https://www.um.edu.mt/library/oar/handle/123456789/2286 2026-10-16T15:26:41Z 2026-10-16T15:26:41Z https://www.um.edu.mt/library/oar/handle/123456789/149588 2026-10-01T11:45:38Z 2026-01-01T00:00:00Z

Title: Introducing national quality and patient safety indicators for acute care hospitals : a stakeholder-based approach Abstract: Background: Healthcare organisations must deliver safe, effective, and person-centred care consistently. Measuring quality and safety is essential for monitoring performance, preventing harm, identifying errors, and supporting continuous improvement. Quality and patient safety indicators are needed to generate data that support governance processes and drive quality assurance and improvement initiatives by hospitals. Aim: To develop indicators to support the licensing and monitoring of the quality of care in acute care hospitals in Malta. It also aimed to evaluate the feasibility of implementing such indicators. Methodology: A mixed-method, exploratory sequential design was employed. A structured, purposive sampling approach was employed to recruit participants. A focus group was conducted with policymakers. The RAND/UCLA Appropriateness Method was used to set the indicators. This comprised an online questionnaire with key stakeholders for the first rating of indicators and a consensus meeting for the second-round rating of indicators. Each indicator was evaluated against three criteria: ‘Relevance/Appropriateness,’ ‘Validity and Reliability,’ and ‘Feasibility.’ Information about factors affecting the implementation of indicators from the different methods was triangulated. Results: The preliminary set of indicators was identified from the literature. The final 92 indicators were mapped into a conceptual framework comprising five quality dimensions and three domains. Most indicators were mapped to the structure and process domains, while the outcome domain included the Patient-Reported Experience Measures (PREMs). Indicators related to domains of safety and effectiveness were rated highly prioritised, reflecting participants’ familiarity with clinically oriented, evidence-based practices and the presence of supporting mechanisms. In contrast, indicators addressing the domains related to human factors and system-level patient safety, particularly responsive governance and person-centred care, were less prioritised and often rated uncertain or low potential. Feasibility received the lowest scores overall, highlighting gaps in safety governance and significant systemic weaknesses that hinder the implementation of these indicators. Conclusions and recommendations: This research identified quality and patient safety indicators for acute care hospitals. Recommendations were made for the implementation of these indicators. Description: M.Sc.(Melit.)

2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145310 2026-04-02T10:28:36Z 2025-01-01T00:00:00Z

Title: The second victim phenomenon : a case study for Malta Abstract: The Second Victim Phenomenon (SVP) refers to the emotional and occupational challenges healthcare professionals face directly or indirectly after adverse events, with global prevalence ranging from 9% to over 90%. This study investigated SVP in Malta through a nationwide survey of 900 medical practitioners, nurses, and pharmacists. The Second Victims in Deutschland (SeViD) tool, the Big Five Inventory–10 (BFI-10), and open-ended questions were used to examine how demographic, workplace, cultural, and personality traits influenced risk, symptom load, and recovery. Prevalence reached 77.7% in medical practitioners, 69.8% in nurses, and 42.3% in pharmacists. Fewer than 40% recognised the term “second victim.” Event types varied by profession: medical practitioners reported patient deaths, harm, or aggression; nurses cited aggression and deaths; pharmacists noted aggression and dispensing errors. Emotional and cognitive symptoms predominated, particularly reliving the incident, self-doubt, and concentration difficulties, with prolonged symptoms reported by 18.9% of medical practitioners, 14.7% of nurses, and 11.0% of pharmacists. Risk factors differed: in medical practitioners, fewer years of experience predicted higher symptom load; in nurses, older age increased risk, while experience was protective; in pharmacists, female gender and non-Maltese nationality predicted higher symptom load, while area of practice influenced prevalence. Personality traits did not predict SVP status but shaped symptom severity, with neuroticism heightening symptoms in nurses and pharmacists and openness in medical practitioners. Support was largely informal: nurses relied on peers, medical practitioners reported minimal structured help, and pharmacists expressed stronger expectations for institutional backing. Findings aligned with European research but revealed distinctive patterns, including high prevalence and unresolved trauma in medical practitioners, age-related risk and stronger behavioural symptoms in nurses, and nationality-linked severity in pharmacists. This highlights the need for targeted interventions to build resilience, reduce stigma, and implement a phased strategy to prevent SVP and lessen its impact in Maltese healthcare. Description: M.Sc.(Melit.)

