Evaluation of Health Services Quality in Saudi Hospitals Using a Quality Improvement Model (2014 -2017)

Abstract

The healthcare system in Saudi Arabia has serious problems with quality and safety despite the enormous fiscal expenditure by the government. There is evidence that Saudi Arabia has used some quality improvement models such as TQM to improve healthcare services during the last two decades. However, the results are still far beyond expectations. This study aims to evaluate the quality of healthcare services in Saudi hospitals using a quality improvement model. A three-phase sequential mixed method was used. In Phase one a proposed model for QI was developed using primary data from questionnaires and interviews and secondary data from literature review. The model was refined by 12 quality experts and pilot using one group pretest, posttest approach. Phase two involved selecting three hospitals for application of the model in real life settings. In Phase three multiple true experiments using Pre-test Post-test control-group design were conducted to evaluate the effect of the model on randomly selected clinical indicators. QI implementation in Saudi hospitals was found to be significantly low as measured by seven dimensions adapted from the literature with (P-value = < 0.05). The experimental study revealed significant differences between the pretest and posttest measurements in the experimental group in the three hospitals (p-value 0.035, 0.004, 0.006 consecutively) while there were no changes in the control group. This means, the proposed model has led to significant positive improvements in the experimental group. We also found no difference in the experimental group after six months of the intervention in the three hospitals (p-value 0.157, 0.704, 0.804 consecutively). This means, the improvement has been sustained after the intervention. Finally, the results showed that participants have significantly positive perceptions about the model (p-value 0.000). Apparently, there are four key factors influencing the implementation of quality improvement in Saudi hospitals. These are: organizational culture, human resources utilization, processes and systems, and structure. This study provides evidence of what quality techniques and tools facilitate successful quality improvement implementation in the Saudi context. Recommendations for Saudi hospitals are to consider these practical strategies in order to increase chances of improving and sustaining improvement. Limitations are that, this study involved three MOH hospitals only and that other governmental and private hospitals were not involved.