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Healthcare
Special Issues
Continuous Quality Improvement and Patient Safety in Healthcare
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Continuous Quality Improvement and Patient Safety in Healthcare

A special issue of Healthcare (ISSN 2227-9032).

Deadline for manuscript submissions: closed (30 April 2026) | Viewed by 4572

Editor

Dr. Antonio Giulio De Belvis

E-Mail Website
Guest Editor
Agostino Gemelli University Hospital—Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 00168 Rome, Italy
Interests: quality improvement; patient safety; value-based model; audit & feedback; performance measurement

Special Issue Information

Dear Colleagues,

In recent years, continuous quality improvement (CQI) has become a cornerstone in the pursuit of excellence in healthcare delivery. As systems face increasing complexity, limited resources, and evolving patient needs, healthcare organizations must adopt systematic, data-driven approaches to improve clinical outcomes, reduce errors, and enhance patient satisfaction.

We are pleased to invite you to contribute to this Special Issue of Healthcare titled "Continuous Quality Improvement and Patient Safety in Healthcare". This Special Issue aims to explore methodologies, frameworks, and case studies that illustrate how CQI principles can be applied across diverse clinical and organizational contexts to promote patient safety and better health outcomes. This topic aligns with the journal’s mission to support evidence-based practices that elevate the quality and sustainability of healthcare systems.

Original research articles and reviews including (but not limited to) the following areas of interest are welcome:

  • CQI models and their applications in clinical settings;
  • Performance assessments with feedback regarding results;
  • Value-based healthcare;
  • Digital, real-time quality monitoring systems/dashboards;
  • Multidisciplinary approaches to patient safety;
  • Patient-centered quality initiatives;
  • The collection and analysis of PREMs and PROMs for patient satisfaction.

We look forward to receiving your valuable contributions.

Dr. Antonio Giulio De Belvis
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • continuous quality improvement
  • patient safety
  • value-based healthcare
  • outcome measurement
  • clinical performance evaluation
  • patient satisfaction

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (5 papers)

