Healthcare Quality Improvement Research Articles

Development of a Web-Based Intervention for Middle Managers to Enhance Resilience at the Individual, Team, and Organizational Levels in Health Care Systems: Multiphase Study.

Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams. This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience. An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador. The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points. The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings.

Exploring a Co-Designed Approach for Healthcare Quality Improvement—Learning Through Developmental Evaluation

Background: Healthcare setting teams were challenged to understand how and what to measure regarding healthcare quality improvement (HQI), who should be involved, and what approach to apply. We aimed to determine if a generic co-design approach involving patients/families, multi-disciplinary care providers, and other staff was feasible to apply for HQI across diverse care settings. Developmental evaluation embedded in the co-design approach would determine its effectiveness, challenges, and other experiences across care settings and teams. Methods: Twenty-two acute and community care settings agreed to participate in applying a phased co-design approach to their HQI initiatives, including developmental evaluation. Each care setting team received co-design orientation and support. Semi-structured interviews and focus groups were conducted with patient/family advisors (PFAs) and care setting staff/care providers to gather their experiences with the co-design approach applied to their phased HQI work. Transcripts were thematically analyzed and triangulated with observation notes of care setting team discussions. Experiences were gathered from 17 PFAs and 68 staff/care providers across the 22 participating healthcare settings. Results: Themes for the orientation and each phase emphasized the importance of participants’ understanding, engagement, and ongoing open communication throughout the HQI co-design process. The orientation was viewed as key to facilitating good outcomes. Participants valued working together, gathering real-time experiences to “make a difference”, and having PFA voices involved in co-designing the HQI initiatives. Challenges were identified, including time commitment. Conclusions: Based on the overall developmental evaluation findings, there was consensus that a generic co-design of HQI initiatives was effective, feasible, and sustainable across care settings.

Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop

ABSTRACT Background Malawi has made progress in improving access to maternity care services, shifting the focus to quality of care as an essential determinant of maternal health outcomes. However, no effective mechanisms exist to use patients’ experiences of care at health facilities to inform and improve the quality of maternal healthcare. Objective To use maternal sepsis patient journeys in a workshop with maternal health stakeholders to identify and prioritise barriers in care and recommend interventions to improve maternal healthcare quality in Malawi. Methods In February 2024, in Blantyre, Malawi, using a modified nominal group technique, 28 stakeholders reviewed the patient journeys of three women hospitalised at Queen Elizabeth Central Hospital, who had sepsis after childbirth. Patient journeys narrate events experienced within a healthcare system in the patient’s words. In a multiframework approach (Four Delays, Respectful Maternity Care, and WHO Quality of Care), stakeholders identified and prioritised barriers to care and recommended interventions to improve the quality of maternal healthcare. Content analysis of the workshop data linked barriers with stakeholders’ suggested interventions. Results Nineteen barriers identified included various delays in receiving care, mistreatment by healthcare providers, and suboptimal quality of care. Stakeholders found patient journeys valuable and insightful for identifying gaps in the quality of care and promoting sepsis awareness among healthcare workers and the public. Conclusions Patient journeys are a novel tool for capturing the experience of care in Malawi. They have the potential to guide strategic improvements in maternal healthcare quality and ultimately reduce maternal morbidity and mortality.

Advancements in Interoperability: Achieving Anatomic Pathology Reports That Adhere to International Standards and Are Both Human-Readable and Readily Computable.

Over the past 50 years, multiple pathology organizations worldwide have evolved in cancer histopathology reporting from subjective, narrative assessments to structured, synoptic formats using controlled vocabulary. These reporting protocols include the required data elements that represent the minimum set of evidence-based, clinically actionable parameters necessary to convey the diagnostic, prognostic, and predictive information essential for patient care. Despite these advances, the synoptic reporting protocols were not harmonized across the various pathology organizations. Cancer pathology continues to be widely reported and stored in free-text format, or without encoded data such that it is neither computable nor interoperable across organizations. In 2020, SNOMED International created the Cancer Synoptic Reporting Working Group (CSRWG). This resulted in international collaboration across multiple pathology organizations. CCRWG's mission was to use SNOMED Clinical Terms (CT) concepts to represent the required content within the College of American Pathologists (CAP) and International Collaboration on Cancer Reporting (ICCR) published pathology reporting protocols. In late 2023, the CSRWG published over 1,300 new or revised SNOMED CT concepts to represent all required pathology cancer data elements for adult and pediatric solid tumors in both CAP and ICCR using the semantic principles of the SNOMED-CT concept model. Thus, computability and interoperability would be broadly established. This work brings to fruition the longstanding desire for an international, interoperable, human- and machine-readable cancer pathology report for use in patient care, health care quality improvement, population health, public health surveillance, and translational and clinical trial research. The following report describes the project, its methods, and applications in the stated use cases.

