title: The disparity of frontline clinical staff and managers' perceptions of a quality and patient safety initiative.
abstract: OBJECTIVE
  Arguably, a shared perspective between managers and their clinical staff on an improvement initiative would allow for most effective implementation and increase programme success. However, it has been reported that research has failed to differentiate between managers and line employees on quality management implementation and examine their differences in perceptions of quality and safety initiatives. The aim of this study was to compare clinical frontline staff and senior managers' perceptions on the importance of an organization-wide quality and safety collaborative: the Safer Patients Initiative (SPI).
  
  
  METHODS
  A quantitative study obtained 635 surveys at 20 trusts participating in SPI. Participants included the teams and frontline staff involved within the programme at each organization. Independent T-tests were carried out between frontline staff and senior managers' perceptions of SPI programme elements, success factors and impact & sustainability.
  
  
  RESULTS
  Statistically significant differences were found between the perceptions of frontline staff and senior managers on a wide number of issues, including the frontline perceiving a significantly larger improvement on the timeliness of care delivery (t = 2.943, P = 0.004), while managers perceived larger improvement on the culture within the organization for safe, effective and reliable care (t = -2.454, P = 0.014).
  
  
  CONCLUSIONS
  This study has identified statistically significant disparities in perceptions of an organization-wide improvement initiative between frontline staff and senior managers. This holds valuable implications for the importance of getting both frontline and management perspectives when designing such interventions, in monitoring their performance, and in evaluating their impact.
authors.affiliation: Imperial College London, London, UK. a.parand@imperial.ac.uk
authors.forename: Anam
authors.initials: A
authors.lastname: Parand
authors.forename: Susan
authors.initials: S
authors.lastname: Burnett
authors.forename: Jonathan
authors.initials: J
authors.lastname: Benn
authors.forename: Anna
authors.initials: A
authors.lastname: Pinto
authors.forename: Sandra
authors.initials: S
authors.lastname: Iskander
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D006282:Health Personnel; D006740:Hospital Administrators; D006801:Humans; D015279:Organizational Culture; D061214:Patient Safety; D010465:Perception; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D017751:Safety Management / Q000458:organization & administration*; D013997:Time Factors