https://www.um.edu.mt/library/oar/handle/123456789/39758 Fri, 17 Apr 2026 18:46:07 GMT 2026-04-17T18:46:07Z https://www.um.edu.mt/library/oar/handle/123456789/40661 Title: Beyond medical errors : patient safety culture in a Maltese obstetrics department Abstract: The World Health Organisation (2016a) defines patient safety as the absence of preventable harm to a patient during the delivery of healthcare. Evidence from several scholars and researchers has shown the high incidence of patient harm and subsequent high cost of medical errors in hospitals in general and within Obstetric Units. This research study tests a moderated mediated relationship between patient safety friendly working environment and perceived unsafe performance in the Maltese Obstetrics department with burnout as the mediator variable and management support as the moderator. A cross-sectional descriptive and analytical research study was conducted. The target population includes the three Obstetric wards, the Central Delivery Suite, the Breastfeeding clinic and the Neonatal Intensive Care Unit. A sample of 184 healthcare professionals, who fit the eligibility criteria, participated in the research study, achieving a response rate of 73.6%. The research tool in this study was adapted from the ‘Safety Attitudes Questionnaire- Labour and Delivery version’ (Appendix B), from Sexton et al., (2006). Overall, the findings support the theoretical framework. Findings support the hypothesis: the higher the extent to which a patient safety friendly working environment is perceived as favourable to the obstetric team, the lower the obstetric team’s perceived unsafe performance. Findings also support the hypothesis: burnout mediates the relationship between a patient safety friendly working environment and perceived unsafe performance. Moreover, findings support the hypothesis: management support has a negative relationship on perceived unsafe performance. Essentially managers should be seen as supportive and as leaders who act safely, work safely, speak of safety and engage others in safety standards and initiatives. The present research study sheds light on the fact that managers should not focus on safety in isolation, but should implement safety management systems where threats and disturbances that may destabilize the system are identified, monitored and controlled as recommended by Carayon et al., (2006). Health service managers are recommended to create a working environment which fosters staff wellbeing that protects against burnout by finding a balance between job demands and job resources. Future research should adopt a longitudinal design, so as to be able to measure independent variable mediator and moderator at T1 and dependent variable at T2, while controlling for T1. Furthermore a mixed methods approach would have given more depth to the research study. Further research should identify and investigate other safety culture dimensions, develop level-specific subscale perceptions and analyse data at the work group level. In addition, further research should extend the present research study to other healthcare settings, focus on the effectiveness of strategies aimed at improving a patient safety friendly working environment and management support and how these strategies can be adapted to specific units and to hospital subcultures. Description: M.SC.HEALTH SERVICES MANGT. Mon, 01 Jan 2018 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/40661 2018-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/40659 Title: Primary health care reforms in Malta : an analysis of the policy process Abstract: Background: The World Health Organisation has repeatedly encouraged the development of primary care, viewed as an essential component for health systems to fulfil their core objectives. However, the Maltese health system is to date relatively weak in terms of primary care performance. Historically, several initiatives to reform the Maltese primary care system yielded limited results. The purpose of this study is to analyse the local policy-making process in primary care spanning the last six decades. Objectives: The objectives of the study are 1) to understand the history and background of primary health care policy in Malta, 2) to explore the factors contributing to the success and/or failure of primary care policy proposals and 3) to reflect on past local primary care policy in order to provide foundations for relevant future policies. Methodology: This qualitative case study employed a snowball sampling technique. A self-designed tool was utilised to conduct semi-structured interviews. Triangulation of results was achieved through documentary analyses. Results: Seventeen interviews were conducted yielding a response rate of 81%. A new conceptual framework based on Kingdon’s theory combined with an inspired concept of actors from Sabatier’s theory was devised as the analytical framework. The attempted reforms studied include: the 1987-1993 family doctor scheme, the 1999 proposals in improving primary care services, the 2008-2010 doctor of your choice scheme and the 2013 public sector contractual agreement. The main focus of attempted local reforms revolved around implementing a patient registration scheme in order to introduce a gatekeeping role. Despite being very close in achieving such a system in the 1987-1993 initiative, all these efforts were futile and such a system was never implemented. Moreover, participants elicited how the ten-year medical-political dispute influenced all subsequent primary care policy negotiations. The sensitive nature of health in a locally highly charged political context was perceived to have dominantly shaped primary care policy-making throughout the years. Findings further revealed how different stakeholders shifted ground between one attempt at reform and another, highlighting the relationship of veto players in policy-making processes. Conclusions: This is the first study of its kind to have been attempted locally. The obstacles in reforming the Maltese primary care setting are mainly perceived to be political and financial factors. Interviewees suggested the importance of formulating policy according to local contextual needs and circumstances rather than based on what is observed in other countries. The importance of creating and implementing gradual, subtle changes was emphasised in order to minimise resistance. It is recommended that promoting public involvement and aiming for innovative approaches to render the sector attractive for young newly qualified doctors who seem to hold the potential for future improvements in the Maltese primary care sector, are actions that should be pursued. Hence, key implications suggest to meticulously include all stakeholders from initial policy formation stages and to invest more efforts in long-term, culturally and contextually appropriate sustainable policy goals. Description: M.SC.HEALTH SERVICES MANGT. Mon, 01 Jan 2018 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/40659 2018-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/40648 Title: Employee engagement and adaptive performance achieved by agile transformational leaders in a changing healthcare system Abstract: While transformational leadership has been a well-known concept, excelling as a leadership model, as work environments continue encountering continuous change, leadership agility is steadily gaining momentum. Today’s leaders must be able to equip their staff with skills and practices, enabling them to engage and adapt their performance to change. The study aims to examine the hypothesized relationships between transformational leadership and leadership agility, and how their interaction impacts adaptive performance. Furthermore, the study seeks to look into work engagement as a mediator to the described relationship. A cross sectional study, repeated at two time points, was deemed the most appropriate method for this study. Quantitative data were collected by means of a psychometrically validated questionnaire. The sample consisted of 881 professionals working within the sampled units within Mater Dei Hospital, Rehabilitation Hospital Karin Grech, and Gozo General Hospital. A response rate of 49% in data collection one, and 45% in data collection two, was acquired. The findings show that the interaction of transformational leadership with leadership agility, heightens their effect on adaptive performance. Furthermore, the absence of leadership agility in the relationship resulted in a negative impact of transformational leadership on adaptive performance in the second data collection. Conflicting results emerged with work engagement as a mediator to the relationship. While a statistically significant result emerged in the first data collection, establishing work engagement as a mediator, this was not reciprocated in the second data collection. The study supported the notion that the interaction of transformational leadership and leadership agility, enhances their effect on adaptive performance. Since this concept was not looked into before, it adds on to existing literature. However, the conflicting results of work engagement as a mediator pushes forward the need for further research on the topic. Description: M.SC.HEALTH SERVICES MANGT. Mon, 01 Jan 2018 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/40648 2018-01-01T00:00:00Z