primary care centres in the Gaza Strip and examined differences by selected sociodemographic and work-related characteristics. Method A cross-sectional survey was conducted among healthcare providers in nine UNRWA primary care centres selected by stratified multistage sampling from May to June 2022. Of 270 questionnaires, 259 were completed. Patient safety culture was assessed using an Arabic Safety Attitudes Questionnaire. Descriptive statistics, t tests, and analysis of variance with eta-squared effect sizes were used. Multivariable linear regression examined independent predictors of the total Safety Attitudes Questionnaire score. Results The overall weighted positive-response score was 73.1%. Job satisfaction (79.2%) and teamwork climate (77.5%) were highest, while working conditions (61.9%) and perceptions of management (66.1%) were lowest. Although 93.4% rated patient safety as very good or excellent, 79.9% had submitted no formal incident or medical-error report in the preceding year. In adjusted analysis, more than 20 years of UNRWA service and middle-area location were associated with higher total scores, while allied health and pharmacy staff had lower scores than medical and dental staff. Conclusion Providers reported a generally favourable safety culture, but working conditions, management perceptions and formal incident reporting remain priorities. The findings provide a pre-war baseline and support non-punitive reporting, leadership engagement, workforce support and safety-focused learning in refugee-serving primary care.
Abstract Background The quality of healthcare in Ghana like many other countries has been described both anecdotally and empirically as suboptimal in spite of the many efforts. Unfortunately, many frontline healthcare leaders and providers do not also have the required knowledge, skills, and competence to improve the quality-of-care outcomes. This study sought to build the capacity of health care leaders and frontline health care providers in quality improvement (QI) and COVID-19 case management. Methods The study was conducted in a secondary healthcare facility in Accra, Ghana. A paired t-test was used to evaluate the impact of phase 2 of the interventions on participants’ knowledge on person centered care (PCC) and QI. The project had a three-phased multi-pronged set of interventions deployed at the study site to attain the set objectives. Phase 1 of the project involved constituting a seven-member project technical committee while phase 2 involved the implementation of the project activities including the deployment of the web-based client experience system. In addition, there was the hospital-wide training of health care workers (HCWs) in PCC; and training of the quality focal persons and the hospital’s Rapid Response Team (RRT). Phase 3 involved exploring mechanisms to ensure sustainability of the gains. Results Client satisfaction improved from 77% in December 2022 to 88% (95% CI = 85.4%–89.7%) by 31 December 2023. Generally, there was a significant (P < .001) increase in knowledge with respect to all the knowledge assessments. Overall, there was an increase in knowledge from 32.62% (95% CI = 30.87–34.39) to 58.72% (95% CI = 56.62–60.81) and the difference was statistically significant (26.09%; 95% CI = 23.77–28.41). The main outcomes of the study were to improve client satisfaction and knowledge of healthcare providers in healthcare quality, PCC, COVID-19 case management, and infection prevention and control (IPC). Conclusion There was a significant increase in knowledge among all the participants in all the training and capacity building (PCC; COVID-19 Case Management & IPC; and quality and patient safety) programs; and client satisfaction.
Abstract Background Clinical guidelines are essential tools for standardizing and improving the quality of care, particularly in chronic illnesses such as diabetes mellitus. However, one of the significant challenges is adherence to these clinical guidelines by healthcare providers in low- and middle-income countries. Objective To assess the level of adherence to diabetes mellitus standard treatment guidelines among prescribers in southwestern Uganda. Method A cross-sectional design was employed involving 75 prescribers, including doctors and clinical officers. Data were collected using a structured questionnaire and analyzed using IBM SPSS version 26. Results Findings revealed that only 16% of prescribers demonstrated high adherence to Uganda Clinical Guidelines (UCG), while 75% exhibited low adherence. Lifestyle modification was the most consistently applied aspect (48%), while patient monitoring and follow-up had the lowest adherence (12%). Key barriers to adherence included limited availability of recommended medications, patient-related challenges, lack of knowledge about the guidelines, and workload/time constraints. Multivariate logistic regression showed that male gender [adjusted odds ratio (aOR) = 11.60, P = .006] and prior training on the UCG (aOR = 25.73, P < .001) were significantly associated with higher adherence. Education level and years of experience were not significant predictors in the multivariate model. Conclusion The study concludes that adherence to UCG for diabetes management among prescribers is suboptimal, potentially compromising patient outcomes. To improve adherence, it recommends regular training programs, better dissemination of the guidelines, strengthening of the drug supply chain, and enhanced institutional support. These interventions could significantly improve the quality and consistency of diabetes care.