Inpatient Implementation of Portable Ocular Fundus Photography Among Neurology Residents.

Background: Nonmydriatic ocular fundus photography has been studied with demonstrated benefit in the evaluation of emergency department neurological complaints, particularly in triaging headache and focal neurological deficits. Likewise, portable fundus camera usage may be practical for inpatients with neurological complaints, although feasibility has not been studied in a neurology teaching service. Purpose: The objective of this study is to determine if a portable, nonmydriatic fundus camera could be integrated into routine clinical care by neurology inpatient housestaff at a tertiary medical center. Research Design: Housestaff were asked to obtain fundus photographs for patients with specific indications for fundoscopy. Study Sample: During a 1-month pilot period, housestaff were successfully able to upload images from 21 patients, which were reviewed by a neuro-ophthalmology attending, with input from on-call ophthalmology if desired. Results: Surveys of housestaff before (n = 13) and after (n = 12) implementation demonstrated increased confidence in camera operation and in ocular structure identification, description, and interpretation. Thematic analysis on qualitative feedback suggested benefits in clinical (improving fundus visualization, aiding in triage, sharing images with offsite staff), health systems (reducing length of stay, reducing ophthalmology consultations, reduced unnecessary testing), and educational domains (facilitating group discussions of images, sharing photographs with patients). Conclusions: Overall, inpatient portable fundus photography was shown to be feasible and effective for rapid fundus visualization for neurological inpatients, enhancing the ability to share, document, and compare examinations among neurology housestaff. Further work is needed to confirm clinical and educational benefits of portable fundus photography usage by neurology residents, as suggested by this healthcare quality improvement pilot study.

Need of the hour: A service failure recovery reorientation for U.S. hospitals.

Many hospitals in the United States are facing significant postpandemic operational challenges largely as a result of increasing demand for health care services. Operational issues increase the risk of service failures. Improving the patient experience after service failures may lead to better outcomes for both patients and hospitals. Drawing support from service failure recovery and quality management paradigms, we suggest that hospitals could periodically obtain deidentified patient feedback data drawn from multiple sources-including social media-to build a comprehensive patient experience dashboard that can be used to improve health care quality. We offer an overarching conceptual framework to support organizational learning and make hospitals more adaptive to patient feedback. Staff members and leaders could examine patient feedback data to identify service failures and take appropriate action to prevent their recurrence in hospitals. A patient experience dashboard can be developed to document and visualize remedial actions taken by hospitals against each past service failure and shared with all stakeholders. Reorienting health care as a service where hospitals immediately listen to patients and promptly address their questions and concerns may help to strengthen the continuity of health care services offered by hospitals as well as improve their financial position, quality of care, and the overall patient experience.

From Policy to Practice: Challenges in Implementing PROMs Reporting Under the New CMS Mandate.

The Centers for Medicare & Medicaid Services (CMS) recently introduced mandatory reporting of patient-reported outcomes (PROs) following primary, elective total joint arthroplasty (TJA) procedures. This article explores the implications and implementation challenges of this policy shift in the field of orthopaedic surgery. With a review of the existing literature, we analyze the potential benefits and limitations of PROs, discuss the role of CMS in health-care quality improvement initiatives, explain the predicted difficulties in the successful implementation of this new mandate, and provide recommendations for the successful integration of the reporting of PROs in clinical practice.

Quality Improvement for Pediatric Acute Mental Health Care: Opportunities and Challenges.

Quality Improvement for Pediatric Acute Mental Health Care: Opportunities and Challenges.

