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Purpose: Despite the numerous benefits of adopting international construction joint ventures (ICJVs), effective operation of the joint ventures in Saudi Arabia is impeded by various limitations. Thus, this paper is aimed at determining, analyzing, and prioritizing these major limitations and to propose a strategy that can provide guidance on how best to promote the achievement of efficient joint ventures in international construction in Saudi Arabian construction industry. Design/methodology/approach: Content analysis was augmented by the expert-based assessment process to identify the critical limitations while the interpretive structural modeling (ISM) technique was utilized to analyze and determine the hierarchical structure of the limitations. This is important in order to comprehend and describe the complex relationship between the limitations. Findings: The results identified "selecting unsuitable partner", "divergent organizational cultures, policies and procedures", and "poor knowledge of local regulations by foreign partners" as the most critical limitations affecting the efficiency of joint ventures in international construction in Saudi Arabia. Research limitations/implications: The inclusion of many variables (limitations) increases the complexity of the ISM technique, which compels the researchers to consider reduced number of variables in establishing the ISM structural hierarchy. Other variables that were perceived to be less critical were not included in the development of the ISM structural hierarchy. On the other hand, the structural hierarchy was not validated statistically, and this requires the use of other linear structural relationship techniques like the Structural Equation Modeling to test the validity of the hypothetical ISM structural hierarchy. The proposed strategy to mitigate the limitations presented in this study was not validated, and this requires further study to verify the accuracy of the strategy. Practical implications: The implications inferred in this study are better performing ICJVs in the execution of mega infrastructure projects in Saudi Arabia. The findings and managerial implications of the study are expected to further provide an invaluable guide that can support policymakers and all key stakeholders to establish efficient strategies and suitable measures that can enhance the successful implementation of ICJVs. Originality/value: The findings of this study provide comprehensive understanding of the limitations affecting the efficiency of ICJVs in Saudi Arabia. This can assist in mitigating the potential impacts of these limitations and to advocate for the achievement of efficient joint ventures in international construction in Saudi Arabia. Meanwhile, there is a need to further develop a framework that can elucidate on the proposed strategy to promote better performing ICJVs in Saudi Arabia. Also, the further study will seek to investigate the influence of project duration, value, location, or ownership on the performance of the joint ventures in order to generalize the findings to all forms of ICJVs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to empirically test the association between total quality management (TQM) and small and medium enterprises' (SMEs) performance. In particular, it examines whether organizational culture (OC) has a mediating effect on the TQM–SME performance relationship. Design/methodology/approach: The conceptual model for this study was developed based on the literature review of TQM, OC and SME performance. As the research framework, a self-administered questionnaire was used to collect data from managers/owners of SMEs in the Riyadh, Mecca and Eastern regions of the Kingdom of Saudi Arabia. The instrument was evaluated for its validity and reliability. A structural equation model was designed to examine the relationships, using PLS 3.0. Findings: Statistical outcomes add to the literature through displaying a positive direct effect of TQM and OC on SMEs' performance, and a significant and positive indirect effect of TQM on SMEs' performance through OC. Research limitations/implications: The quantitative cross-sectional research design investigated a sample of manufacturing SMEs. Future research could use qualitative techniques or a case study approach for further information analysis. Practical implications: The findings of this research provide insights into SMEs' owners/managers in today's dynamic manufacturing environment, focussing on TQM as a mechanism for improving their performance. The results can help SMEs by providing guidance on OC, because of its effect on the successful implementation of TQM, therefore improving the level of performance. Originality/value: The research extends the literature of TQM with a comprehensive understanding of TQM from the perspective of SMEs in Saudi Arabia. It fills the gap in empirical studies that investigate the joint effect of TQM and OC on SMEs' performance. This paper highlights the theoretical contribution and managerial implications as well as making recommendations for future research. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine how nurse managers' leadership styles, work engagement, and nurses' organizational commitment are related in Saudi Arabia. Methods: This study used a cross-sectional design using an online survey instrument targeted at nurse managers and nurses working in Saudi Arabian hospitals. Multi-factor leadership questionnaire (MLQ), organizational commitment questionnaire (OCQ), and Utrecht Work Engagement Scale (UWES) were used in the Questionnaire. The survey link is forwarded to HR administrators of 71 hospitals, which includes public, private, and public–private partnership hospitals. The survey link was active from 27th November 2021 to 18th December 2021, and at the end of the survey, 394 responses were received. After removing the incomplete responses, 390 participant responses are considered for data analysis. t-tests and correlation analysis are used to analyze the data. Results: Among the participants, 84.4% of the participants were nurses and 15.6% were nurse managers. Significant difference (p < 0.05) of opinions is observed among nurse managers in relation to transformational and transactional leadership styles and engagement. Transformational and transactional leaderships are positively correlated with organizational commitment and nurses' engagement. Conclusion: Differences in leadership style perceptions among nurses and nurse managers reflected issues in nursing management, which have to be addressed in light of rapid infrastructural changes owing to Saudi vision 2030. [ABSTRACT FROM AUTHOR]

Accreditation is a widespread culture internationally and nationally. The effectiveness of compliance with accreditation standards was positively correlated with health care settings' performance in multiple aspects: leadership, professional performance, patient safety and organizational culture. There is limited knowledge of the national compliance rate with accreditation standards. Therefore, it is important to assess the hospital compliance with accreditation rate in the Kingdom Saudi Arabia (KSA) and its related factors. This paper presents a quantitative cross-sectional study. Data were extracted from the annual Essential Safety Requirement (ESR) survey database from the Central Board for Accreditation of Health care Institutions (CBAHI) research center during the period 2016 to 2018. Hospitals that started their operation after the first ESR survey round in 2016 or shut down during the study period were excluded. The hospital scoring was on a scale of 0 to 100 and classified as follows: score 2 if the hospital satisfactory compliance (Fully Met) was ≥ 80% and score 1 if particular compliance (Partially Met) was ≥ 50% to < 80%. Then, a score of 0 indicated insufficient compliance (Not Met) when < 50% and a score of not applicable (NA) if the standard does not apply to the hospital. A total of 437 hospitals were surveyed in 20 regions in the KSA and had an overall compliance rate on average that was higher among private hospitals than among public hospitals (77% vs. 66%). Overall, private hospitals had a significantly better compliance rate than public hospitals (mean rate = 84% vs. 68%, respectively, P = 0.019). Large hospitals had more compliance with some standards than smaller hospitals. After adjusting for the year of the survey report, the private hospital type was more compliant than the public hospital. This study supports mandatory accreditation programs for both public and private health sectors, with increased monitoring by the concerned parties (i.e., CBAHI and the Ministry of Health). The authors encourage the application of accreditation for specialized and independent health services. [ABSTRACT FROM AUTHOR]