Abstract Background Sepsis is a leading cause of neonatal morbidity and mortality in low- and middle-income countries. Appropriately prescribed and promptly administered antibiotics may improve patient outcomes. Methods A pre–post-intervention study to improve antibiotic prescribing was conducted, focussing on reducing prescription errors and hangtime (time from sepsis diagnosis to administration of the first dose of antibiotic) in hospitalized very low birth weight neonates at a large South African hospital. Utilization of multiple complex dosing recommendations contributed to prescription errors. Standardized dosing guidelines were produced and staff received training on accurate antibiotic prescribing and prompt administration. Prescribing errors and hangtime duration were retrospectively compared for the five most frequently prescribed antibiotics (meropenem, piperacillin-tazobactam, amikacin, vancomycin and colistin) pre- (July 2018 to December 2019) and post- (November 2023 to June 2024) implementation of the prescribing intervention. Results 386 prescriptions from 130 neonates (pre-intervention) and 956 prescriptions from 246 neonates (post-intervention) were analysed. The median birth weight (1060 g) and gestational age (28 weeks) was comparable between the two cohorts. Dosing errors (14% to 4.2%; P < .001) and dose interval prescription errors (14% to 4.5%; P < .001) were significantly reduced post-intervention. The median hangtime was reduced from 115 (Interquartile range 48 to 210) minutes pre-intervention to 50 (Interquartile range 22 to 100) minutes (P < .001). Conclusion Low-cost interventions, including simplification of dosing guidelines and staff education, were successful in reducing antibiotic prescription errors and hangtime in this resource-limited neonatal unit. Ongoing training to sustain the improved antibiotic prescribing and administration practices is essential.
Abstract Background Adherence to treatment is essential for people with type 2 diabetes mellitus (T2DM). Objective This study aimed to evaluate the added impact of an online education intervention in patients with T2DM. Methods The intervention group (57 out-patients) attended 12 online workshops on T2DM. The comparison group (57 out-patients) did not attend any workshop. Primary outcomes were glycosylated haemoglobin and fasting blood glucose level. Secondary outcomes included blood lipid levels and behaviour favouring blood glucose control. Baseline and final measurements compared the primary and secondary outcomes. Secondary analysis assessed potential confounders. Results Five patients dropped out of the intervention group. At baseline, the average glycosylated haemoglobin at baseline in the comparison group was 8.7% and 8.9% (P = .65) in the intervention group; the final measurements were 8.39% in the comparison group, and 7.79% in the intervention group (P = .1). The average fasting blood glucose level in the baseline was 167 mg/dL in the comparison group and 174 mg/dL (P = .62) in the intervention group; the final measurements were 162 mg/dL in the comparison group, and 139 mg/dL in the intervention group (P = .05). Three secondary outcomes (triglyceride, low-density lipoproteins (LDL), and high-density lipoproteins (HDL) levels) and two patient habits (high-caloric intake and number of meals) showed a significant difference (P < .05) in favour of the intervention group. Conclusion The intervention was associated with fasting blood glucose <130 mg/dL; the intervention group showed lower glycosylated haemoglobin and fasting blood glucose levels. Sharing these results with service providers and patients might motivate them to reinforce diabetes control through an online education intervention initiative.
Abstract Objective Transurethral resection of bladder tumor is the initiation of bladder cancer management, yet its quality often varies. Incomplete resections and inadequate documentation remain a challenge in making optimal treatment decisions. The European Association of Urology sets standards for high-quality procedures that can aid diagnosis and prognosis. This study reports a 4-year closed-loop audit that used a targeted approach to enhance TURBT practice and reporting in a developing world hospital. Methods We reviewed primary bladder tumor resection procedures during July–December 2020 (Cycle 1, n = 52) and July–December 2024 (Cycle 2, n = 55) that were done in one of the largest tertiary care hospitals of Pakistan. Following Cycle 1, interventions included structured operative templates and mandatory bladder diagrams. Compliance with the guidelines was compared across both the cycles. Results Documentation of tumor size improved from 44% to 76% (P = .001), and inclusion of bladder diagrams in operative notes increased from 92% to 98%. The presence of detrusor muscle in resected specimens rose from 83% to 95%. Histopathology reporting showed significant improvements in documenting Tumor stage, lamina propria status, and muscle presence. Areas requiring further quality improvement included the documentation of carcinoma in situ. Implications The use of structured operative templates and standardized reporting significantly enhances adherence to TURBT quality indicators. Closed-loop audit methodology provides a practical and low-cost strategy to improve surgical documentation and specimen quality in resource-limited settings. Conclusion This closed-loop audit with structured operative and histopathology templates improved adherence to TURBT quality indicators over a 4-year period in a tertiary care center.
Abstract Background Artificial airway suctioning can cause transient adverse events such as desaturation, bleeding, and hemodynamic changes, as well as longer-term consequences, such as mucosal injury and hospital-acquired infections. Practicing safe suctioning is therefore essential to optimize therapeutic outcomes. Methods This prospective quality improvement project was conducted in the Paediatric Intensive Care Unit of a tertiary care hospital in South India, using the clinical audit framework. The aim was to assess and enhance compliance with evidence-based guidelines for endotracheal suctioning. Ten parameters essential for safe endotracheal suctioning were identified based on American Association of Respiratory Care (2022) guidelines and taking into consideration the departmental guidelines. A pro forma was used to document the suctioning practices as observed by visiting at different hours. The percentage compliance to set standards was calculated for each parameter. Post the first audit cycle, targeted interventions were implemented including sharing of structured learning modules with the critical care therapists, emphasizing the importance of safe suctioning, as well as involving the Medical Gas Engineering Department to repair or replace the suction apparatus and pressure gauges found to be malfunctioning. A second audit cycle was conducted post-intervention and the results compared. Results Re-audit showed an increase in the compliance with use of appropriate negative pressure (<120 mmHg) during suctioning from 13% to 56%, and use of thumb control from 61% to 80%. There was a marginal increase in the number of beds with safe suction depth displayed at the bedside (70%–72%). Conclusion The re-audit demonstrated an improvement in compliance with guidelines for safe suctioning, thus demonstrating that regular audits and educational interventions can positively influence clinical practice and contribute to improved patient care and safety. Sustaining these improvements may require periodic re-audits, continued on-boarding training for new staff and systemic support including timely maintenance of equipment.
