title: Healthcare professional perspectives on quality and safety in New Zealand public hospitals: findings from a national survey.
abstract: BACKGROUND
  Few studies have sought to measure health professional perceptions of quality and safety across an entire system of public hospitals. Therefore, three questions that gauge different aspects of quality and safety were included in a national New Zealand survey of clinical governance.
  
  
  METHODS
  Three previously used questions were adapted. A total of 41040 registered health professionals employed in District Health Boards were invited to participate in an online survey. Analyses were performed using the R statistical environment. Proportional odds mixed models were used to quantify associations between demographic variables and responses on five-point scales. Relationships between other questions in the survey and the three quality and safety questions were quantified with the Pearson correlation coefficient.
  
  
  RESULTS
  A 25% response rate delivered 10303 surveys. Fifty-seven percent of respondents (95% CI: 56-58%) agreed that health professionals in their District Health Board worked together as a team; 70% respondents (95% CI: 69-70%) agreed that health professionals involved patients and families in efforts to improve patient care; and 69% (95% CI: 68-70%) agreed that it was easy to speak up in their clinical area if they perceived a problem with patient care. Correlations showed links between perceptions of stronger clinical leadership and performances on the three questions, as well as with other survey items. The proportional mixed model also revealed response differences by respondent characteristics.
  
  
  CONCLUSIONS
  The findings suggest positive commitment to quality and safety among New Zealand health professionals and their employers, albeit with variations by district, profession, gender and age, but also scope for improvement. The study also contributes to the literature indicating that clinical leadership is an important contributor to quality improvement. WHAT IS KNOWN ABOUT THE TOPIC? Various studies have explored aspects of healthcare quality and safety, generally within a hospital or group of hospitals, using a lengthy tool such as the 'safety climate survey'. WHAT DOES THIS PAPER ADD? We used a simple three-question survey approach (derived from existing measures) to measuring healthcare professionals' perceptions of quality and safety in New Zealand's public hospitals. In doing so, we also collected the first such information on this. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? New Zealand policy makers and health professionals can take some comfort in our findings, but also note that there is considerable scope for improvement. Our finding that more positive perceptions of quality and safety were related to perceptions of stronger clinical leadership adds to the international literature indicating the importance of this. Policy makers and hospital managers should support strong clinical leadership.
authors.affiliation: Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
authors.forename: Robin
authors.initials: R
authors.lastname: Gauld
authors.affiliation: Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Horsburgh
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009520:New Zealand; D009741:Nursing Staff, Hospital; D061214:Patient Safety; D010564:Personnel, Hospital / Q000523:psychology*; D011787:Quality of Health Care; D055815:Young Adult