Aims: The aims of this integrative review were to describe leadership styles from the nursing literature in Saudi Arabia and to identify the current state of evidence about relationships between leadership styles and nurse, patient and organization outcomes in Saudi Arabia. Design: Integrative review was used as a design for this study. Methods: The following search terms were used with databases: 'Saudi Arabia', 'leadership theory*', 'leadership style*', 'leadership model*', 'management style' and 'nurse*'. Methodological quality was assessed using two different quality rating tools for quantitative and qualitative studies. Databases used for this review included Nursing & Allied Health Database, Cochrane Database of Systematic Reviews, PubMed, CINAHL, Embase, PsycINFO, Scopus, Web of Science and ProQuest Dissertations & Theses. Results: Nine manuscripts representing eight studies were included in this review. The papers reviewed included quantitative (n = 6), qualitative (n = 2) and mixed methods studies (n = 1). Results were grouped into different themes, identified as nursing leadership styles in Saudi Arabia, leadership styles and nurses' outcomes, and demographics and leadership styles. [ABSTRACT FROM AUTHOR]

Purpose: Quality issues, increasing patient expectations and unsatisfactory media reports are driving patient safety concerns. Developing a quality and safety culture (QSC) is, therefore, crucial for patient and staff welfare, and should be a priority for service providers and policy makers. The purpose of this paper is to identify the most important QSC drivers, and thus propose appropriate operational actions for Saudi Arabian hospital managers and for managers in healthcare institutions worldwide.Design/methodology/approach: Quantitative data from 417 questionnaires were analyzed using structural equation modeling. Respondents were selected from various hospitals and managerial positions at a national level.Findings: Findings suggest that error feedback (FAE) and communication quality (QC) have a strong role fostering or enhancing QSC. Findings also show that fearing potential punitive responses to mistakes made on the job, hospital staff are reluctant to report errors.Practical Implications: To achieve a healthcare QSC, managers need to implement preemptive or corrective actions aimed at ensuring prompt and relevant feedback about errors, ensure clear and open communication and focus on continuously improving systems and processes rather than on failures related to individual performance.Originality/value: This paper adds value to national healthcare, as Saudi study results are probably generalizable to other healthcare systems throughout the world. [ABSTRACT FROM AUTHOR]

Purpose Lack of client involvement in construction of public projects has been identified as the main cause of many operational problems. Organizational culture (OC) plays a major role in guiding and shaping behavior of organizations, which could lead to the lack of client involvement. The purpose of this paper is to investigate the influence of OC on client’s involvement in construction project delivery.Design/methodology/approach A questionnaire survey was distributed to various government agencies of the Kingdom of Saudi Arabia. Structural equation modeling is used to determine the significance of the impact of OC factors on the involvement of clients in construction projects.Findings This study suggests that OC plays a major role in influencing and increasing the client involvement in construction projects by emphasizing team orientation, which includes team contribution and team accountability. In addition, it is also important to value employee’s idea.Research limitations/implications This study was limited to government agencies as clients in construction projects, i.e. only public sector construction projects (not private sector projects). Therefore, researchers are encouraged to investigate client involvement in the private sector projects.Originality/value This paper provides empirical evidence of the relationships between OC and the client involvement in construction projects by emphasizing team orientation. [ABSTRACT FROM AUTHOR]

Empathy plays an important role in nursing so that the patients are provided with quality care and are satisfied with the services provided. Saudi Arabian patient interactions, including initial exploring, tend not to be formulaically initiated as in other countries. In this current study, the researcher aimed to highlight the critical role of nurse introductions in creating a desirable patient experience in the inpatient centers of Ministry Of Health hospitals in Saudi Arabia. This study was a cross-sectional secondary data analysis using the National Health Links/Presses Ganey surveys for every quint between the period 2021 and 2022. The methodology comprised an in-depth analysis of the Patient Experience Management Program (PXMP) survey that was involved as the uniform survey concluded by the Health Links/PressGaney. During the analysis, however, the results were found to have significant differences as 71.3% of the patients had a very good impression of their overall patient experience. This was specifically designed to address specific issues such as personal characteristics. The results of this study contribute to the understanding of what drives the nurses-patient interactions and forge the need for enhancing the way nurses are introduced to their patients to increase the average level of satisfaction of patients in the Ministry Of Health hospitals in Saudi Arabia. This study recommends that Saudi nurses should be trained to establish rapport in their interactions with patients as this promotes patient-centeredness and subsequently patients' experiences and care outcomes. [ABSTRACT FROM AUTHOR]

The patient's safety culture measures and prevention from different types of physical and social pain in hospitals of Saudi Arabia is a missing point. It is important to determine the safety culture among doctors and nurses in hospitals of Saudi Arabia. For this purpose, sixteen doctors and nurses were selected from some of the hospitals of Saudi Arabia and were interviewed. The findings of this paper showed the importance of educational training for the doctors and nurses of hospitals as well as improving the level of safety in those hospitals to prevent from occurrence of any type of injuries and physical and social pains. [ABSTRACT FROM AUTHOR]