Abstract Background Health systems are increasingly expected to reduce their environmental impact. In England, the National Health Service (NHS) has committed to achieving net zero greenhouse gas (GHG) emissions by 2040 for emissions under its direct control. General practice is critical to this ambition due to its high volume of patient contacts, prescribing-related emissions, and role in prevention. However, little is known about how patients understand and evaluate environmental initiatives in primary care. Methods This qualitative interview study, conducted as part of the GPNET-0 Study, explored patient perspectives on the rationale, implementation, and perceived consequences of environmental initiatives in general practice. Semi-structured interviews were conducted with purposively sampled patients through general practices and nearby community and faith organizations across three contrasting regions in England. Interviews were conducted via Microsoft Teams (video-conferencing) between December 2024 and May 2025. Data were analysed using framework analysis informed by Normalization Process Theory (NPT) and Theoretical Domains Framework (TDF). Results Twenty-four participants took part, representing a range of ages, socioeconomic backgrounds, and health statuses. Four interrelated themes were identified: (1) patient care as the overriding priority; (2) limited visibility of environmental initiatives, weak communication, and unclear responsibility; (3) perceptions of limited impact of general practice-level action; (4) digitalization and prevention as acceptable and credible approaches. While participants broadly supported environmentally responsible healthcare, this support was conditional on safeguarding quality, access, and equity. National leadership and adequate resourcing were viewed as prerequisites for meaningful local action. Conclusion Patients regard environmental initiatives in general practice as legitimate only when it is clearly aligned with patient-centred care and supported by transparent communication and system-level coordination. Embedding environmental initiatives within routine clinical priorities, rather than positioning it as an additional burden, appears critical for public acceptance. These findings underscore the need for whole-system approaches that protect trust, equity, and care quality while advancing environmental goals.
Abstract Background The high volume of patients presenting with acute chest pain places pressure on the parties that refer and receive them. Referral letters for such patients need immediate evaluation. Hastily prepared referral letters often lack information that is essential for making precise decisions. Our objective was to assess how the quality of acute coronary syndrome (ACS) referral letters influences decision-making. Methods In our cohort study, we examined all consecutive ACS referrals to Helsinki University Hospital (HUS) from January 2021 to April 2022. The study sample comprised 1075 patients. The content of the referrals was gathered on an Excel sheet and analysed in a structured manner. The data were categorized on the basis of the number and the quality of the essential information items: chest pain symptoms, risk factors, electrocardiogram findings, and troponin values. We evaluated references to ischemia (chest pain, release of cardiac troponin or ischemic electrocardiography) and other classified relevant information items (altogether 25 different comorbidities: classical atherosclerosis risk factors, previous myocardial infarction, stroke, cancer, etc.). We cross-tabulated the collected information with all the coronary angiographies performed at HUS during the study period. Results The median number of relevant classified information items in a referral was 8 (5–10). The three most important information items—troponin values, electrocardiograms, and patient symptoms—were referred to in 84.5%, 76.6%, and 91.3%, of referrals, respectively, whereas all three were reported in 66.0%. References to ischemia were associated with the odds of undergoing coronary angiography [age- and sex-adjusted odds ratio (OR) 2.02 (1.65–2.48), P < .001] and with a shorter wait for angiography [adjusted risk ratio 0.83 (0.77–0.89), P < .001]. The number of classified relevant information items was also associated with the likelihood of undergoing coronary angiography [adjusted OR 1.06 (1.02–1.11), P = .008] but not with the length of the wait for the procedure. A prior percutaneous coronary intervention, however, was associated with a higher probability of undergoing coronary angiography [univariable OR 3.78 (1.46–11.78), P = .011]. Conclusions Although the overall quality of the referrals was satisfactory, the recipient of the referral had to make many decisions on the basis of incomplete information. References to ischemia increased the probability of adequate patient care and decreased the wait for coronary angiography. Other information only had a minor effect on the same measures. Key messages The recipient of the referral makes many decisions based on incomplete information, because the overall quality of the referrals are only satisfactory A reference letter should include at least information about the references to ischemia, which increased the probability of adequate patient care. 3) Adequate information decreases the wait time for coronary angiography.