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Research

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17 pages, 2807 KB  
Article
Online Patient Reviews for Continuous Quality Improvement: Topic Modeling of Hospital Service Quality in Taiwan and the United States
by Sheng-Hsun Hsu and Shwu-Fen Chiu
Healthcare 2026, 14(11), 1580; https://doi.org/10.3390/healthcare14111580 - 4 Jun 2026
Viewed by 191
Abstract
Background/Objectives: Continuous quality improvement (CQI) requires timely, patient-centered evidence on how people experience healthcare delivery. Structured surveys provide important benchmarks, but their predetermined items may miss emerging or system-specific concerns. This study assesses whether unsolicited online patient reviews can serve as a [...] Read more.
Background/Objectives: Continuous quality improvement (CQI) requires timely, patient-centered evidence on how people experience healthcare delivery. Structured surveys provide important benchmarks, but their predetermined items may miss emerging or system-specific concerns. This study assesses whether unsolicited online patient reviews can serve as a scalable patient-experience data source for identifying hospital service quality priorities across contrasting healthcare systems. Methods: We analyzed 8247 Google Maps hospital reviews posted in 2024, including 5007 Chinese-language reviews from 24 Taiwanese medical centers and 3240 English-language reviews from 21 large U.S. referral hospitals. Separate language-specific preprocessing pipelines and Latent Dirichlet Allocation (LDA) topic models identified patient-salient service quality dimensions in each country. Cross-lingual semantic mapping then distinguished universal dimensions from system-specific concerns, and star-rating differences across semantically equivalent dimensions were compared. Results: Seven service quality dimensions emerged in each country: five were cross-nationally shared (emergency care, positive care experience, professional medical team, administrative process, and inpatient/treatment care), and each system had two system-specific dimensions. Taiwanese reviews foregrounded service attitude and facility/environment quality, while U.S. reviews foregrounded billing/insurance and clinic systems/access. Ratings for emergency care and administrative process were consistently low across both systems, whereas ratings for the professional medical team were substantially higher in U.S. reviews. Conclusions: Online patient reviews can complement formal patient-experience instruments by revealing actionable CQI priorities that are both universal and context dependent. Emergency care and administrative efficiency represent shared improvement needs across both systems. System-specific interventions include interpersonal training and infrastructure investment in high-utilization single-payer settings, and billing transparency and care coordination in fragmented multi-payer systems. Institutional structures appear to play a more prominent role than cultural factors in shaping which service quality dimensions emerge, though both forces contribute. Established frameworks may inadequately capture system-specific patient concerns. Full article
(This article belongs to the Special Issue Continuous Quality Improvement and Patient Safety in Healthcare)
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18 pages, 1292 KB  
Article
Threaded Antibiotic-Coated Locking Nails in Osteomyelitis-Associated Long-Bone Non-Union: Short-Term Outcomes of a Prospective Cohort
by Akef Obeidat, Abdal Ahmad, Akhtar Hussain, Saeed Ahmad, Hidayat Ullah, Mahmood Ul Hassan, Muhammad Abrar and Sadia Qazi
Healthcare 2026, 14(8), 1091; https://doi.org/10.3390/healthcare14081091 - 20 Apr 2026
Viewed by 418
Abstract
Background: Long-bone non-unions complicated by osteomyelitis remain a major reconstructive and healthcare challenge, particularly in resource-limited settings with a high prevalence of multidrug-resistant (MDR) pathogens. Conventional staged management is associated with a prolonged treatment burden, repeated procedures, and delayed functional recovery. This [...] Read more.
Background: Long-bone non-unions complicated by osteomyelitis remain a major reconstructive and healthcare challenge, particularly in resource-limited settings with a high prevalence of multidrug-resistant (MDR) pathogens. Conventional staged management is associated with a prolonged treatment burden, repeated procedures, and delayed functional recovery. This study evaluated the clinical, radiological, functional, and short-term safety outcomes of a single-stage approach using custom-threaded antibiotic-coated locking nails (TACLNs) in a high-resistance cohort. Methods: This prospective single-center cohort study enrolled 30 adults with osteomyelitis-associated femoral or tibial nonunion at a tertiary hospital in Peshawar, Pakistan. All patients underwent radical debridement and single-stage stabilization with a chest tube mold TACLN loaded with vancomycin and gentamicin, with culture-directed adjunctive antibiotics for resistant organisms. Outcomes were assessed at baseline, Weeks 3 and 6, and Month 6 using inflammatory markers, RUST score, VAS pain, EQ-5D-5L, ASAMI criteria, and return to work or usual activity. No formal sample size calculation was performed, and this study was exploratory in nature. Results: The cohort (mean age 44.9 ± 9.9 years) had a challenging microbiological profile, with 40.0% MDR