A realist review of how, why, for whom and in which contexts quality improvement in healthcare impacts inequalities

IntroductionQuality improvement (QI) is aimed at improving care. Equity is one of the six domains of healthcare quality, as defined by the Institute of Medicine. If this domain is ignored,...

Impacts of Hospital Data Breach on Healthcare Quality.

To examine the effects of data breach incidents on healthcare quality and to explore potential mechanisms. Hospital-level data breach reports from the U.S. Department of Health and Human Services and patient-level hospitalization records from Florida State Inpatient Database during 2013-2017. We employ a propensity score matching difference-in-difference model to estimate changes in a patient's emergency department (ED) door-to-hospital admission hours, days to undergo principal procedure after admission, length of stay days, and in-hospital mortality rates following data breaches. We compare the health information technology (HIT) functionalities of breached and non-breached hospitals during both pre and post periods. Our primary analysis covers 1,295,537 records of inpatients admitted through the EDs of 12 hospitals. Data breaches are associated with long-term improvements in healthcare quality, particularly in the timeliness of patient care and acute myocardial infarction (AMI) mortality. Over time, patients experience a reduction of 0.56 h in ED door-to-hospital admission time (95% confidence interval [CI]: -1.04 to -0.06 h) and a decrease of 0.18 days in time to undergo the principal procedure after hospital admission (95% CI: -0.23 to -0.13 days). Additionally, AMI patients experience a one percentage point reduction in in-hospital mortality (95% CI: -2 to -0.06 percentage points), while mortality rates for other patient groups remain unchanged. Hospitals affected by data breaches show long-term advancements in their HIT functionalities. Hospital data breach incidents are associated with improved healthcare quality. This improvement may be attributed to hospitals' enhanced functionality of HIT.

How Do Jordanian Physicians and Nurses Perceive the Importance of Electronic Health Records’ Use in Health Care Quality? A Mixed Method Study

Background: Electronic health records (EHRs) are widely used in hospitals nowadays. Physicians and nurses utilize the EHR system in their daily tasks. Their perceptions of this system are very important in improving the care delivered to the patients. Purpose: This study aimed to assess the physicians’ and nurses’ perceptions about the use of EHRs in health care. Methods: This is an exploratory sequential mixed-method study utilizing both quantitative and qualitative approaches and conducted on physicians and nurses who are working in five governmental and teaching hospitals in northern Jordan. Results: A total of 601 participants completed the questionnaire, with 67% nurses and 33% physicians. Over 73% agreed that EHRs are essential for medical practice, though 30% disagreed that EHRs reduce workload. Qualitative analysis of 15 interviews identified three themes: EHRs improve health care quality and patient safety, but require system improvements and better inter-hospital collaboration. Conclusion: This study reveals that young physicians and nurses in Jordan positively perceive EHRs as improving health care quality, efficiency, and patient safety, while also noting that EHRs add workload, reduce direct patient care time, and require ongoing updates and training. However, the findings may be limited by the sampling scope, which focuses on a specific region, and generalizability may be restricted beyond similar health care settings. Implications for Nursing: The findings of this study highlighted the importance of continuous use and updating of the EHR software by physicians and nurses in order to provide more accurate care to patients. Moreover, this study indicated that more privilege should be given to nurses, so that they can follow the orders properly. Keywords: Electronic health records, Perceptions, Nurses, Health care quality, Jordan.

Exploring the Impact of Transformational Leadership on Healthcare Quality Improvement

Introduction: Transformational leadership has also become a well-accepted means to improve quality of care in practice. What it means is that leaders need to lead with motivation and inspiration to embrace the changing landscape of the business world and instill this urge to achieve higher standards. The purpose of this study is to examine the effect of transformational leadership on healthcare quality improvement. Methods: A systematic literature review was performed, and articles were chosen from different electronic databases. Inclusion criteria had been studies that focused on transformational leadership and healthcare quality improvement. Fifteen articles were included in the analysis.Results: Overall the results indicated positive effects of transformational leadership regarding healthcare quality improvement across studies in hospitals, long-term care, and community health settings. The findings showed components of transformational leadership, like individualized consideration, inspirational motivation, and intellectual stimulation, were integral to facilitate the quality improvement initiative. They create an environment for healthcare teams to learn and collaborate, leading to improved patient outcomes and satisfaction.Conclusions: Caution about potential hidden variable persistency in research applications of this type should be applied. When organizations commit to transformational leadership, their healthcare environment can sustain continuous improvement. There is a need for additional study to determine how transformational leadership affects healthcare quality specifically and what solutions can be developed to determine its best application.