Background: Measuring patient safety culture can provide insight into areas for improvement and help monitor changes over time. This study details the findings of a re-assessment of patient safety culture in a multi-site Medical City in Riyadh, Kingdom of Saudi Arabia (KSA). Results were compared to an earlier assessment conducted in 2012 and benchmarked with regional and international studies. Such assessments can provide hospital leadership with insight on how their hospital is performing on patient safety culture composites as a result of quality improvement plans. This paper also explored the association between patient safety culture predictors and patient safety grade, perception of patient safety, frequency of events reported and number of events reported.Methods: We utilized a customized version of the patient safety culture survey developed by the Agency for Healthcare Research and Quality. The Medical City is a tertiary care teaching facility composed of two sites (total capacity of 904 beds). Data was analyzed using SPSS 24 at a significance level of 0.05. A t-Test was used to compare results from the 2012 survey to that conducted in 2015. Two adopted Generalized Estimating Equations in addition to two linear models were used to assess the association between composites and patient safety culture outcomes. Results were also benchmarked against similar initiatives in Lebanon, Palestine and USA.Results: Areas of strength in 2015 included Teamwork within units, and Organizational Learning-Continuous Improvement; areas requiring improvement included Non-Punitive Response to Error, and Staffing. Comparing results to the 2012 survey revealed improvement on some areas but non-punitive response to error and Staffing remained the lowest scoring composites in 2015. Regression highlighted significant association between managerial support, organizational learning and feedback and improved survey outcomes. Comparison to international benchmarks revealed that the hospital is performing at or better than benchmark on several composites.Conclusion: The Medical City has made significant progress on several of the patient safety culture composites despite still having areas requiring additional improvement. Patient safety culture outcomes are evidently linked to better performance on specific composites. While results are comparable with regional and international benchmarks, findings confirm that regular assessment can allow hospitals to better understand and visualize changes in their performance and identify additional areas for improvement. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To examine the predictors and outcomes of patient safety culture (PSC) among oncology nurses working in public Saudi hospitals according to participant characteristics and evaluate the relationship between PSC domains. Background: PSC is crucial in healthcare systems, particularly in oncology and chemotherapy units, and its assessment can enhance the standard service provided and cancer care quality. There is currently limited research on the status, predictors and outcomes of PSC in cancer care settings in developing countries, including Saudi Arabia. Design: A cross‐sectional correlational study. Methods: A convenience sample of 101 oncology nurses working in two large Saudi tertiary care hospitals participated in this study. The Hospital Survey on Patient Safety Culture validated instrument and demographic and work surveys were completed by the participants. The study methods were compliant with the STROBE checklist. Descriptive statistics and multiple linear regressions were used to analyse the data. Results: The areas of PSC strength were related to organizational learning–constant improvement, feedback and communication about errors, and transitions and handoffs. Manager/supervisor actions and expectations, hospital management support, communication openness, experience in the current unit and oncology unit/area were the predictors of PSC. In terms of PSC outcomes, the oncology nurses reported either no or one to two adverse events and a substantially good patient safety rating. Conclusion: The level of PSC was lower than expected. Communication openness, experience in the current unit and oncology unit/area were the strongest predictors of PSC. Investing in oncology nursing practice that addresses these concerns and prioritizes patient safety is critical in Saudi cancer care settings to increase patient safety. Relevance to clinical practice: The findings contribute to a better understanding of the predictors and outcomes of PSC, which should be considered when establishing effective nursing interventions or strategies for PSC in cancer care settings. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: Patient safety in primary care is an emerging field of research with a growing evidence base in western countries but little has been explored in the Gulf Cooperation Council Countries (GCC) including the Sultanate of Oman. This study aimed to review the literature on the safety culture and patient safety measures used globally to inform the development of safety culture among health care workers in primary care with a particular focus on the Middle East. Methods: A systematic review of the literature. Searches were undertaken using Medline, EMBASE, CINAHL and Scopus from the year 2000 to 2014. Terms defining safety culture were combined with terms identifying patient safety and primary care. Results: The database searches identified 3072 papers that were screened for inclusion in the review. After the screening and verification, data were extracted from 28 papers that described safety culture in primary care. The global distribution of the articles is as follows: the Netherlands (7), the United States (5), Germany (4), the United Kingdom (1), Australia, Canada and Brazil (two for each country), and with one each from Turkey, Iran, Saudi Arabia and Kuwait. The characteristics of the included studies were grouped under the following themes: safety culture in primary care, incident reporting, safety climate and adverse events. The most common theme from 2011 onwards was the assessment of safety culture in primary care (13 studies, 46%). The most commonly used safety culture assessment tool is the Hospital survey on patient safety culture (HSOPSC) which has been used in developing countries in the Middle East. Conclusions: This systematic review reveals that the most important first step is the assessment of safety culture in primary care which will provide a basic understanding to safety-related perceptions of health care providers. The HSOPSC has been commonly used in Kuwait, Turkey, and Iran. [ABSTRACT FROM AUTHOR]

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This study examined the level of perceived responsibility junior and senior psychiatric nurses have for human resources and governance in Saudi Arabia. Bullying is a significant issue in nursing and an entrenched cultural practice that highlights a failure in governance and human resource responsibilities. A total of 90 responses (43.1%) to a 5‐point Likert Scale survey that sought respondent perceptions on leadership, governance and human resources. This study is reported using EQUATOR network recommendations (SQUIRE 2.0). This survey revealed that junior and senior nursing respondents weakly agree with all statements. Neither nurse rank, educational status nor nationality affected the answers of the respondents; there were age, gender and experience effects. There is a significant correlation between all responses to the statements implying there is a social desirability bias to the responses. If bullying, and its derived consequence of burnout, is to be addressed there needs to be a cultural shift in the attitudes of junior and senior nurses towards more acceptance of their HR and governance responsibilities. Furthermore, there needs to be an increased focus on shared leadership responsibilities, with greater nurse‐manager interaction and cooperation on transformational practices that will bring cultural change to the clinical space. [ABSTRACT FROM AUTHOR]

Considering the rise of implementation of big data analytics (BDA) in Saudi Arabian higher education institutions but with relatively lesser optimal performance, the study investigated the causality of organisational culture (OC) and BDA's social and technical subsystems, following the Socio- Technical Systems theory, with the strategic decision-making in Saudi Arabian higher education institutions. The study's objectives are based on the ontological positivist paradigm, and the methodology applies a quantitative cross-sectional survey. The sample population involved the IT staff and data scientists representing the big data people (BDP) and top management as the OC in the Saudi Arabian universities. The data was collected using validated scales of previous studies through an online survey, and the hypotheses were evaluated using PLS-SEM. The PLS-SEM analysis conducted to test the hypotheses highlighted the insignificance of organisational culture in big data systems (BDS), although having a positive value. Nonetheless, the organisational culture significantly impacted BDP, implying the influence of a data-driven culture and supportive top management on the workforce's attitude towards BDA-related change and skill development. Besides, the social and technical subsystems of the BDA— the BDS and BDP— are significantly correlated, along with their correlation with strategic decision-making. The study's implications comprised insights guiding the managers and policymakers to acknowledge the importance of organisational culture (hierarchical, adhocratic, market, and clan) while strategising the implementation of BDA and its systems and developing training modules for its BDP accordingly. [ABSTRACT FROM AUTHOR]

