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A structural model of total quality management, work values, job satisfaction and patient-safety-culture attitude among nurses.

AIM
This study explores the impact of total quality management on patient-safety-culture attitudes among clinical nurses, focusing on the correlations between total quality management, work values, employee satisfaction, and patient-safety-culture attitudes.


BACKGROUND
Implementing total quality management can improve nurses' attitudes towards patient-safety culture.


METHOD
This hospital-based, cross-sectional survey used a convenience sample of 30 inpatient units and 12 intensive care units at five Taiwanese regional teaching hospitals with over 500 beds. Seven hundred questionnaires were distributed (140 to each hospital) during 25 June-5 July 2015. Data were collected using an anonymous, self-administered, and structured questionnaire. The model was tested using structural equation modelling and serial mediation analysis.


RESULTS
Of 515 completed questionnaires (73.6% response rate), 23 were invalid and 492 were used (70.3% retrieved rate). The total effect of total quality management on patient-safety-culture attitudes was significant via work values, which had a direct influence on patient-safety-culture attitude. Total quality management affected employee satisfaction, which directly influenced patient-safety-culture attitudes.


CONCLUSION
Total quality management creates a beneficial working environment and improves patient-safety culture. Total quality management, work values, and employee satisfaction orientation are important predictors of nurses' attitudes toward patient-safety-culture attitudes.


IMPLICATIONS FOR NURSING MANAGEMENT
Health care managers should cultivate nursing performance to achieve continuous quality improvement in nursing care.