Quality improvement in palliative care: A review of the ethics.

Quality improvement is the systematic seeking of improvements in care and experience. This discussion paper will explore how the principles of good clinical care and the established ethical frameworks for research can help guide its practice, using examples from palliative care. Palliative care is well positioned to be at the vanguard of quality improvement in healthcare. But it holds ethical particularities which require specific considerations, that are helpful for other specialities. The experiences of two improvement activities in palliative care, the Liverpool Care Pathway and Do Not Attempt Resuscitation status reviews, illustrate potential dangers of QI. Recommendations for ethically sound quality improvement projects in palliative care include paying attention to the burden of time, viewing informed consent as a tool, monitoring for vulnerability and coercion and transparency in the use of data. The ethics and practices in clinical encounters provide a framework for approaching consent and protecting those with palliative care needs who are deemed as vulnerable. It is explicit in palliative care that time and energy are precious and finite resources. These must be valued and respected in any quality improvement projects. Respect for beneficence and autonomy is essential to avoid coercion and for any project to be ethically sound. Quality improvement processes are an integral part of good healthcare practices. High ethical standards, a supportive culture, transparency and candour are needed for the promotion and sustainability of quality improvement in palliative care.

Parental Perspectives on Pediatric Surgical Recovery: Narrative Analysis of Free-Text Comments From a Postoperative Survey.

Qualitative experience data can inform health care providers how to best support families during pediatric postoperative recovery. Patient experience data can also provide actionable information to guide health care quality improvement; positive feedback can confirm the efficacy of current practices and systems, while negative comments can identify areas for improvement. This study aimed to understand families' perspectives regarding their children's surgical recovery using qualitative patient experience data (free-text comments) from a prospective cohort study conducted within a larger study developing a postoperative-outcome risk stratification model. Participants were parents or guardians of children aged 0-18 years who underwent surgery at a pediatric tertiary care facility; children undergoing either outpatient or inpatient procedures were eligible to be enrolled. Participants with English as a second language were offered translational services during the consent process and were included if any family member could translate the surveys into their preferred language. Participants were ineligible if they and their families could not understand English or the child had a neurodevelopmental disability. Perioperative data were collected from families using web-based surveys, including 1 preoperative survey and follow-up surveys sent on postoperative days 1, 2, 3, 7, 15, 30, and 90. Surveys were completed until the family indicated the child was fully recovered or until postoperative day 90 was reached. Follow-up surveys included opportunities to leave free-text comments on the child's surgical experience. In total, 91% (453/500) of enrolled families completed at least 1 postoperative survey; 53% (242/453) provided at least 1 free-text comment and were included in the presented analysis, based on a total of 485 comments. The patient's age distribution was bimodal (modes at 2-3 and 14-15 years), with 66% (160/242) being male. Patients underwent orthopedic (60/242, 25%), urological (39/242, 16%), general (36/242,15%), otolaryngological (31/242, 13%), ophthalmological (32/242, 13%), dental (27/242, 11%), and plastic (17/242, 7%) surgeries. Largely positive comments (398/485, 82%) were made on the recovery and clinical care experience. A key theme for improvement included "communication," with subthemes highlighting parental concerns regarding the "preoperative discussions," "clarity of discharge instructions," and "continuity of care." Other themes included "length of stay" and "recovery experience." Feedback also suggested survey design amendments for future iterations of this instrument. Collecting parental recovery feedback is feasible and valued by families. Findings underscored the significance of enhancing communication strategies between health care providers and parents to align expectations and support proactive family-centered care. Our postoperative surveys allowed families to provide actionable suggestions for improving their experience, which may not have been considered during their hospital encounter. Our longitudinal survey protocol may be expanded to support continuous quality improvement initiatives involving near-real-time patient feedback to improve the health care experience of patients and families.

