Clinical governance and staffing for healthcare quality: perceptions of nurses, doctors, and senior managers at two tertiary hospitals in Jamaica

To describe the characteristics of effective workforce and staffing culture among doctors and nurses at two tertiary hospitals in Jamaica, and to explore perceptions of senior managers relating to the health workforce for the delivery of quality care. A mixed-methods study was done among 216 nurses and 112 doctors, and 17 senior managers. Data on patient safety culture and the effective workforce component were collected for quantitative component. In-depth interviews were done for the qualitative component. Quantitative data were analyzed using descriptive and inferential statistics, and qualitative data were thematically analyzed and compared with selected elements of the quantitative data. Staffing culture for patient safety among doctors and nurses was poor (35% positive score). More nurses (73.6%) than doctors (34.8%) reported working 40–59 h per week. A higher proportion of nurses (85%) than doctors (67.9%) practiced responsibly with consideration of fatigue and human factors (p = 0.001), with a significant difference by institution (Institution A – 75.0%, Institution B – 81.6%; p = 0.009). Fewer than 70% of respondents reported receiving annual performance appraisals. Qualitative findings revealed issues with staff capacity development, performance management, and persistent staffing challenges, which contributed to gaps in staffing culture for patient safety. Staffing culture for patient safety was suboptimal among doctors and nurses. Key challenges identified by senior managers include inadequate staffing, limited capacity development, and weak performance appraisal systems. Strategic investment in workforce development, effective performance management, and evidence-based staffing policies is critical to strengthen clinical governance and achieve quality health care delivery. Staffing and workforce culture are critical components of clinical governance and have a direct impact on patient safety and quality of care in Jamaica. Despite global recognition of the need for strong health workforce policies, staffing culture at two major Jamaican hospitals was found to be poor, with only 35% of staff reporting positive perceptions related to safety and workload. Key challenges identified include insufficient staffing, weak performance appraisal systems, and limited institutional support for capacity development. Strategic investment in evidence-based staffing models, performance management systems, and a national health workforce strategy could strengthen clinical governance and improve the delivery of quality health care.