The psychological contract was both conceptualised and has been investigated primarily in Western contexts. While research has demonstrated its utility for exploring the nature of the individual employment relationship in other cultures, the fundamental tenets of the psychological contract have never been challenged. In particular, there is an absence of empirical research on how the notion of implicit promises might be viewed in Eastern contexts, in spite of promises constituting a significant plank of employee interpretation of the psychological contract. Using two case studies in Saudi Arabia, this research investigates how different sources of information influence the construction of implicit promises in a culturally unique employment context. We propose a theoretical model that outlines key factors that shape employee beliefs of implicit promises in order to guide future research in the field of psychological contracts. [ABSTRACT FROM AUTHOR]

The current nursing shortage jeopardizes the quality and safety of patient care globally. In Saudi Arabia, there are insufficient numbers of Saudi nurses to support the healthcare system, and Saudi hospitals rely heavily on expatriate nurses to meet staffing demands. The purpose of this study was to examine the effect of job satisfaction and intent to leave on the patient safety culture. The present study was carried out using a cross-sectional design. Convenience sampling method was applied, and 214 nurses participated in the study. Study was conducted in three hospitals operated by Saudi Ministry of Health in Madinah city. Three instruments were used to measure the study variables. Data were analysed using SPSS. The findings of the current research showed that the suitable work environment for the participant nurses in the current research. The findings of this study showed that nurse's job satisfaction has a positive and significant influence on patient safety culture (β = 0.28, p = 0.003). Furthermore, the results from the parsimonious regression model indicated that intentions to leave had a negative and significant effect on patient safety culture (β = −0.34, p < 0.01). Based on the study findings, patient safety should be considered as a strategic priority for the senior nurses' managers of the health system. To enhance patient safety, the current study emphasizes that nurse managers should pay attentions to factors such as job satisfaction and intent to leave to evaluating safety culture in organizations that deliver health service, especially hospitals. [ABSTRACT FROM AUTHOR]

Despite the long history of integrating non-medical practitioners into the extended cardiac surgical team, concerns about job design that reduce job satisfaction persist in the literature. In the Kingdom of Saudi Arabia (KSA), previous research has found that these non-medical practitioners known as cardiac surgical assistants (SAs) express significant dissatisfaction with multiple aspects of their role. Improving job satisfaction can positively impact on the recruitment and retention of this valuable workforce who increase surgical capacity within cardiac units. This qualitative study was therefore conducted to gain an in-depth understanding of cardiac SAs' perspectives of their role and to explore how it could be redesigned to improve their job satisfaction. Through thematic analysis of 14 individual interviews, six themes were identified: the importance of the role, low level of autonomy, lack of recognition, inconsistency of training, poor appraisal and feedback, and feeling unappreciated and undervalued. The data allowed a number of specific recommendations to be formulated that could be implemented at service, organisational and professional levels to enhance SA job satisfaction. It is important that the working conditions of surgical assistants should be further improved to address the issues which cause lower levels of motivation and a greater intention to leave their role. [ABSTRACT FROM AUTHOR]

Aim and Objectives: This article examined the association between workplace incivility experiences of nurses and patient safety (PS) culture in hospitals. Background: Workplace incivility, which is characterised by low‐intensity behaviours with unclear intention to harm and disruption of workplace ambiance of mutual respect, may threaten the work environment, resulting in an unhealthy and unsafe workplace. Design: Cross‐sectional study. Method: This study surveyed 261 nurses in Saudi Arabia from June 2019 to August 2019 using the 'Hospital Survey of Patients' Safety Culture' and the 'Nurse Incivility Scale'. A multiple linear regression was performed with unit‐ and hospital‐level PS culture as the dependent variables. Results: 'Organizational learning–continuous improvement' and 'Teamwork within units' were recognised as PS culture strengths. The nurses reported workplace incivility from patient/visitor as the most frequently experienced (mean = 2.27, standard deviation = 0.88). Working in Hospital B (ß = 0.24, p <.001, 95%CI = 0.15, 0.33) and having a baccalaureate degree in nursing (ß = 0.13, p =.014, 95%CI = 0.03, 0.23) were associated with better perceptions of unit‐level PS, whereas working in medical‐surgical wards (ß = −0.16, p =.002, 95%CI = −0.26, −0.06) and in intensive care units (ß = −0.19, p =.002, 95%CI = −0.32, −0.07) and experiencing patient/visitor incivility (ß = −0.09, p =.004, 95%CI = −0.15, −0.03) were associated with poor unit‐level PS culture perceptions. Experiences of general incivility (ß = −0.24, p <.001, 95%CI = −0.35, −0.13) and supervisor incivility (ß = −0.26, p =.011, 95%CI = −0.46, −0.06) were associated with poor hospital‐level PS culture perceptions. Conclusions: Workplace incivility from patients/visitors had a negative association with unit‐level PS culture perceptions, whereas experiences on general and supervisor incivilities had an adverse relationship with hospital‐level PS culture perceptions. Relevance to Clinical Practice: The study emphasises the call to eradicate any form of incivility in healthcare settings to guarantee a PS culture. Hospital and nursing managers should prioritise the creation and implementation of policies aimed at eliminating uncivil behaviours in clinical settings to ensure that unit‐ and hospital‐level PS culture are above standards. [ABSTRACT FROM AUTHOR]

Supervisor's human resources (HR) decisions have a significant impact on the employees they manage but have been found to be subject to bias. The upward influence tactics use by subordinates can play a role in this. We investigated the effects of seven upward influence tactics on supervisor job‐performance ratings and the extent of subordinate flexible working arrangements (FWAs). Supervisors are often responsible for determining whether employees are granted FWAs. We posit an alternative theoretical mechanism by which upward influence tactics bring about their effects, mediated through two distinct types of respect, mutual appraisal respect and mutual recognition respect. We collected data from 389 matched supervisor–subordinate dyads, and found that both mutual appraisal respect and mutual recognition respect mediated relationships between several upward influence tactics and both job‐performance ratings and FWAs. Our findings show that upward influence tactics affect the quality of the relationship between employees and their supervisors, specifically, these two forms of mutual respect. Further, both mutual appraisal respect and mutual recognition respect may explain why supervisors show favoritism to some subordinates over others, in reaching HR decisions in these areas. [ABSTRACT FROM AUTHOR]