and 13.3% extensively drug-resistant (XDR) infections. By Month 6, short-term infection control was achieved in 96.7% of patients, with significant reductions in ESR and CRP (both p < 0.001). Radiographic union was achieved in 90.0% of cases at a mean of 18.6 weeks, and the mean RUST score improved from 4.87 to 10.43 at the final follow-up. The VAS pain decreased from 5.23 at week 3 to 0.73 at month 6, EQ-5D-5L improved from 0.39 to 0.84, and 90.0% returned to work or usual activity by month 6. No cement debonding, implant failure, or nephrotoxicity was noted. Conclusions: In this single-arm exploratory cohort, TACLNs were associated with favorable short-term infection control, radiographic union, and functional recovery in osteomyelitis-associated long-bone nonunion, including in an MDR/XDR setting. The independent contribution of the threaded core design cannot be established. Larger multicenter comparative studies with longer follow-ups are needed to confirm the durability and implementation feasibility. Full article
(This article belongs to the Special Issue Continuous Quality Improvement and Patient Safety in Healthcare)
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11 pages, 382 KB  
Article
Changes in Health Facility Readiness for Providing Quality Maternal and Newborn Care After Implementing the Safer Births Bundle of Care Package in Five Regions of Tanzania
by Damas Juma, Ketil Stordal, Benjamin Kamala, Dunstan R. Bishanga, Albino Kalolo, Robert Moshiro, Jan Terje Kvaløy, Godfrey Guga and Rachel Manongi
Healthcare 2025, 13(23), 3060; https://doi.org/10.3390/healthcare13233060 - 26 Nov 2025
Viewed by 1278
Abstract
Background: Maternal and newborn morbidity and mortality remain a pressing challenge with uneven progress globally and in Tanzania. The capacity of health facilities to provide quality care is critical to improving outcomes. This study aimed to assess changes in health facilities’ readiness to [...] Read more.
Background: Maternal and newborn morbidity and mortality remain a pressing challenge with uneven progress globally and in Tanzania. The capacity of health facilities to provide quality care is critical to improving outcomes. This study aimed to assess changes in health facilities’ readiness to provide quality maternal and newborn care, and hence aimed to inform improvements in quality-of-care interventions in Tanzania. Methods: A before and after assessment of 28 comprehensive emergency obstetric and newborn care health facilities implementing the Safer Births Bundle of Care package in five regions of Tanzania was carried out in December 2020 and January 2023. We adapted the World Health Organization’s Service Availability and Readiness Assessment tool, which covered amenities, equipment, staff, guidelines, medicines, and diagnostic facilities. Composite readiness scores were calculated for each category and results were compared at the health facility level. For categorical variables, we tested for differences by Fisher’s exact test; for readiness scores, differences were tested by linear fixed and mixed model analyses, considering dependencies within the regions. We used p < 0.05 as our level of significance and measured change from baseline using a paired t-test. Results: The overall readiness improved significantly from 67.6% to 83.7% (p < 0.05). Statistically significant improvements were seen in medical equipment (77.1% to 94.0%), diagnostic/treatment commodities (69.3% to 83.1%), and availability of guidelines (50.8% to 96.7%). Changes in amenities (78.1% to 84.2%) and staff (63.0% to 61.7%) were not significant. The overall readiness improved in all facility types and the change was statistically significant in district hospitals and health centres (p < 0.05). There were significant differences in improvement between regions (p < 0.05) Conclusions: The overall readiness has improved significantly, reflecting a positive change. However, there remains a need for further enhancement, particularly in terms of staffing, to ensure high-quality maternal and newborn care. Authorities should take swift action to address the identified gaps, selecting the most effective and practical interventions while closely monitoring progress in readiness and sustaining the gains. Full article
(This article belongs to the Special Issue Continuous Quality Improvement and Patient Safety in Healthcare)
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16 pages, 1262 KB  
Article
Measuring Surgical Waiting Times in Breast Cancer: Admission to Surgery Versus Biopsy Result to Surgery
by Cem Tandoğan, Mustafa Berkeşoğlu, Ferah Tuncel, Didem Derici Yıldırım, Cumhur Özcan, Sami Benli, Erkan Güler and Eda Bengi Yılmaz
Healthcare 2025, 13(23), 3010; https://doi.org/10.3390/healthcare13233010 - 21 Nov 2025
Viewed by 974
Abstract
Background: Preoperative timelines may lengthen due to tailored evaluation and system constraints. We examined whether two complementary measures of time-to-surgery (TTS)—admission-to-surgery (A-TTS) and biopsy-result-to-surgery (B-TTS)—behave similarly and whether parallel tracking offers service value. Methods: In a single-center retrospective cohort of eligible women undergoing [...] Read more.
