title: Assessing health-care providers' readiness for reporting quality and patient safety indicators at primary health-care centres in Lebanon: a national cross-sectional survey.
abstract: BACKGROUND
  Successful endorsement of quality indicators hinges on the readiness and acceptability of care providers for those measures. This paper aims to assess the readiness of care providers in the primary health-care sector in Lebanon for the implementation of quality and patient safety indicators.
  
  
  METHODS
  A cross-sectional survey methodology was utilized to gather information from 943 clinical care providers working at 123 primary health-care centres in Lebanon. The questionnaire included two sections: the first assessed four readiness dimensions (appropriateness, management support, efficacy, and personal valence) of clinical providers to use quality and safety indicators using the Readiness for Organization Change (ROC) scale, and the second section assessed the safety attitude at the primary care centre utilizing the Agency of Health Research and Quality (AHRQ) Safety Attitude Questionnaire (SAQ)-Ambulatory version.
  
  
  RESULTS
  Although two thirds (66%) of respondents indicated readiness for implementation of quality and patient safety indicators in their centres, there appear to be differences by professional group. Physicians displayed the lowest scores on all readiness dimensions except for personal valence which was the lowest among nurses (60%). In contrast, allied health professionals displayed the highest scores across all readiness dimensions. Generally, respondents reflected a positive safety attitude climate in the centres. Yet, there remain a few areas of concern related to punitive culture (only 12.8% agree that staff should not be punished for reported errors/incidents), continuity of care (41.1% believe in the negative consequences of lack in continuity of care process), and resources (48.1% believe that the medical equipment they have are adequate). Providers with the highest SAQ score had 2.7, 1.7, 7 and 2.4 times the odds to report a higher readiness on the appropriateness, efficacy, management and personal valence ROC subscales, respectively (P value <0.01). Nurses displayed relatively lower odds of readiness across all other ROC subscales as compared to all other providers.
  
  
  CONCLUSIONS
  Health-care providers at the primary health care (PHC) centres in Lebanon are ready to engage in employing quality and patient safety indicators. This is a key finding given the active efforts by the MoPH to strengthen the quality culture in the PHC sector through various strategies.
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon. ma164@aub.edu.lb.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Alameddine
authors.affiliation: Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon. ss117@aub.edu.lb.
authors.forename: Shadi
authors.initials: S
authors.lastname: Saleh
authors.affiliation: Department of Health Management and Policy, College of Public Health, University of Iowa, CPHB - N277, 145 N. Riverside Dr., Iowa City, IA, 52242, USA. nabil-natafgi@uiowa.edu.
authors.forename: Nabil
authors.initials: N
authors.lastname: Natafgi
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006268:Health Facilities; D006282:Health Personnel; D006801:Humans; D007861:Lebanon; D008297:Male; D008875:Middle Aged; D009726:Nurses; D061214:Patient Safety; D010820:Physicians; D011320:Primary Health Care; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires