Background Assessments of the culture surrounding patient safety can inform healthcare settings on how their structures and processes impact patient outcomes. This study investigated patient safety culture in Primary Health Care Centres in Kuwait, and benchmarked the findings against regional and international results. This study also examined the association between predictors and outcomes of patient safety culture in these settings. Methods This cross-sectional quantitative study used the Medical Office Survey on Patient Safety Culture. The study was targeted at staff of all the Primary Health Care Centres in Kuwait with at least one year of experience. Data were analysed using SPSS 23 at a significance level of ≤ .05. Univariate (means, standard deviations, frequencies, percentages) and bivariate (chi-squared tests, student t-tests, ANOVA F-tests, Kruskal–Wallis tests, Spearman’s correlation) analyses provided an overview of participant socio-demographics and the association between patient safety culture composites and outcomes. We undertook a multivariate regression analysis to predict the determinants of patient safety culture. Results were benchmarked against similar local (Kuwait, 2014), regional (Yemen, 2015) and international (US, 2018) studies. Results The responses of 6602 employees from 94 centres were included in the study, with an overall response rate of 78.7%. The survey revealed Teamwork (87.8% positive ratings) and Organisational Learning (78.8%) as perceived areas of strength. Communication about Error (57.7%), Overall Perceptions of Patient Safety and Quality (57.4%), Communication Openness (54.4%), Owner/Managing Partner/Leadership Support for Patient Safety (53.8%) and Work Pressure and Pace (28.4%) were identified as areas requiring improvement. Benchmarking analysis revealed that Kuwait centres are performing at benchmark levels or better on four and six composites when compared to international and regional findings, respectively. Regression modelling highlighted significant predictions regarding patient safety outcomes and composites. Conclusions This is the first major study addressing the culture of patient safety in public Primary Health Care Centres regionally. Improving patient safety culture is critical for these centres to improve the quality and safety of the healthcare services they provide. The findings of this study can guide country-level strategies to develop the systems that govern patient safety practices.

Purpose This paper aims to determine and assess leadership styles in six government general hospitals. Design/methodology/approach This is a cross-sectional study that uses a self-administered questionnaire to determine the leadership styles by self or followers’ rating. The participants were 66 leaders and 1,626 followers. The data were analyzed using suitable statistical methods. Findings The prevailing leadership style of hospitals’ leaders is the transformational style, where self-rating as transformational is higher than followers’ rating. The demographic characteristics of leaders are statistically insignificant. Research limitations/implications Other health-care settings were not included in the study. In addition, the study is designed to determine the relationship between variables, not to identify cause and effect. However, effective leadership has a substantial value and impact in health care. The paper confirms the existence of a transformational style effect on all organizational outcomes and represents a baseline for future studies in determining leadership styles and organizational culture types to highlight improvement areas. Practical implications The paper recommends designing training programs to improve transformational leadership behavior. Moreover, investment in research is needed to understand how to build transformational leaders. In addition, leaders' recruitment must be conditioned by obtaining a leadership certification. Originality/value This topic is under-researched in Kuwait health-care system. The use of leadership style as an indicator for a health-care organization's performance is still not well known in Kuwait.

Purpose This study aims to evaluate the relationships between leadership style and reported incidents, reporting practices and patient safety initiatives in Kuwaiti hospitals. Design/methodology/approach This cross-sectional and retrospective quantitative multi-centre study was conducted in a secondary care setting. The multifactor leadership questionnaire and the patient safety questionnaire were distributed in six general hospitals to a sample of physicians, nurses and pharmacists. Incident reports were reviewed in each hospital to assess reporting practices. Findings The hospital with the most safety incident reports scored the highest on good reporting practices, whereas the hospital with the lowest score of poor reporting practices had reported fewer incidents. Reporting was better if an error reached the patient but caused no harm. Overall, reporting practices and implementation of patient safety initiatives in the hospitals were suboptimal. Nevertheless, a transformational leadership style had a positive effect on patient safety and reporting practices. Practical implications This study represents a baseline for researchers to assess the relationship between leadership style and patient safety. Moreover, it highlights significant considerations to be addressed when planning patient safety improvement programmes. More investment is needed to understand how to raise transformational leaders who are more effective on patient safety. Further studies that include primary and tertiary health-care settings and the private sector are required. Originality/value To the best of the authors’ knowledge, this study is the first in Kuwait to report on the relationship between transformational leadership and safety practices.

Purpose: To investigate the organizational culture, assess the quality of care, and measure their association with a transformational/transactional leadership style in six hospitals. Materials and Methods:We used cross-sectional and retrospective quantitative approaches in government-sponsored secondary-care hospitals. A sample of 1626 was drawn from a frame of 9863 healthcare workers in six hospitals. Followers were surveyed using the Multifactor Leadership Questionnaire and the Organizational Description Questionnaire. We reviewed and analyzed one year (2012) of quarterly and annual quality indicators from the hospitals. Data were analyzed using suitable statistical analyses. Results: We collected 1626 responses from six hospitals. 66.4% to 87.1% of participants in each hospital identified their hospital's organizational culture as transformational, whereas 41 out of 48 departments were identified as having a transformational culture. The percentage of participants at each hospital rating their leader and organizational culture as transformational ranged from 60.5% to 80.4%. The differences between leadership style and organizational culture were statistically significant for four of the hospitals. For most of the quality indicators, there was a positive, but nonsignificant, correlation with leadership style. Conclusion: Leaders define and influence organizational culture. The prevailing transformational leadership style creates and maintains a transformational organizational culture. The effect of transformational leadership on the quality of care delivered by the organization was measured in this study, and showed a positive and nonsignificant relationship between generic quality indicators and the transformational style.

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