Digital Skills in the 21st Century: Understanding the Impact of Digital Literacy on Nurses

The aim of this research is to draw attention to the importance of digital literacy in nursing services. Technological advances have driven global development in an unprecedented manner over the last two decades, leading to significant growth in access and connectivity for billions of people worldwide. Approximately 2.5 billion people own smartphones, and four billion people use social media. Digital literacy now requires not only the ability to use technology on a social level, but also the capacity to analyze and integrate digital information. The increasing demand from the labor market for individuals to be digitally literate has spurred targeted interventions and innovations aimed at equipping the future workforce with necessary digital skills. However, despite these efforts, the digital skills gap remains a global challenge. A digitally enabled profession ensures citizens receive the highest quality healthcare. Health-related infrastructures are rapidly digitalizing, leading to significant improvements in healthcare quality. Digital literacy is crucial for accessing and interpreting data, analyzing medical images, and using technology to enhance patient care. Assessing digital literacy levels within healthcare is an issue that should not be overlooked, as technology plays an increasingly important role in both clinical work and research. It is noted that the digital literacy levels of nursing students vary globally, and there is limited research on the factors that influence these levels. Therefore, academics should prioritize this concept and invest in further research and educational initiatives to improve digital literacy.

Sustainability of Interprofessional Education: Protocol for a Scoping Review.

Interprofessional education (IPE) is an approach that can improve health care quality, contribute to the qualification of health care professionals, and train undergraduate students. Although this strategy has made significant progress in the last decade, integration, sustainability, and institutional growth are still priorities worldwide. Thus, maintaining strategies is essential for their full development and evolution. This study aimed to identify discussions about the sustainability of IPE and map its actions or strategies (or both). The scoping review will follow the Joanna Briggs Institute methodology. This scoping review protocol follows the JBI Reviewers' Manual, with 6 stages: identifying the research question; identifying relevant studies; study selection; data extraction and coding; analysis and interpretation of results; and consultation with stakeholders. Two independent and blind reviewers will evaluate and select studies available in English, Portuguese, and Spanish based on the eligibility criteria. Searches will be conducted on LILACS, Embase, Scopus, PubMed/MEDLINE, ERIC, Web of Science, CINAHL, Google Scholar databases; ProQuest Dissertations & Theses Global, and Brazilian Digital Library of Theses and Dissertations. The main research question is as follows: What have been the sustainability strategies for IPE actions? This scoping review will incorporate studies (empirical or theoretical-reflective) that address strategies or actions (or both) for IPE sustainability. They must present a quantitative, qualitative, or mixed methods approach and be available in full text. Data on strategies or actions for IPE sustainability will be extracted and inserted into a spreadsheet for analysis. Quantitative data will be analyzed using descriptive statistics, while qualitative analysis will identify meanings and patterns through thematic analysis. Thus, the aim is to present the compiled findings in tables and charts. The database search was conducted on March 22, 2024. In April and May 2024, duplicate studies were excluded. From July to November 2024, study selection will be carried out. In December 2024, data extraction and tabulation will take place, as well as consultation with stakeholders. The aim is to publish the results in scientific journals in January 2025. This protocol will guide this scoping review to identify discussions on the sustainability of IPE and map its actions or strategies (or both); summarize the definitions and institutions that develop or promote IPE; and present the main recommendations for the area under study. Additionally, possible research gaps can be identified to guide future studies. This review will shed light on existing knowledge gaps and the current state of research, which could provide support for future research, programs, and policy responses to foster collaboration and interprofessional practice and, consequently, improve the quality of user care. This information will be useful in supporting decision-making by government officials, managers, teachers, facilitators, and students in the implementation, maintenance, and development of IPE. Open Science Framework 5VNJS; https://osf.io/5vnjs/. DERR1-10.2196/60763.

Advancements in Artificial Intelligence-Enhanced Imaging Diagnostics for the Management of Liver Disease-Applications and Challenges in Personalized Care.

