Measuring and improving the person centeredness and quality of care in Saudi Arabia

Abstract

Background Although the health care system in Saudi Arabia (SA) has improved dramatically over the last three decades, there is a need for further improvement in the quality of health care provision. Patient safety, clinical effectiveness and person-centredness are some of the many areas requiring improvement. Several studies have investigated patient safety and clinical effectiveness for hospitals in SA, while person-centredness has received little attention in SA and elsewhere. Recently, there have been increasing calls for a person-centred rather than a disease-centred approach to health care in SA. The implementation of person-centred care (PCC) in healthcare settings has been one of the important changes in many developed countries. This is the first study in the context of SA to evaluate the quality of healthcare services by assessing person-centredness.

Aims The primary aim of this study is to explore the extent to which healthcare is person-centred in teaching and non-teaching hospitals in SA, and to investigate the literature on person-centred care and to review the level of quality of care in hospitals in SA. It also aims to validate the Arabic versions of the person-centred climate questionnaires and to make recommendations for improving PCC in hospitals in SA.

Method Design: This is a quantitative study that employed a comparative design using a cross-sectional, survey research approach. Setting: Eight tertiary hospitals from two different providers of health care in SA. Four teaching hospitals funded by the Ministry of Education, and another four non-teaching hospitals funded by the Ministry of Health were included in this study. Participants: 705 patients, 698 family members and 778 healthcare professionals completed the person-centred climate questionnaire (PCQ) that was used to explore the extent to which healthcare is person-centred in teaching and non-teaching hospitals in SA. The PCQ patient and family member versions have three subscales (a climate of safety, everydayness and hospitality), whereas the PCQ staff version has three dimensions (safety, everydayness, and community).

Results The response rate was more than 77% from the two sectors. Overall, the study findings showed that there were statistically significant differences between respondents’ views in teaching and non-teaching hospitals in relation to the PCQ total mean scores and its three subscales (safety, everydayness and hospitality or community). Participants in teaching hospitals reported a higher level of person-centred care compared to those in non-teaching hospitals. This study indicates that patients had a significantly higher level of PCC (M= 46.10, SD= 8.48) at p <.05 followed by family members. Healthcare professionals reported a low level of PCC compared to the other two groups. The overall results of this study showed that there were satisfactory levels of PCC, particularly in safety and hospitality subscales as reported by patients, family members and healthcare professionals. However, the findings highlighted that the everydayness subscale had lower mean scores as compared to other subscales indicating the healthcare environment lacked positive physical attributes and was not recognised as home-likeness. The Arabic version of the person-centred climate questionnaire showed satisfactory validity and reliability for assessing patients’, family members’ and staff’ perceptions of PCC in Saudi hospitals settings with a Cronbach’s alpha of 0.95, 0.97 and 0.98 respectively.

Conclusion This study exemplifies the need for further improvement in the quality of healthcare in SA. Many of the problems identified in this thesis could be addressed by establishing and implementing PCC at the primary, secondary and tertiary care level. In order to maximise the level of PCC in SA, factors related to the physical environment such as layout, artwork, paintings or decorations need improvements to make the healthcare setting feels homely, quiet and peaceful area with positive distraction from unpleasant thoughts. Moreover, a comprehensive and continuous quality assessment and improvement system in Saudi hospitals is essential to achieve high level of quality of healthcare