(1) Background: Organisational culture provides a framework and guidelines that influence behaviour and control employees' performance and activities. (2) Methods: This study uses Hofstede's five dimensions of organisational culture to understand better the organisational culture of three of the National Water Company's (NWC) branches in Saudi Arabia. A random sample of 500 employees, consisting of 50 managers, 100 supervisors, and 350 officers, were surveyed, and 334 reliable responses were received. SPSS was employed to analyse the responses, and the empirical findings suggest that NWC's corporate culture is in line with the findings of Hofstede. (3) Results: There was a sharp contrast between the male and female responses, with men ranking power distance, uncertainty avoidance, collectivism, masculinity, and short-term orientation, high, and the women ranking them low. Unfortunately, innovation and productivity suffer within this autocratic culture, resulting in the NWC not meeting Saudi Arabia's new national mandates outlined in Vision 2030. (4) Conclusion: The study recommends how HRM can help NWC change its organisational culture to increase innovation and productivity. [ABSTRACT FROM AUTHOR]

Aim: This study aims to establish postgraduate students' perceptions of the organizational culture and readiness for evidence‐based practice of their workplaces in the Kingdom of Saudi Arabia. Background: Nurse shortages and a reliance on a transient nurse workforce have long been a challenge in the Kingdom of Saudi Arabia. Developing a home‐grown nurse workforce, a key objective of the Government of Saudi Arabia, can help to address this. Evidence‐based practice offers a mechanism to address this. Evidence‐based practice implementation is heavily reliant on the prevailing organizational culture. Establishing the organizational culture and readiness for evidence‐based practice is crucial for sustainable evidence‐based practice implementation. Methods: A pre‐experimental pilot study collected data from the same participants at three different points. As part of this, a questionnaire measuring organizational culture and readiness for evidence‐based practice was administered twice. Descriptive, inferential and correlational statistics were employed to analyse the data. Results: Results demonstrated improved participant perceptions of the organizational culture and readiness for evidence‐based practice of their workplaces between the first (M = 76.58, SD = 19.2) and second (M = 92.10, SD = 23.68) data collection points, indicating moderate movement towards a culture of evidence‐based practice. Strengths, challenges and opportunities for improvement were identified. Conclusion: This study established participants' perceptions of the organizational culture and readiness for evidence‐based practice of their workplaces, affording insight into context‐specific strategies to embed evidence‐based practice in health care organizations. Implications for Nursing Management: Assessing an organization's culture and readiness for evidence‐based practice (EBP) can afford insight on the strengths, challenges and opportunities that exist to equip nurse managers to advance evidence‐based practice at individual, professional and organizational levels. This study demonstrated the importance of promoting an environment conducive to EBP and putting in place the necessary resources to support evidence‐based practice implementation. Nurse managers can play a central role in this. [ABSTRACT FROM AUTHOR]

Due to its increased reliability, adaptability, scalability, availability, and processing capacity, cloud computing is rapidly becoming a popular trend around the world. One of the major issues with cloud computing is making informed decision about adoption of community cloud (CC) computing (ACCC). To date, there are various technology acceptance theories and models to validate perspective of ACCC at both organizational and individual levels. However, no experimental studies have been carried out to provide a comprehensive assessment of the factors of ACCC, specifically in the area of the Saudi Higher Education (HEI) Institution. Thus, this research was aimed at exploring the factors of ACCC and the relationship to the experiences of the employees. The analysis of the employee context was driven by the success factors of technological, organizational, environmental, human, security, and advantage contexts on community cloud computing adoption in HEI. The data collection was a questionnaire-based survey based on 106 responses. We present findings based on descriptive analysis in identifying the significant component that contributed to the effective implementation of ACCC. Security concerns are a significant influencing element in the adoption of community cloud technology. [ABSTRACT FROM AUTHOR]

Hospital‐acquired pressure ulcers (HAPUs) negatively affect patients during hospitalisation, putting patients at risk for further complications. HAPUs are one of the hospital quality key performance indicators (KPIs) that necessitate quality initiatives and/or programmes to minimise its occurrence and consequences. When quality initiatives are put into place and proven effective, the next important focus is sustainability of the effects. The original Saudi Arabian study based on data collected from 50 441 patients, showed that implementation of the pressure ulcer prevention programme (PUPP) was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The aim of this follow‐up check of the original study was to assess if the PUPP's effectiveness success was retained. Also, to try and determine why the implemented quality improvement programme to prevent HAPUs was so successfully retained. Designed and conducted as a systemic review, it tracked the outcomes of pressure ulcer rates during and post PUPP implementation that mostly focused on evidence‐based staff education, concentrating on years 2016 to 2018. Statistically significant reductions were captured by data that have been presented through Pearson Chi squares. HAPU decline was notable between year 2017 and 2018. This was followed by a further reduction in year 2018. The results determine retention effect sustainability of the initial positive results achieved. By doing so, the study was further able to establish that the PUPP had been integrated into the hospital system's care culture as evidenced by the reduction of HAPUs despite a large inpatient growth. Consideration of what contributing factors led to this successful integration of new knowledge into the care culture are also examined. KPIs can be used as indicators to help reinforce staff education. Culture of care (support of values and interventions taught during the PUPP) offer hope that these may be duplicated in future improvement projects. The supportive nature of a given culture of care may in fact be just as important as the practical education provided to staff members. [ABSTRACT FROM AUTHOR]

Decision-making processes (DMPs) can be altered by several factors that might impact patient outcomes. However, nurses' views and experiences regarding the multitude of personal and organizational factors that may facilitate or inhibit their decision-making abilities have rarely been studied. Purpose: To explore the personal and organizational factors that influence nurse DMPs in clinical settings at Ministry of Health hospitals (MOH). Method: A qualitative research design was conducted. A purposive sample of 52 nurses was recruited from general and critical wards in two major Ministry of Health hospitals in Hail, Saudi Arabia. A total of eight focus groups (semi-structured interviews) were conducted to elicit participant responses. Results: In this study, the personal differences covered nurses' experience, physical and psychological status, autonomy, communication skills, values, and cultural awareness. Organizational factors included the availability of resources, organizational support, workload, the availability of educational programs, the availability of monitoring programs, and the consistency and unity of policies, rules, and regulation applications. Conclusions: The major contribution of this study is the comprehensive illustration of influential factors at both the personal level and the organizational level that impact DMPs to achieve desired outcomes for patients and health organizations. This study utilizes a framework that could explain the nature of nurse DMPs. [ABSTRACT FROM AUTHOR]

