Inge Dhamanti

Understanding variations in hospital performance and patient safety is critical for improving health system efficiency, particularly in decentralized healthcare systems such as that of Indonesia. While geographic disparities in health outcomes are often emphasized in research, the relative contribution of spatial patterns remains underexplored. The aim of this study was to identify and visualize spatial clustering of hospital performance and mortality-oriented patient safety. Data from 428 hospitals in East Java, Indonesia, were used to develop standardized composite indices for measuring hospital performance and mortality-oriented patient safety outcomes. Spatial autocorrelation was assessed using global and local Moran’s I at both hospital and district scales. Subgroup spatial autocorrelation analyses were additionally conducted to examine whether hospitals with different institutional characteristics exhibit distinct spatial clustering patterns. The findings reveal no significant spatial clustering at the hospital level for either hospitals’ performance or patient safety outcomes. However, significant spatial clustering of patient safety outcomes emerged at the district level. Subgroup analyses revealed that class A and B hospitals show significant spatial clustering of patient safety outcomes. Local Moran's I identified high-high mortality clusters in Bondowoso and Jember districts for gross death rate, and in Madiun and Bojonegoro districts for net death rate. Low-low clusters representing districts with consistently favorable mortality outcomes were identified in Mojokerto and Bangkalan for both indicators. For policymakers, these findings highlight the need to prioritise governance and quality improvement efforts in high-risk districts while systematically learning from districts demonstrating consistently lower mortality outcomes.

Understanding variations in hospitals’ operational performance and patient safety is critical for improving health system efficiency, particularly in decentralized healthcare systems such as that of Indonesia. While geographic disparities in health outcomes are often emphasized in research, the relative contribution of spatial patterns remains underexplored. Addressing this gap, this study analyzed data from 428 hospitals in East Java, Indonesia. Composite indices were developed to measure hospitals’ operational performance and patient safety outcomes using standardized indicators. Spatial autocorrelation was assessed using global and local Moran’s I at both hospital and district scales. The findings reveal no significant spatial clustering at the hospital level for either operational performance or patient safety outcomes. However, significant spatial clustering of patient safety outcomes emerged at the district level. Finally, the findings of local Moran’s I revealed the specific districts with high and low mortality rates. For policymakers, the implications are clear. Districts revealed as high mortality regions need to receive additional attention immediately. For example, best practices could be learned from districts where low mortality prevails.

Background: The implementation of patient safety goals in hospitals, including operating rooms, is inseparable from the competence of nurses. High levels of competence also contribute to improving the quality of nursing care and enhancing patient safety. This study aims to gain a deeper understanding of the relationship between the clinical competence of operating room nurses and the achievement of patient safety goals. Methods: This study used a cross-sectional design and collected data from seven private hospitals in Ambon City, with a sample of 66 surgical nurses. The sampling technique used was simple random sampling, a method of selecting participants from a population without regard to the strata within that population. Results: The clinical competence of surgical nurses was measured using three subdomains aligned with competency areas: ethical and legal professional practice and cultural sensitivity; nursing care provision and management; and personal and professional quality development. The frequency distribution of respondents was analyzed based on these clinical competence domains. There was a significant relationship between the clinical competence of surgical nurses and patient safety goals, particularly regarding surgical procedures. Conclusions: Clinical competence is a critical component of patient safety, as it helps ensure that nurses provide safe and effective care while promoting active involvement and participation in achieving patient safety goals.

Falls are a major public and environmental health concern among older adults, frequently associated with hazardous home environments, thereby undermining the achievement of SDG 3 by increasing morbidity, injuries, and healthcare burden. Although home hazard assessment and environmental modification are widely recommended for fall prevention and creating age-friendly homes, evidence regarding their effectiveness remains inconsistent. This systematic review and meta-analysis aimed to evaluate the effects of home hazard assessment and environmental modification on fall-related outcomes among community-dwelling older adults. A systematic search was conducted in five databases (Cochrane Library, PubMed, Scopus, ProQuest, and Web of Science) from July to August 2025. Randomised controlled trials involving adults aged more than 60 years were included. Outcomes assessed were fall incidence, fall-related injury events, and medically attended falls. Risk of bias was evaluated using the RoB 2 tool. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using fixed- and random-effects models as appropriate. Ten randomized controlled trials involving 3,191 participants were included. Home hazard assessment and modification significantly reduced fall incidence (OR = 0.69; 95% CI: 0.59-0.79) and medically attended fall events (OR = 0.59; 95% CI: 0.37-0.93). However, a modest increase in reported fall-related injury events was observed (OR = 1.19; 95% CI: 1.01-1.41), likely reflecting improved surveillance and reporting. Home hazard assessment and environmental modification effectively reduce falls and fall-related healthcare utilization among community-dwelling older adults and should be integrated into community-based fall prevention strategies and age-friendly housing policies.