Liver disease can significantly impact life expectancy, making early diagnosis and therapeutic intervention critical challenges in medical care. Imaging diagnostics play a crucial role in diagnosing and managing liver diseases. Recently, the application of artificial intelligence (AI) in medical imaging analysis has become indispensable in healthcare. AI, trained on vast datasets of medical images, has sometimes demonstrated diagnostic accuracy that surpasses that of human experts. AI-assisted imaging diagnostics are expected to contribute significantly to the standardization of diagnostic quality. Furthermore, AI has the potential to identify image features that are imperceptible to humans, thereby playing an essential role in clinical decision-making. This capability enables physicians to make more accurate diagnoses and develop effective treatment strategies, ultimately improving patient outcomes. Additionally, AI is anticipated to become a powerful tool in personalized medicine. By integrating individual patient imaging data with clinical information, AI can propose optimal plans for treatment, making it an essential component in the provision of the most appropriate care for each patient. Current reports highlight the advantages of AI in managing liver diseases. As AI technology continues to evolve, it is expected to advance personalized diagnostics and treatments and contribute to overall improvements in healthcare quality.

Kindness: Poor cousin or equal kin to Compassion and Empathy in the Healthcare Literature? A Scoping Review

ObjectiveThis scoping review seeks to understand how kindness, compassion and empathy are defined and conceptualised within existing healthcare services literature.IntroductionLittle consensus exists on how healthcare literature defines and conceptualises kindness....

Modelling the cost-effectiveness and budget impact of pay-for-performance programs in health care

IntroductionWith an upward trend in adoption by industrialized nations, pay-for-performance (P4P) mechanisms are increasingly recognized for fostering quality improvement in healthcare. P4P programs conventionally reward providers with supplemental payments upon achieving predefined performance targets. This study aims to utilize decision modelling to determine the cost-effectiveness and maximum incentive levels of P4P programs.MethodsA decision model, grounded in previously published models exploring the cost-effectiveness of implementation programs, was developed. The model evaluates the cost-effectiveness of P4P programs for an exogenous reward size under varied reward mechanisms and also in scenarios with and without a budget or time constraint.ResultsIn instances where P4P programs do not substitute other healthcare programs, their incremental cost-effectiveness ratio (ICER) is deterministically set and ranges from treatment ICER to infinity, irrespective of the reward mechanism. With a budget or time constraint in play, the P4P program is incentivized up to the point where its population cost or ICER aligns with that of the program being replaced.ConclusionThe proposed decision model effectively calculates the cost-effectiveness and budget impact of P4P programs, accommodating various reward mechanisms and scenarios, both with and without budget or time constraints.

Flexible scan statistic with a restricted likelihood ratio for optimized COVID-19 surveillance.

Disease surveillance remains important for early detection of new COVID-19 variants. For this purpose, the World Health Organization (WHO) recommends integrating of COVID-19 surveillance with other respiratory diseases. This requires knowledge of areas with elevated risk, which in developing countries is lacking from the routine analyses. Focusing on Ghana, this study employed scan-statistic cluster analysis to uncover the spatial patterns of incidence and Case Fatality Rates (CFR) of COVID-19 based on reports covering the four pandemic waves in Ghana between 12 March 2020 and 28 February 2022. Applying flexible spatial scan statistic with restricted likelihood ratio, we examined the incidence and CFR clusters before and after adjustment for covariates. We used distance to the epicentre, proportion of the population aged ≥ 65, male proportion of the population and urban proportion of the population as the covariates. We identified 56 significant spatial clusters for incidence and 26 for CFR for all four waves of the pandemic. The Most Likely Clusters (MLCs) of incidence occurred in the districts in south-eastern Ghana, while the CFR ones occurred in districts in the central and the northeastern parts of the country. These districts could serve as sites for sentinel or genomic surveillance. Spatial relationships were identified between COVID-19 incidence covariates and the CFR. We observed closeness to the epicentre and high proportions of urban populations increased COVID-19 incidence, whiles high proportions of those aged ≥ 65 years increased the CFR. Accounting for the covariates resulted in changes in the distribution of the clusters. Both incidence and CFR due to COVID-19 were spatially clustered, and these clusters were affected by high proportions of the urban population, high proportions of the male population, high proportions of the population aged ≥ 65 years and closeness to the epicentre. Surveillance should target districts with elevated risk. Long-term control measures for COVID-19 and other contagious diseases should consider improving quality healthcare access and measures to reduce growth rates of urban populations.