Aim and Objective: This study aimed to examine the association between workload and patient safety culture (PSC) among intensive care unit (ICU) nurses. Background: ICU nurses play a vital role in promoting patient safety and are essential indicators in any healthcare system including ICUs. Research studies focusing on the relationship between nursing workload and PSC among ICU nurses are limited. Design: Descriptive correlational design. Methods: The study participants involved 380 ICU nurses at two hospitals in Riyadh, Saudi Arabia. Data were collected between February 2019–April 2019 and were analysed using SPSS v.22 statistical software. This study was guided by the STROBE checklist. Results: The results showed that ICU nurses have high positive perceptions in the following PSC subscales: teamwork within units, organisational learning–continuous improvement, frequency of events reported, feedback and communication about error, management support for patient safety, teamwork across units, supervisor/manager expectations and actions promoting patient safety, handoffs and transitions, nonpunitive response to errors, staffing and overall perceptions of patient safety. However, the participants collectively considered the overall grade on patient safety as poor. The participants had high mean scores in physical demand, effort, mental demand and overall workload. A statistically significant variability existed in the mean scores of the PSC subscales and workload of ICU nurses. The overall workload was significantly and negatively associated with the PSC perceptions of ICU nurses. Conclusion: The ICU nurses experienced high overall workload, physical demand, effort and mental demand which influenced the poor grade of their overall perceived PSC. Relevance to Clinical Practice: Identifying differences and associations with the perceptions of ICU nurses regarding workload and PSC is important because such perceptions may affect their delivery of nursing care. Hospital and nursing administrators must use the study results to find strategies that address workload issues and enhance patient safety. [ABSTRACT FROM AUTHOR]

Aims and objectives: To assess the nursing practice environments and nurse job‐related outcomes in two types of hospitals in Saudi Arabia. Background: The nursing shortage is a challenging problem in Saudi hospitals. Studies have shown that poor practice environments and high patient‐to‐nurse ratios are associated with poor nurse job outcomes (i.e. job dissatisfaction, burnout and intention to leave) and that can lead to nurse turnover and compound the nursing shortage. However, little research has been conducted on this topic in Saudi Arabia. Design: A cross‐sectional design. A model that links the nursing practice environment and patient‐to‐nurse ratio to nurse job outcomes was tested through a path analysis of survey data. Methods: A sample of 404 nurses from public and military hospitals in Saudi Arabia completed a survey that included the Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory and questions related to job dissatisfaction and intention to leave the job. A model of nurse turnover was used to test the relationships among study variables. This study was carried out in accordance with the STROBE checklist for cross‐sectional studies. Results: The nursing practice environment and nurse job outcomes were better in military hospital compared with public hospital. Overall, 53% of participants had high burnout, 39% were dissatisfied, and 26% intended to leave their jobs. The path analysis showed that the nursing practice environment and patient‐to‐nurse ratio were predictors of burnout and job dissatisfaction, which in turn lead to intention to leave. The tested model had good fit and explained the direct and indirect effects of study variables. Conclusion: Poor nursing practice environments and high patient‐to‐nurse ratios contribute to poor nurse job outcomes in Saudi hospitals. Relevance to clinical practice: Nurse leaders can focus on enhancing practice environments and reducing patient‐to‐nurse ratios as retention strategies to improve nurse job outcomes. [ABSTRACT FROM AUTHOR]

Aims: This study identifies and analyses the risk factors contributing to nursing turnover in Saudi Arabia and identifies practical solutions to decrease turnover and encourage nurses to stay in their jobs. Background: Saudi Arabia has a unique nursing profile, as the majority of the nursing workforce are expatriates. The Saudi health care system relies on contracted expatriate nurses to provide most of the direct patient health care. For nurses from other countries, Saudi Arabia can be a challenging place to work due to a range of factors including personal, policy and organisational variables. There is a high turnover of expatriate nurses, and this has been long‐standing problem for the Saudi Arabian health care system. Method: A cross‐sectional survey design among nurses in Saudi Arabia including 502 nurses, of whom 83.7% are female. Structural equation modelling is used to examine the relationships between the study variables. Confirmatory factor analysis is used to create and validate the measurement models for variables. Results: The analysis of the survey data identifies that Filipino nurses are more likely to intend to leave their current position than other expatriates, including Malaysian, Pakistani, Indian or local Saudi nurses. Many expatriates identify discrimination as an important contributing factor for their intention to leave, citing that the national salary remuneration for nurses should be based on competency and delivery of care. Furthermore, several independent variables are found to be significant predictors of anticipated turnover, including discrimination; social support from immediate supervisor; organisational commitment; and autonomy. Conclusions: This study provides the most comprehensive information available to date about the factors that influence nurses' desire to leave their current job and provides evidence for better health workforce planning in Saudi Arabia. This study strongly indicates that the main factor related to turnover is the unfair and unequal salaries paid to nurses of different nationalities in Saudi Arabia. Implications for Nursing Management: The findings relating to both Saudi and foreign nurse employment could be helpful to policymakers and the Ministry of Health in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Incident-reporting systems are designed to obtain information about events and situations affecting patient safety. These incidents can be used to inform individual and organizational learning and improvement opportunities for quality and patient safety. Aim: This study aims to evaluate incident reporting at the Johns Hopkins Aramco Healthcare (JHAH) since the implementation of Datix and the staff's behavior towards incident reporting. Methods: This is a prospective, mixed methods study. Incident-reporting system reports are used to evaluate the volume of incident reporting before and after implementing the new software. A questionnaire was developed to assess the attitude of hospital staff members to reporting incidents in general and the use of Datix in particular. Results: Incident reporting increased in 2017 and 2018 by 51% and 57%, respectively, using Datix compared with the previously implemented software. JHAH has 3812 active employees, with nearly 60% of them using Datix. The study received 377 survey responses (response rate approximately 10%). We received a majority of positive responses about the workplace safety culture and the value of the system. Conclusion: Implementation of the Datix reporting system resulted in an increased number of incident reports. An action plan was put in place that may improve incident reporting by further increasing awareness regarding the importance of reporting and supporting more training. [ABSTRACT FROM AUTHOR]