Background This study applied geographical standards (coverage distance) and demographic standards to investigate the capabilities of primary healthcare facilities to cover the largest area of the study area and the service area that can be accessed. This study aimed to determine the number of primary healthcare (PHC) centres required to ensure adequate healthcare coverage for the entire community. Methods Data was obtained by applying geographic information system (GIS) techniques, including proximity analysis, spatial overlay, and network analysis, to analyze primary care facilities using the demographic and geographic standards for primary care facilities. The study was conducted in Sleman District, Yogyakarta, Indonesia, using ArcGIS 10.5 and QGIS software for spatial analysis. Results PHC centers cover 79% of the study area according to the geographical standard. The study area needs 41 additional centers to cover the shortfall in service provision per the demographic and geographic standards. Conclusions A significant deficiency in the number of primary care centers found in the study area compared to the large population at the geographical and demographic standards level.

In response to the COVID-19 pandemic, healthcare workers were required to implement safety practices to protect themselves from high transmission risks. The aim of this study is to analyze the influence of personal safety practices, organizational practices, and perceived responses by healthcare workers on how they manage COVID-19 risks. This study is an analytical research using a cross-sectional method. The research instrument used was an online questionnaire distributed in June 2022. The inclusion criteria were healthcare workers serving as frontliners at Community Health Centers (Puskesmas) and Government or Teaching Hospitals in Surabaya City, with a minimum of three months of work experience during the pandemic (2020–2021). A total of 221 respondents participated in the study. The data were analyzed using multiple regression tests to examine the effect of independent variables (perceptions of personal safety practices, organizational practices, and perceived responses related to COVID-19) on the dependent variable (ways of managing COVID-19 risks). The majority of respondents were female (85.5%); 76.5% were married; 88.7% worked at Puskesmas, with 48.4% of them being accredited with full status, and 11.3% worked at hospitals, with 8.1% of those hospitals also fully accredited. This study found that personal safety practices (p = 0.000) and perceived responses (p = 0.025) had a significant effect on how healthcare workers managed COVID-19 risks. Meanwhile, organizational safety practices did not significantly affect risk management. Healthcare facilities need to provide safety training and psychosocial support to enhance healthcare workers’ preparedness and resilience during crises.

Introduction: Nurses' autonomy is a critical component of effective clinical practice, closely tied to professional competence, patient safety, job satisfaction, and organizational support. Despite its importance, autonomy remains variably defined and experienced across different healthcare systems and cultural contexts. This review explores the determinants, expressions, and implications of nurses’ autonomy based on an analysis of recent international studies.Methods: This research design uses a PRISMA-ScR in February 2024 based on PRISMA guidelines. Studies were taken from Esco, ScienceDirect, Google search, and PubMed and searched in English using the keywords nurse or nurses or registered nurse, clinical privilege or clinical autonomy or professional autonomy nurse, patient safety or quality of care from 2020 to 2024. Results: The findings reveal that nurses’ autonomy is positively associated with professional competence, role clarity, and supportive work environments. Autonomy enables nurses to participate in safety activities, advocate for patients, and contribute meaningfully to decision-making processes. Conversely, autonomy is often limited by hierarchical organizational structures, inadequate staffing, and a lack of managerial support. Studies also show that autonomy is context-dependent, with higher levels reported in critical care settings and among more experienced or specially trained nurses. Tools such as HSOPSC, SAQ, and NPC scales were commonly used to assess related variables.Conclusions: The review highlights that fostering nurses’ autonomy requires not only individual competence but also systemic change. Educational initiatives, leadership development, and non-punitive safety cultures are essential to empowering nurses.

Introduction The surgical safety checklist (SSC) is designed to improve the safety of surgical procedures, reduce avoidable complications and deaths and foster better communication and collaboration among healthcare providers. Despite the global acceptance of the initiative, there is limited comprehensive research on the challenges, success factors, impact and the role of professional organisations in SSC implementation in Indonesia. This study aimed to explore the implementation of SSC in Indonesia by investigating the challenges, success factors, impact and role of professional organisations in SSC implementation in Indonesia based on the perspective of the surgical team. Method This descriptive qualitative study, part of a larger research project, employed purposive sampling to select 13 interview participants from surgical teams across hospitals with varying ownership structures, as well as members of surgical-related professional organisations. Data were collected through in-depth interviews and analysed using thematic analysis. Results Participants acknowledged the positive impact of SSC on patient safety; however, challenges such as compliance issues, teamwork dynamics and unsafe behaviour persisted. Key success factors included strong organisational and policy support at the institutional level, including hospital accreditation, educational programmes, safety and quality committees, regular audits and workload management. However, professional organisations in Indonesia have not played a significant role in promoting SSC. Conclusion Effective SSC implementation strategies must target the micro, meso and macro levels for comprehensive success. Future research should prioritise overcoming barriers and harnessing the influence of professional organisations to standardise SSC practices, ultimately enhancing patient safety across healthcare settings.