Background: Preoperative timelines may lengthen due to tailored evaluation and system constraints. We examined whether two complementary measures of time-to-surgery (TTS)—admission-to-surgery (A-TTS) and biopsy-result-to-surgery (B-TTS)—behave similarly and whether parallel tracking offers service value. Methods: In a single-center retrospective cohort of eligible women undergoing upfront surgery for invasive breast cancer (2010–2021; n = 167), we reported quality indicators for timeliness (target attainment, agreement and discordance, the interval gap, and the surgery-to-adjuvant interval), while analyzing recurrence as the primary endpoint and overall survival as secondary. Discrimination analyses, logistic regression, and Cox models were used; non-proportional hazards were handled with a log–time interaction centered at 24 months. Results: The two time measures were not interchangeable: discordant cases were frequent and pointed to different bottlenecks. A-TTS ≤ 24 days was independently associated with recurrence (OR 3.16; 95% CI 1.13–8.82) and showed a large early hazard for death at 24 months that attenuated over time (HR 22.83; 95% CI 6.44–80.98; interaction HR 0.06; 95% CI 0.02–0.21), whereas B-TTS showed no association. Conclusions: Lymphovascular invasion remained the strongest pathologic correlate of survival. Tracking both intervals, paired with brief, reason-coded reviews of discordant cases, may support scheduling, quality dashboards, and breach governance better than a single TTS metric. Full article
(This article belongs to the Special Issue Continuous Quality Improvement and Patient Safety in Healthcare)
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19 pages, 283 KB  
Hypothesis
From Criminal Liability to Patient Safety: The Possible Impact of the Italian 2025 Reform Proposal on Senior Healthcare Leadership and Clinical Risk Management
by Sandro La Micela, Gloria Stevanin, Anna Pancheri, Camilla Faes, Annamaria Bonetti, Silvia Atti, Ilaria Tocco Tussardi and Stefano Tardivo
Healthcare 2026, 14(11), 1494; https://doi.org/10.3390/healthcare14111494 - 28 May 2026
Viewed by 477
Abstract
This article analyses the Italian Legislative Delegation Bill of 4 September 2025 (DDL 2025), which proposes the recontextualization of healthcare liability through the introduction of Article 590-septies into the Italian Criminal Code (c.p.) and the amendment of Article 590-sexies c.p. and of Articles [...] Read more.
This article analyses the Italian Legislative Delegation Bill of 4 September 2025 (DDL 2025), which proposes the recontextualization of healthcare liability through the introduction of Article 590-septies into the Italian Criminal Code (c.p.) and the amendment of Article 590-sexies c.p. and of Articles 5 and 7 of the Gelli-Bianco Act (Law No. 24/2017). The study examines the extent to which the reform, if enacted, would produce a shift of criminal negligence liability from the individual frontline clinician towards the apex management figures of healthcare organizations—at both the corporate and hospital levels—and under what conditions such a shift would be compatible with the constitutional principle of personal criminal responsibility (Art. 27 Const.) and with the evidentiary criteria for criminally relevant omission. Adopting a doctrinal and jurisprudential analysis approach, the study formulates a falsifiable hypothesis, accompanied by four ex post verifiability indicators observable over a five-year time horizon following the possible entry into force of the provision. The analysis demonstrates how the DDL 2025 would recontextualize the notion of culpa—encompassing imperizia (lack of skill), negligenza (negligence), and imprudenza (imprudence), functionally comparable to forms of criminal negligence in common law systems—by linking fault assessment to contextual factors such as organizational deficiencies and resource scarcity. This approach would adopt a deflationary framework, establishing a distinction between avoidable human error and errors caused by systemic dysfunctions and foreshadowing a potential shift of liability towards apex management, who are required to ensure organizational models adequate to patient safety. This orientation, far from constituting a doctrinal novelty, would formalize ex lege a trajectory already established in civil and criminal case law of the Court of Cassation (Cass. No. 6386/2023, “Travaglino”), further intersecting with the administrative liability regime for organizations under Legislative Decree 231/2001. Significant interpretive challenges remain, related to the application of criminal liability criteria to the omissive conduct of healthcare managers, as well as to the contrasting international evidence on the behavioural effectiveness of medical liability reforms. The redefinition of top-management liability would therefore be configured not merely as a tool for the protection of the individual professional but as a derived constitutional guarantee of the right to health and the safety of care, pursued through formalized risk governance, the integration of incident reporting and organizational audit systems, the transition towards Enterprise Risk Management models, and the traceability of apex decision-making processes. Examples drawn from other European jurisdictions illustrate the heterogeneity of legal approaches to medical fault and frame the Italian proposal as a context-specific solution that nonetheless could contribute to the international debate on institutional and organizational accountability for patient safety. Full article
(This article belongs to the Special Issue Continuous Quality Improvement and Patient Safety in Healthcare)
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