BACKGROUND:
Providing quality care is a fundamental principle of healthcare delivery globally. Although substantial research has examined the relationship between hospital structure and process measures and the quality of healthcare, evidence from intensive care unit (ICU) settings remains limited. This study examined the impact of hospital structure and process measures on the quality of healthcare services in ICUs of Namibian hospitals.

METHODS:
A cross-sectional survey was conducted in six hospitals, comprising 11 (n=11) ICUs from both the public and private sectors. A total sampling method of all categories of nurses (n=110) was used, with a survey response rate of 73%. Descriptive and inferential statistics were derived using ANOVA-type hierarchical linear modelling.

RESULTS:
Most ICUs were general units (n=5; 45.5%), with a mean unit size of nine beds and high occupancy rates (88%). The nursing workforce was predominantly composed of bachelor’s-prepared registered nurses (n=87; 81.3%), most of whom had three or more years of clinical experience (n=39; 37.9%). The nurses rated the overall patient safety and quality of care as good (M=2.8, SD=1.2). However, they reported moderate occurrences of adverse events. It was found that process measures seemed to have more and larger effects than structure measures, specifically the practice environment and the subscales of nurse participation in hospital affairs, nurse foundations of quality of care, nurse manager ability, leadership and support for nurses, and collegial nurse-physician relations. Regarding the hospital structure unit type, unit size, bed occupancy and nurse-patient ratios had effects on the quality of care.

CONCLUSIONS:
To improve the quality of care in the ICU, greater emphasis is needed on hospital process measures, particularly the practice environment. In addition, ICU quality improvement should prioritise structural factors, including unit type, unit size, bed occupancy, and nurse–patient ratios.