An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
- Full Text:
An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
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An investigation into factors influencing lack of improvement towards achieving compliance with the quality national core standards in KSD clinics, O.R. Tambo District
- Authors: Mnyamana, Tozama Nobom
- Date: 2018
- Subjects: Health facilities--Standards , Health facilities--South Africa , Medical care--South Africa
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/19498 , vital:43133
- Description: The purpose of this study was to explore factors associated with lack of improvement in the health care provided towards achieving compliance with the National Core Standards (NCS) in King Sabata Dalindyebo (KSD) sub-district clinics, in OR Tambo District in the Eastern Cape. A quantitative design was seen as the most suitable for this study. This method was chosen as the one that would best assist the researcher to meet the objectives of the study. A purposive sampling method was chosen, according to which the researcher selected five sites; all clinics that had been previously inspected for quality standards by the Office of Health Standards Compliance at least once. Participants for the study were all employees of those clinics and one representative of the governing structure of each. Twenty-eight participants in total formed part of the study as two did not return their responses. For collecting data from the participants, self-administered questionnaires were used. Throughout the data collection process, ethical standards of nursing research regarding anonymity, confidentiality and privacy were adhered to. Collected data were analysed using the Statistical Package for the Social Sciences (SPSS) computer software. The distribution of results is presented in tables and bar graphs. The results of the study reveal that a quality-oriented culture is lacking in our clinics with poor participation of clinics teams in quality improvement processes. Leadership and management at clinic level need strengthening. It was also found that there is insufficient capacitation of departmental strategic shift innovations, revealed in the complete absence of information sharing and feedback regarding previous assessments. In addition, there is a shortage of resources including basic equipment in clinics. , Thesis (MPH) -- University of Fort Hare, 2018
- Full Text:
- Authors: Mnyamana, Tozama Nobom
- Date: 2018
- Subjects: Health facilities--Standards , Health facilities--South Africa , Medical care--South Africa
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/19498 , vital:43133
- Description: The purpose of this study was to explore factors associated with lack of improvement in the health care provided towards achieving compliance with the National Core Standards (NCS) in King Sabata Dalindyebo (KSD) sub-district clinics, in OR Tambo District in the Eastern Cape. A quantitative design was seen as the most suitable for this study. This method was chosen as the one that would best assist the researcher to meet the objectives of the study. A purposive sampling method was chosen, according to which the researcher selected five sites; all clinics that had been previously inspected for quality standards by the Office of Health Standards Compliance at least once. Participants for the study were all employees of those clinics and one representative of the governing structure of each. Twenty-eight participants in total formed part of the study as two did not return their responses. For collecting data from the participants, self-administered questionnaires were used. Throughout the data collection process, ethical standards of nursing research regarding anonymity, confidentiality and privacy were adhered to. Collected data were analysed using the Statistical Package for the Social Sciences (SPSS) computer software. The distribution of results is presented in tables and bar graphs. The results of the study reveal that a quality-oriented culture is lacking in our clinics with poor participation of clinics teams in quality improvement processes. Leadership and management at clinic level need strengthening. It was also found that there is insufficient capacitation of departmental strategic shift innovations, revealed in the complete absence of information sharing and feedback regarding previous assessments. In addition, there is a shortage of resources including basic equipment in clinics. , Thesis (MPH) -- University of Fort Hare, 2018
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Challenges hindering the implementation of quality supervision in primary health care facilities in Oliver Reginald Tambo District, Eastern Cape Province
- Zamxaka, Nontlantla Caroline
- Authors: Zamxaka, Nontlantla Caroline
- Date: 2018
- Subjects: Hospitals -- Administration , Health services administration , Hospitals -- Business management
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/29256 , vital:77707
- Description: The study investigated the factors that prevent quality supervision in primary health care(PHC) facilities in Oliver Reginald Tambo (O.R. Tambo) district of the Eastern Cape Province of South Africa. The motivation for this study was a concern regarding consistently poor performance by PHC facilities in the province despite regular supervisory visits. The objectives of the study were to explore practices of PHC supervisors in implementing supervision, and to assess perceptions, opinions, and attitudes of PHC supervisors and PHC operational managers with regards to PHC supervisory visits. On search methodology, qualitative approach was predominating whilst quantitative data was supplementing the study. A purposive sample of PHC supervisors and operational managers was drawn from PHC facilities which had a consistent, 100% rate of supervisory visits. The data was analysed thematically. The results revealed systemic and structural challenges that affect the implementation of quality supervision, rendering supervisory visits inefficient. These were: a high workload resulting from inconsistency in the allocation of facilities, as well as the many other responsibilities which supervisors have; a lack of knowledge and experience in supervisors; a lack of health service resources including transport; a high turnover of nurses; lack of support from the district and sub-district leadership and management; lack of collaboration, coordination and integration of activities; and delayed procurement processes resulting in a recurring lack of equipment and medical supplies. The findings of the study brought an understanding of the systemic and structural requirements that need to be made for a functioning quality supervisory system. Successful interventions require strengthening of leadership and governance, and the diligent application of the systems approach to solving problems at facility, district and provincial level. An improvement in leadership and governance should include innovative strategies to utilise the limited resources available without compromising the key objective of quality health care. , Thesis (MPH) -- Faculty of Health Sciences, 2018
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- Authors: Zamxaka, Nontlantla Caroline
- Date: 2018
- Subjects: Hospitals -- Administration , Health services administration , Hospitals -- Business management