Abstract Background This sustainability and quality improvement project aimed to reduce the environmental burden and financial cost of personal protective equipment (PPE) used in the Oral and Maxillofacial Surgery (OMFS) department at Mid Yorkshire Teaching NHS Trust. Specifically, it evaluated the impact of replacing single-use gowns with disposable aprons for dentoalveolar procedures under local anaesthetic (LA) carried out in theatres. Methods The AQUA Theatreman system was used to identify all LA dentoalveolar theatre procedures between 1 January and 31 December 2024. PPE use was calculated assuming three scrubbed staff per case. Carbon footprint data were taken from published estimates (905 g CO2e per gown; 65 g CO2e per apron). Cost information was obtained from the Trust. Following approval, a standard operating procedure allowing apron use was introduced in February 2025. Results A total of 613 LA cases were assessed, equating to 1839 gowns. This generated 1664 kg CO2e and cost £2979.18. Equivalent apron use would produce 358 kg CO2e and cost £36.78, saving 1306 kg CO2e and £2942.40. Patients also, anecdotally, reported reduced anxiety with apron use. Conclusion Replacing gowns with aprons substantially decreases environmental impact and financial costs while improving patient experience, supporting the NHS Net Zero agenda and offering a scalable sustainability intervention.
Abstract Background Insulins, opioids, and antithrombotics are classified as high-alert medications (HAMs), posing a significant risk of serious patient harm when used in error. This study aimed to describe the frequency and nature of reported medication safety incidents involving these medicines in a Finnish university hospital. Methods This retrospective study analysed safety incidents involving insulin, antithrombotics, and opioids reported at Tampere University Hospital between January 2019 and December 2021. Quantitative methods, including content analysis, were used. Data were obtained from HaiPro, a web-based, voluntary incident reporting system used in Finnish healthcare, with reports submitted by healthcare professionals. Contributing factors related to the medication process were identified through quantitative content analysis of the incident reports. Results A total of 1087 medication safety incidents involving insulins, opioids, and antithrombotic medications were reported during the study period, of which 983 were processed and included in the analysis. Of these, 79% involved patients, while 21% were classified as near misses. The most frequent types of incidents were related to medication administration (63%) and prescribing (22%). Antithrombotics accounted for 47% of the incidents, opioids for 35%, and insulins for 18%. The most common contributing factor for administration errors was failure to verify the medication order from the electronic medication list in the patient information system (20%). For prescribing errors, the most frequent contributing factors were entering the medication order in the wrong section or duplicating it in the patient information system. Conclusions This study identified the most common medication safety incidents and their contributing factors in the use of insulins, opioids, and antithrombotics. Errors most frequently occurred during administration and prescribing. These risks may be mitigated by developing and implementing safer practices throughout the medication process. The findings are relevant both nationally and internationally, as these HAMs are widely used across healthcare settings.
Abstract Background Effective governance in fragile and conflict-affected settings depends not only on health-system “hardware” but also on relational “software”, including trust, responsiveness, fairness, and legitimacy. In Somalia, the Marwo Caafimaad female community health workforce and DHIS2-enabled community feedback mechanisms represent two linked governance innovations intended to strengthen service delivery and accountability. Objective To examine the association between deployment of the Marwo Caafimaad programme together with DHIS2-enabled digital accountability mechanisms and maternal and child health service utilisation, governance responsiveness, and perceived service-level legitimacy in Somalia. Method An explanatory sequential mixed-methods case study was conducted across multiple Federal Member States of Somalia. Quantitative analysis used routine DHIS2 data from 2018 to 2024 on antenatal care (ANC1), skilled birth attendance (SBA), and thirddose pentavalent vaccination (DPT3), with difference-in-differences models applied where phased roll-out allowed. Qualitative data collected in 2024 through key informant interviews and focus group discussions were analysed using a realist evaluation lens to derive mechanism–context–outcome configurations, and findings were triangulated through joint display. Results Districts implementing both interventions showed statistically significant improvements in ANC1, SBA, and DPT3 relative to comparison districts. Qualitative analysis identified three reinforcing mechanisms: culturally aligned female community health workers increased trust and acceptability; digital feedback loops enabled timely responsiveness and problem resolution; and visible fairness and accountability strengthened pragmatic legitimacy. These mechanisms supported improved service uptake despite insecurity and variable facility readiness. Conclusion In fragile settings, alignment of community health workforce strategies with actionable digital accountability mechanisms is associated with better service performance and stronger service-level legitimacy. Somalia’s experience suggests that governance “software” can amplify the impact of technical reform.