Aim: This research aimed to assess the culture of quality in infection prevention (CQIP) of a university hospital as perceived by health care workers (HCWs). Background: Health care‐associated infections are serious concerns in hospitals in Saudi Arabia. Hence, assessing their CQIP is necessary. Method: An investigation employing a descriptive and cross‐sectional design was carried out among 623 HCWs (doctors, nurses and nursing assistants) in a university hospital in Saudi Arabia by using the Leading a Culture of Quality in Infection Prevention (LCQ‐IP) scale. Results: The overall mean in the LCQ‐IP was 3.86 (SD = 0.62). The subscale "prioritization of quality" (M = 4.11, SD = 0.79) was rated the highest dimension, whereas "supportive work environment" was perceived as the poorest dimension (M = 3.56, SD = 0.54). Gender, nationality, highest education and job title affected the four factors of the HCWs' perceptions of the hospital's CQIP. Conclusion: HCWs modestly perceived their hospital's CQIP. The study highlighted the need for improving CQIP based on the four dimensions. Implications for Nursing and Hospital Management: This study provided valuable implications for hospital and nursing management to ensure high‐quality culture of infection prevention. [ABSTRACT FROM AUTHOR]

Aim: To explore the challenges in nursing education in Saudi Arabia from nurse educators' and leaders' perspectives. Background: Saudi Arabia considerably lacks Saudi nurses and most nurses in Saudi healthcare facilities are expatriates with diverse academic, cultural, and linguistic backgrounds. The perception regarding nurses' profession and their low status in Saudi Arabia affect the nursing profession negatively, leading to staff insufficiency. Understanding the difficulties of the nursing profession could help intervene accordingly, in encouraging students to pursue a career in nursing. Methods: An exploratory qualitative method was used. Three Saudi nursing educators and four leaders were interviewed. They were recruited through purposive sampling. The interviews were transcribed verbatim and data were analyzed using thematic analysis. Findings: Participants indicated that nursing education in Saudi Arabia is facing multiple challenges requiring serious attention from Saudi leaders. The challenges were divided to four themes and different categories; cultural challenges, educational challenges, organizational challenges (weak nursing authority, lack of acknowledgement for Saudi nurses), and work challenges (poor working environment, language barrier). Discussion: The challenges that face nursing education in Saudi Arabia were mainly at three levels: management, system, and social. These challenges were the reasons for Saudi nurses to leave the profession. Conclusion: This study revealed some of the challenges facing nursing education in Saudi Arabia. These challenges are not unique to Saudi Arabia but knowing about these challenges will help nurse educators and leaders to improve nursing programs, enhance students' clinical experiences, and promote nursing profession in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Background: Patient safety is a significant challenge facing healthcare systems. The administration of medication is pivotal to patient safety, and errors in drug administration are associated with mortality and morbidity. In this study, we assessed the factors contributing to the occurrence and reporting of medication errors from the nurse's perspective. Methods: In this descriptive cross‐sectional study, we distributed a validated questionnaire to 367 nurses at a large public hospital and obtained a response rate of 73.4%. The questionnaire comprised 65 questions, including 29 on the causes of medication errors, 16 on the reasons why medication errors are not reported and 20 that estimated the percentages of the different medication errors actually reported. Informed consent was obtained from all participants, and the anonymity and confidentiality of participants’ information were preserved throughout the process. This study received institutional review board approval. Descriptive statistics were used for data analysis. Results: The main factors associated with medication errors by nurses were related to medication packaging, nurse–physician communication, pharmacy processes, nurse staffing and transcribing issues. The main barriers to the reporting of errors by nurses were related to the administrative response, fear of reporting and disagreements regarding the definitions of errors. Conclusion: Medication errors by nurses are related to medication packaging, poor communication, unclear medication orders, workload and staff rotation. To prevent medication errors, teamwork must be improved. All healthcare settings should emphasise awareness of the culture of safety, provide support and guidance to nurses and improve communication skills. We also recommend the use of integrated health informatics, including computerised drug administration systems. The limitations of this study include the potential for nonresponse bias associated with the sampling method. Further research is required to explore the complex and multidimensional causes of medication errors and review the responses of nurses regarding the errors reported. [ABSTRACT FROM AUTHOR]

This study examines the influence of a national cultural dimension, specifically a strong orientation towards collectivism/reliance on network relationships, referred to as ‘wasta’, on the way in which psychological contracts form and change in a Saudi organisation. Specifically, it focuses upon how the psychological contract is perceived to have been breached by repatriates because of the role that wasta plays in shaping formal and informal HR practices pre- and post-assignment. The analysis demonstrates that prior to international assignment, wasta was taken for granted and only implicitly acknowledged as influencing selection criteria for assignments and individuals’ expectations and obligations associated with their psychological contract. Once repatriated, wasta was foregrounded and perceived as highly problematic in terms of career advancement. This shaped repatriates’ perceptions that their psychological contract had been breached, influencing their intentions to leave. These findings suggest that the psychological contract can be viewed as highly context-specific, as well as a person-centred phenomenon. We consider the implications of our research in terms of the influence of national cultural characteristics on individual’s perceptions of breaches to the psychological contract and highlight the possible implications generally for Saudi Arabia, which is aiming to be less reliant on foreign labour. [ABSTRACT FROM PUBLISHER]

Context Although research from Western contexts suggests that considerable inequalities for female medical educators exist in the workplace, we do not yet know the views and experiences of women within non-Western contexts. By examining the influence of context, intersecting identities and language use, this study explores female medical educators' views and experiences of gender, career progression and leadership in academic medicine in the Kingdom of Saudi Arabia ( KSA). Methods We conducted individual interviews employing narrative interviewing techniques with 25 female medical educators from five schools in the KSA (June to December 2014). Data were analysed using framework analysis and drew on intersectionality theory. Results Participants expressed their views and experiences of career progression, leadership and gendered workplace cultures. Women's experiences of career progression and leadership in the KSA were influenced by their gender and varied according to their career stage, work environment and specialty. Participants discussed the gendered organisational cultures of academic medicine in the KSA in terms of gender inequalities (e.g. females being overlooked for leadership positions), gender stereotypes (e.g. women perceived as more likely to take part in shared leadership) and gendered specialties (e.g. surgery being male dominated). We revealed women's more tacit understandings about gender, career progression and leadership by examining how they talk (e.g. metaphoric, pronominal and emotional talk). Finally, participants constructed multiple intersecting personal (e.g. female, mother and young) and professional identities (e.g. doctor, teacher and leader) for themselves through their narratives. Conclusion This study provides important new insights into female medical educators' experiences of career progression and leadership in a non-Western context. Investment in the future of women's careers in the KSA through faculty development initiatives and equality and diversity policies is now essential to help close the gender gap. [ABSTRACT FROM AUTHOR]