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/29256 , vital:77707
- Description: The study investigated the factors that prevent quality supervision in primary health care(PHC) facilities in Oliver Reginald Tambo (O.R. Tambo) district of the Eastern Cape Province of South Africa. The motivation for this study was a concern regarding consistently poor performance by PHC facilities in the province despite regular supervisory visits. The objectives of the study were to explore practices of PHC supervisors in implementing supervision, and to assess perceptions, opinions, and attitudes of PHC supervisors and PHC operational managers with regards to PHC supervisory visits. On search methodology, qualitative approach was predominating whilst quantitative data was supplementing the study. A purposive sample of PHC supervisors and operational managers was drawn from PHC facilities which had a consistent, 100% rate of supervisory visits. The data was analysed thematically. The results revealed systemic and structural challenges that affect the implementation of quality supervision, rendering supervisory visits inefficient. These were: a high workload resulting from inconsistency in the allocation of facilities, as well as the many other responsibilities which supervisors have; a lack of knowledge and experience in supervisors; a lack of health service resources including transport; a high turnover of nurses; lack of support from the district and sub-district leadership and management; lack of collaboration, coordination and integration of activities; and delayed procurement processes resulting in a recurring lack of equipment and medical supplies. The findings of the study brought an understanding of the systemic and structural requirements that need to be made for a functioning quality supervisory system. Successful interventions require strengthening of leadership and governance, and the diligent application of the systems approach to solving problems at facility, district and provincial level. An improvement in leadership and governance should include innovative strategies to utilise the limited resources available without compromising the key objective of quality health care. , Thesis (MPH) -- Faculty of Health Sciences, 2018
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Reasons for late booking of pregnant women at antenatal care clinics in King Sabata Dalindyebo Sub-district in the Eastern Cape, South Africa
- Authors: Ntshanga, Nomvume Signoria
- Date: 2018
- Subjects: Pregnant women -- South Africa -- Eastern Cape Prenatal Care Late antenatal care booking
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/10520 , vital:35592
- Description: Background: The initiation of ante-natal care booking is universally recommended in the first trimester of pregnancy. While working in the Oliver Reginald Tambo district in the Eastern Cape Department of Health, the researcher noticed that late booking was the norm in all sub-districts, especially in the King Sabata Dalindyebo (KSD) sub-district, resulting in impaired antenatal care and an increased potential for adverse outcomes such as maternal mortalities. Purpose of the study: The purpose of the study was to explore and describe the reasons for late booking for antenatal care by pregnant women in the KSD sub-district. Objectives: The objective of the study was to determine reasons why women were booking late for antenatal in KSD sub district. Methods: Thirteen in-depth, unstructured interviews were conducted with late bookers (i.e., those who sought antenatal care (ANC) after twenty weeks of pregnancy) between July and August 2015. The interviews were recorded and, subsequently, transcribed by a reputable linguist from Walter Sisulu University (WSU) and analysed using Creswell’s thematic analysis model. Findings: The average gestational age of booking was 22 weeks (ranging from 22 to 28 weeks). Most women were teenagers and young unmarried women, most of whom were still attending school. All were unemployed. Most had experienced previous pregnancies. All these women delayed attending clinic early due to their ignorance of the exact gestational period for one to start the clinic. Although most of the women did not have direct reasons, the bulk of their reasons for delays were linked to long distances being travelled, leading to the payment of expensive taxi fees. This may also be attributed to cultural factors that seem to promote a veil of secrecy regarding pregnancy, the desire for visual evidence of pregnancy first and the practice of married women having to care for sick relatives. Conclusion: Poor access to clinics is a fundamental systemic failure and a major contributor and one of the reasons why women delayed in attending antenatal care clinics. Low socio economic status and cultural beliefs, coupled with long distance and expensive taxi fare, are other reasons for late booking.
- Full Text:
- Authors: Ntshanga, Nomvume Signoria
- Date: 2018
- Subjects: Pregnant women -- South Africa -- Eastern Cape Prenatal Care Late antenatal care booking
- Language: English
- Type: Thesis , Masters , Public Health
- Identifier: http://hdl.handle.net/10353/10520 , vital:35592
- Description: Background: The initiation of ante-natal care booking is universally recommended in the first trimester of pregnancy. While working in the Oliver Reginald Tambo district in the Eastern Cape Department of Health, the researcher noticed that late booking was the norm in all sub-districts, especially in the King Sabata Dalindyebo (KSD) sub-district, resulting in impaired antenatal care and an increased potential for adverse outcomes such as maternal mortalities. Purpose of the study: The purpose of the study was to explore and describe the reasons for late booking for antenatal care by pregnant women in the KSD sub-district. Objectives: The objective of the study was to determine reasons why women were booking late for antenatal in KSD sub district. Methods: Thirteen in-depth, unstructured interviews were conducted with late bookers (i.e., those who sought antenatal care (ANC) after twenty weeks of pregnancy) between July and August 2015. The interviews were recorded and, subsequently, transcribed by a reputable linguist from Walter Sisulu University (WSU) and analysed using Creswell’s thematic analysis model. Findings: The average gestational age of booking was 22 weeks (ranging from 22 to 28 weeks). Most women were teenagers and young unmarried women, most of whom were still attending school. All were unemployed. Most had experienced previous pregnancies. All these women delayed attending clinic early due to their ignorance of the exact gestational period for one to start the clinic. Although most of the women did not have direct reasons, the bulk of their reasons for delays were linked to long distances being travelled, leading to the payment of expensive taxi fees. This may also be attributed to cultural factors that seem to promote a veil of secrecy regarding pregnancy, the desire for visual evidence of pregnancy first and the practice of married women having to care for sick relatives. Conclusion: Poor access to clinics is a fundamental systemic failure and a major contributor and one of the reasons why women delayed in attending antenatal care clinics. Low socio economic status and cultural beliefs, coupled with long distance and expensive taxi fare, are other reasons for late booking.
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