Objective To analyze the evolution of organizational maturity and its role in supporting quality governance in a Brazilian hospital. Methods A longitudinal organizational study was conducted using a structured maturity assessment tool applied between 2020 and 2023. The instrument evaluated subsections across four domains: governance, patient care, diagnostics and therapeutics, and support services. A composite maturity index was calculated based on mean subsection scores. K-means cluster analysis was applied to standardized temporal trajectories to identify patterns of institutional development. Results The global maturity index increased from 0.279 in 2020 to 0.580 in 2023, representing an absolute increase of 0.301 (107.9% relative increase). Domain-level maturity in 2023 was highest in governance (0.619) and lowest in support services (0.510). Cluster analysis identified five distinct patterns of development, indicating heterogeneous trajectories across organizational domains. The greatest improvements were observed in pharmaceutical care, infection prevention and control, supply chain management, neonatal care, and specialized diagnostic services. Conclusion Organizational maturity models can support data-driven quality governance and improve decision-making processes in healthcare organizations.
Abstract Background Outpatient waiting times for specialist review are a challenge in public health, impacting patients’ quality of life, outcomes, and healthcare system efficiency. Evidence supports a range of strategies to reduce outpatient waiting times including operational efficiencies and physiotherapy clinics. Previous work demonstrates introduced models of care can be effective in reducing waiting lists and provide safe care. The objective was to develop an evidence-based model of care, for future implementation and evaluation, to reduce wait times for outpatient non-urgent specialist neurosurgical patients at a metropolitan hospital in South Australia. Methods Multi-method knowledge translation approach, with the Knowledge to Action Framework was used. Data were gathered for people on the non-urgent neurosurgical waiting list including: (i) Surveys (N = 27) (health care utilization/quality of life), (ii) Interviews (N = 12), (iii) Audit of hospital utilization (N = 183), and (iv) Evidence review completed. Stakeholders workshopped feasible models of care from collated results (i–iv). Models of care were developed to reflect the hospital context, including an estimation of public hospital costs only to inform a local business case. Results Survey and interview results identified patients on the neurosurgical waitlist were negatively impacted, feeling frustrated, and demoralized. Emergency department presentations and inpatient admissions during the wait period were calculated to cost the hospital ≥$116 648 annually. Evidence supports physiotherapists effectively managing non-urgent spinal patients referred for specialist opinion. Stakeholders supported physiotherapy involvement in the neurosurgical clinic with consultant oversight. Preliminary analysis of the model of care supports cost savings and reduced wait times. Conclusion Conceptual frameworks grounded in knowledge translation offer a systematic approach to selecting evidence-based interventions for optimizing outpatient waiting lists in specific health services. Comparative studies are warranted to evaluate the relative effectiveness and sustainability of waiting list reduction strategies informed by such frameworks, versus those developed without the explicit integration of knowledge translation principles.
Abstract Background The Organisation for the Economic Co-operation and Development (OECD) undertook the Patient-Reported Indicator Survey (PaRIS) to understand if current healthcare delivery and policy were meeting people’s needs. Although the UK as a whole is an OECD member, Wales participated in the PaRIS study independently of the rest of the UK since healthcare is a devolved matter to the Welsh Government and Wales is internationally acknowledged for its work implementing Patient Reported Outcome Measures. Methods Here, we describe and reflect on how PaRIS was implemented, discussing both the initial field trial and the final survey, which targeted GP practices and patients over the age of 45. We detail the governance structure used for the project, the various parties that cooperated to implement the project, and the stakeholder engagement approach utilized. We also provide descriptive statistics of the sampled GP practices and patients. Results Out of 199 surveyed GP practices, 75 responded to the survey. Out of 109 600 sampled patients, 25 839 responded to the survey, out of which 7 706 patients were from the 75 recruited practices and met the PaRIS inclusion criteria. Participants were representative of the population of Wales with respect to urbanization levels, sex, as well as ethnicity. GP practices were provided with infographics, giving them insight into their patients’ health compared to patients’ health across Wales. While the OECD flagship PaRIS report has now been published, further work is being undertaken in Wales to utilize the available data. Conclusion Wales achieved one of the most comprehensive datasets of all PaRIS nations, despite its small size. The data offered the participating GP practices an opportunity to understand how they and their patients compared to other practices across Wales. The data are now being employed to understand population health and drive policy change and healthcare improvement initiatives across the nation.