2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145309 2026-04-02T10:26:38Z 2025-01-01T00:00:00Z

Title: Malta : an ever-shifting cultural kaleidoscope : exploring cultural competence in doctors working in primary health care Abstract: The increasing cultural diversity within populations presents healthcare systems with the challenge of delivering culturally sensitive care. Although cultural competence is widely recognised as essential, its consistent integration into practice remains limited. This study assessed the cultural competence of family medicine specialists in Malta’s Primary Health Care system, across both public and private sectors, by examining individual competencies and organisational strategies promoted by healthcare leaders. Guided by a pragmatic philosophy and an abductive research strategy, the study employed a concurrent mixed-methods design. Quantitative data were collected using the validated Healthcare Provider Cultural Competence Instrument (HPCCI) via an online survey sent to all eligible family medicine specialists. A total of 41 responses were received from 240 invited MMCFD members, yielding a response rate of 17.1%. Qualitative insights were drawn from seven semi-structured interviews with healthcare leaders and policy-makers from various roles within Primary Health Care. Findings revealed a gap between cultural awareness and its application. While most respondents acknowledged its importance, only 12.2% had received formal training. Younger and less experienced doctors scored higher in awareness and self-assessment, and willingness to engage in training was linked to more culturally responsive behaviours. Although the response rate was low, the findings align with existing literature, supporting their validity. Thematic analysis identified four core themes − Beyond the Textbook, Beyond Barriers, Beyond the White Coat, and Beyond the Present − highlighting conceptual inconsistencies, systemic barriers, emotional strain, and strong support for formal training. The study emphasises the need for longitudinal training, integration of culturally responsive practices into clinical routines, and policy reform to strengthen cultural competence in Malta’s evolving healthcare landscape. Description: M.Sc.(Melit.)

2025-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/145308 2026-04-02T10:24:50Z 2025-01-01T00:00:00Z

Title: The introduction of home haemodialysis in the Maltese islands : a needs analysis Abstract: Chronic kidney disease is a major public health issue, with end-stage kidney disease patients requiring renal replacement therapy. In Malta, haemodialysis is exclusively hospital-based, creating pressures on bed capacity, accessibility and staffing. Home haemodialysis (HHD) may offer improved health outcomes and quality of life while relieving strain on the healthcare system, however, its feasibility and desirability in small island states remain largely unexplored. This study seeks to answer the question: To what extent is home haemodialysis feasible and desirable in a small island state within the European Union? The research, guided by an interpretivist approach, employed a qualitative case-study design. Semi-structured interviews and focus groups with stakeholders were conducted, and the findings were analysed using established frameworks, to provide a multidimensional, person-centred understanding of feasibility and desirability. The analysis revealed five key themes: quality of life and independence, safety and support, training and education, infrastructure and logistics, and sustainability and strategy. Data triangulation across stakeholder groups revealed perceived benefits and concerns, identifying barriers and facilitators. The results indicate that stakeholders perceive home haemodialysis as both feasible and desirable, particularly for its potential to improve quality of life, autonomy, and system efficiency. However, concerns were raised regarding training requirements, psychosocial support, and infrastructural capacity. The study concludes that successful implementation in Malta will depend on careful planning, sustained investment, and supportive policy frameworks. This dissertation contributes to the knowledge base on the introduction of person-centred dialysis care in small island states within the European Union, and its findings may serve as a basis for similar settings. Description: M.Sc.(Melit.)

2025-01-01T00:00:00Z