Background: The current challenges facing healthcare systems, in relation to the shortage of health professionals, necessitates mangers and leaders to learn from different leadership styles and staff empowerment strategies, so as to create a work environment that encourages nursing staff commitment to patients and their organization. This study intends to measure the effects of nurses' overall perception of the leadership style of their managers, and psychological empowerment on their organizational commitment in acute care units, in National Guard Health Affairs, Riyadh City, Saudi Arabia. Methods: This was a cross-sectional survey, where the data was obtained from nurses at King Abdulaziz Medical City. Hard copy questionnaires were distributed to 350 randomly selected nurses. Three hundred and thirty two (332) were completed, representing a response rate of 95 %. Three validated survey instruments were used to obtain the data: (1) The Multifactor Leadership Questionnaire (MLQ), formulated by Bass and Avolio (1997), (2) The Psychological Empowerment Scale developed by Spreitzer (1995) and (3) The Three-Component Model of Employee Commitment developed by Meyer and Allen (1997). A theoretical model that conceptually links leadership, empowerment, and organizational commitment was used. The SPSS program version 19 was employed to perform descriptive and inferential statistics including correlation and stepwise multiple regression analysis. Results: Overall most nurses perceived their immediate nursing managers as not displaying the ideal level of transformational leadership (TFL) behaviors. Nurses' commitment appeared to be negatively correlated with TFL style and perceived psychological empowerment. However, commitment was positively correlated with the Transactional Leadership (TAL) style. Analysis, also, showed that commitment is significantly associated with the nurse's nationality by region: North American (P = 0.001) and Arab (p = 0.027). The other important predictors of commitment include TAL (P = 0.027), Laissez-faire Leadership (LFL (P = 0.012), and autonomy (P = 0.016). The linear combination of these predictors explained 20 % of the variability of the nurses' commitment. Conclusion: The study findings suggest that leadership styles and employee empowerment could play an instrumental role in promoting organizational commitment of nurses working in acute health care settings, at least in the Saudi Arabian context. [ABSTRACT FROM AUTHOR]

Aim To determine factors that influence the job satisfaction of Saudi nurses. Background Saudi Arabia has a chronic shortage of Saudi national nurses. This research contributes to a greater understanding of how job satisfaction influences the recruitment and retention of Saudi nationals within the nursing profession. Methods Qualitative data were gathered from Saudi nurses and content analysis was used to identify themes in the written responses. Results Four main themes emerged from the data: lack of educational opportunities and support and the poor image of the nursing profession, perceptions of favouritism, high workloads and stressful work environment and the effect of religion on job satisfaction. Conclusions Saudi nurses would be more satisfied with their jobs if they had greater access to educational opportunities and if there was a reduction in workload and the perceived favouritism in the workplace was addressed. Religion was also found to play a significant role in supporting job satisfaction. Implications for nursing management These findings suggest the development of educational scholarships, as well as policies that better support equity in the workplace, to address Saudi nurses' level of job satisfaction. The generally positive impact of cultural and religious beliefs is also highlighted in this study. [ABSTRACT FROM AUTHOR]

Aim To discuss the impact of health-care policies and regulations on hospitals' journey towards the Magnet designation in Saudi Arabia. Background Saudi Arabia, like many other countries, faces several challenges in achieving 'the Gold Standard' in nursing practice. Centralised management, the absence of a regulatory professional body, lack of a national benchmarking database and a nursing shortage are all major challenges in advancing nursing practice. Key issue The presence of two Magnet-designated hospitals in Saudi Arabia (not affiliated with the Ministry of Health) is an opportunity to explore how this has been achieved within the organisational and professional context. The nursing leaders in the Ministry of Health could be accountable to address the barriers in advancing nursing practice and to raise nursing awareness regarding the adoption of a new culture of excellence. Implications for Nursing Management Nursing managers in the Ministry of Health hospitals are encouraged to assess the hospitals' readiness to apply for Magnet status. Their readiness must include having a high level of nursing satisfaction and low turnover rate, which goes along with assessing cultural and organisational climates to understand the gaps in work environment and driving evidence of readiness toward achieving Magnet status. Conclusion Health-care policies and regulations, both nationally and globally, can result in several challenges to achieving 'the Gold Standard' in nursing practice. These challenges may not be possible to resolve within an organisational level. Collaborative effort and transformational changes are needed to drive the nursing profession toward the best outcomes for our patients and nurses. [ABSTRACT FROM AUTHOR]

Background/Purpose:This study investigates challenges that students and faculty face to implement assessment for learning; and the activities, capabilities, enablers, and indicators which could impact performance. Method:The study is a mixed methods research, cross-sectional, exploratory study. The study was organized through two phases of data collection and analysis (QUAL → quan). Based on qualitative focus group discussions (FGD), we first gathered data through field notes. Later, we engaged in analysis using techniques drawn from qualitative data including categorization, theme identification, and connection to existing literature. Based on this analysis, we developed a questionnaire that could provide quantitative measures based on the qualitative FGD. We then administered the questionnaire, and the quantitative data were analyzed to quantitatively test the qualitative findings. Twenty-four faculty and 142 students from the 4th and 5th clinical years participated voluntarily. Their perception of FA and the cultural challenges that hinder its adoption were evaluated through a FGD and a questionnaire. Results:The mean score of understanding FA concept was equal in faculty and students (p = 0.08). The general challenge that scored highest was the need to balance work and academic load in faculty and the need to balance study load and training and mental anxiety in students. There was no difference between faculty and students in perceiving “learning is teacher-centered” (p = 0.481); and “past learning and assessment experience” (p = 0.322). There was a significant difference between them regarding interaction with opposite gender (p <0.001). Students showed higher value as regards the “gap between learning theories and assessment practice”, “grade as a priority”, and “discrimination by same faculty gender”. Conclusion:The authors suggested a “Framework of Innovation in Endorsing Assessment for Learning”. It emphasizes a holisitic approach through all levels of the System: Government, Accreditation Bodies, Policy makers; Institution, and Classroom levels. [ABSTRACT FROM PUBLISHER]