Abstract Background Medication errors remain a major contributor to preventable patient harm worldwide, despite global initiatives such as the World Health Organization’s (WHO) Medications Without Harm initiative. While numerous evidence-based interventions exist, they are often implemented in isolation and a comprehensive, multidisciplinary framework to guide system-wide medication safety across diverse healthcare setting is lacking. Objectives To develop a comprehensive, evidence-based framework aimed to address medication errors throughout the entire medication continuum. Methods This study developed of an evidence-based framework to prevent and address medication errors across the medication continuum, using a multi-method, three-stage approach. First, a comprehensive review of peer-reviewed literature and systematic reviews was undertaken to identify common causes of medication errors and effective interventions. Second, key priorities from the WHO Medication Without Harm initiative were integrated to ensure global and policy relevance. Third, sociological theory-building methods were applied to synthesize and organise findings into coherent higher-order domains, ensuring the framework was both comprehensive and practical for diverse healthcare environments. Results The ‘MAPS’ (Medication Accuracy, Protocols and Safety) framework comprises six areas: leadership and organizational culture, technology-enabled safety systems, multidisciplinary collaboration, continuous education and training, medication reconciliation and standardized protocols and global collaboration and systems strengthening. Each domain encompasses practical, evidence-based interventions addressing prescribing, dispensing, administration, monitoring and transitions of care, which can be adopted into daily clinical care, are presented within each focus area. The framework contributes to a more cohesive system-wide approach, enhancing decision-making and promoting medication safety, that is adaptable across healthcare contexts. Conclusion The MAPS framework offers a comprehensive, multidisciplinary approach to medication error prevention aligned to global patient safety priorities. It provides practical guidance to support safer medication practices, improved decision-making and system-wide learning. Further empirical validation is required to evaluate implementation and effectiveness across diverse healthcare settings.
Abstract Background As Thailand moves from professional telepharmacy standards to draft regulatory requirements, implementation success depends on whether community pharmacy operators perceive governance as feasible and fair. We assessed operators’ perceptions of telepharmacy governance and willingness to pay for a shared telepharmacy application, and explored explanations in free-text responses. Methods We conducted a nationwide association-based online survey of community pharmacy operators in Thailand. Structured items measured understanding, perceived safety benefit, feasibility, fairness, pharmacy system role, platform acceptance, and maximum monthly payment. Quantitative data were analysed descriptively and by business characteristics. Open-ended responses were analysed thematically and integrated with quantitative findings. Results Overall, 205 respondents completed the survey; most operated single-outlet pharmacies. Perceived understanding and safety benefit were moderate, whereas feasibility and fairness were lower, especially fairness across pharmacy sizes. A shared professional association application was supported by 71.7%. Usable payment values were available for 188 respondents; the median was 40 Thai baht/month, and 54.3% reported a positive value. Higher daily revenue was associated with greater willingness to pay (WTP) descriptively, but multivariable estimates varied by WTP outcome and should be interpreted cautiously. Themes explaining low feasibility and fairness included proportionate standards, consistent enforcement, pricing sustainability, platform reliability, interoperability, and workforce/training capacity. Conclusions Community pharmacy operators recognized the potential value of telepharmacy governance but questioned its fair and feasible implementation. Scale-up should avoid uniform requirements that disproportionately burden smaller pharmacies and should prioritize proportionate standards, reliable interoperable platforms, training support, transparent pricing, and predictable enforcement.
