Clinical governance implementation challenges in the Department of Health, Mpumalanga, South Africa
- Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
- Authors: Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
- Date: 2022-09
- Subjects: Clinical competence , Health services administration
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/27275 , vital:66532
- Description: Clinical governance (CG) is the system through which health authorities are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence flourishes. South Africa is one of the countries where CG has not been successfully implemented. This study sought to explore the CG implementation challenges in the Mpumalanga province, South Africa. The study objectives included the seven pillars of CG. The study was a qualitative and exploratory, using purposive sampling technique to select study participants. A total of twenty-two (22) individuals were selected for the study. Semi-structured interviews were used for data collection. Each interview was transcribed verbatim by the researcher. Confidentiality was ensured through the coding of interviewee names. The content analysis technique was used for data analysis, using the study objectives as themes. The study found general lack of understanding of the concept of CG, poor performance of clinical audits, sub-standard clinical performance and effectiveness, poor clinical risk management, poor patient and public involvement in patient care, lack of evidence-based practice and research, inadequate training and development of healthcare workers, and sub-standard health information management across the department. The researcher recommends that the CG policy be prioritised by the Mpumalanga DOH, that systems be put in place to facilitate policy implementation, and that the departmental staff establishments at all levels, prioritise healthcare professionals in key leadership positions. In conclusion, there are numerous challenges that confront the Mpumalanga Department of Health regarding the implementation of clinical governance, requiring urgent attention. , Thesis (PhD) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-09
- Authors: Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
- Date: 2022-09
- Subjects: Clinical competence , Health services administration
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/27275 , vital:66532
- Description: Clinical governance (CG) is the system through which health authorities are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence flourishes. South Africa is one of the countries where CG has not been successfully implemented. This study sought to explore the CG implementation challenges in the Mpumalanga province, South Africa. The study objectives included the seven pillars of CG. The study was a qualitative and exploratory, using purposive sampling technique to select study participants. A total of twenty-two (22) individuals were selected for the study. Semi-structured interviews were used for data collection. Each interview was transcribed verbatim by the researcher. Confidentiality was ensured through the coding of interviewee names. The content analysis technique was used for data analysis, using the study objectives as themes. The study found general lack of understanding of the concept of CG, poor performance of clinical audits, sub-standard clinical performance and effectiveness, poor clinical risk management, poor patient and public involvement in patient care, lack of evidence-based practice and research, inadequate training and development of healthcare workers, and sub-standard health information management across the department. The researcher recommends that the CG policy be prioritised by the Mpumalanga DOH, that systems be put in place to facilitate policy implementation, and that the departmental staff establishments at all levels, prioritise healthcare professionals in key leadership positions. In conclusion, there are numerous challenges that confront the Mpumalanga Department of Health regarding the implementation of clinical governance, requiring urgent attention. , Thesis (PhD) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-09
Clinical governance implementation challenges in the Department of Health, Mpumalanga, South Africa
- Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
- Authors: Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
- Date: 2022-09
- Subjects: Clinical competence , Evidence-based medicine , Health services administration
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/23600 , vital:58194
- Description: Clinical governance (CG) is the system through which health authorities are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence flourishes. South Africa is one of the countries where CG has not been successfully implemented. This study sought to explore the CG implementation challenges in the Mpumalanga province, South Africa. The study objectives included the seven pillars of CG. The study was a qualitative and exploratory, using purposive sampling technique to select study participants. A total of twenty-two (22) individuals were selected for the study. Semi-structured interviews were used for data collection. Each interview was transcribed verbatim by the researcher. Confidentiality was ensured through the coding of interviewee names. The content analysis technique was used for data analysis, using the study objectives as themes. The study found general lack of understanding of the concept of CG, poor performance of clinical audits, sub-standard clinical performance and effectiveness, poor clinical risk management, poor patient and public involvement in patient care, lack of evidence-based practice and research, inadequate training and development of healthcare workers, and sub-standard health information management across the department. The researcher recommends that the CG policy be prioritised by the Mpumalanga DOH, that systems be put in place to facilitate policy implementation, and that the departmental staff establishments at all levels, prioritise healthcare professionals in key leadership positions. In conclusion, there are numerous challenges that confront the Mpumalanga Department of Health regarding the implementation of clinical governance, requiring urgent attention. , Thesis (PhD) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-09
- Authors: Maduna, Patrick Hawkins https://orcid.org/0000-0002-4926-1661
- Date: 2022-09
- Subjects: Clinical competence , Evidence-based medicine , Health services administration
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/23600 , vital:58194
- Description: Clinical governance (CG) is the system through which health authorities are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence flourishes. South Africa is one of the countries where CG has not been successfully implemented. This study sought to explore the CG implementation challenges in the Mpumalanga province, South Africa. The study objectives included the seven pillars of CG. The study was a qualitative and exploratory, using purposive sampling technique to select study participants. A total of twenty-two (22) individuals were selected for the study. Semi-structured interviews were used for data collection. Each interview was transcribed verbatim by the researcher. Confidentiality was ensured through the coding of interviewee names. The content analysis technique was used for data analysis, using the study objectives as themes. The study found general lack of understanding of the concept of CG, poor performance of clinical audits, sub-standard clinical performance and effectiveness, poor clinical risk management, poor patient and public involvement in patient care, lack of evidence-based practice and research, inadequate training and development of healthcare workers, and sub-standard health information management across the department. The researcher recommends that the CG policy be prioritised by the Mpumalanga DOH, that systems be put in place to facilitate policy implementation, and that the departmental staff establishments at all levels, prioritise healthcare professionals in key leadership positions. In conclusion, there are numerous challenges that confront the Mpumalanga Department of Health regarding the implementation of clinical governance, requiring urgent attention. , Thesis (PhD) -- Faculty of Health Sciences, 2022
- Full Text:
- Date Issued: 2022-09
The implementation of National Core Standards with specific reference to clinical leadership: A case of Frere Hospital
- Authors: Rasi, Wandisa
- Date: 2021-06
- Subjects: Health facilities -- Standards , Health services administration -- Standards
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/21914 , vital:51842
- Description: BACKGROUND: Generally, many people in South Africa have difficulty accessing quality health services due to poor public service. Over 42 million citizens do not have health insurance and are growing sicker as they age. Health facilities, such as public health centers, are their only recourse. Health authorities in South Africa fail to monitor patient care effectively, as evidenced by their uninspiring record on patient experience. Anecdotes of poor patient experiences are extensive with the health ombudsman. The Office of Health Standards Compliance (OHSC) reports horrifying stories of patients sleeping on hospital floors due to the shortage of beds, patients unable to receive critical surgical treatment due to shortage of doctors, medical supplies and equipment failure or lack thereof. A few union protests have highlighted the poor quality of public healthcare. But it is not uncommon for South Africans to voice their displeasure over poor public healthcare. Health services are individualised and there is no specific interest group or community that is affected by this overall unpleasant experience. Indications of the growing public campaign against the deteriorating healthcare system may be as simple as the increasing number of medical legal claims. This study focuses on the implementation of national core standards with specific reference to clinical leadership. This study focuses on the implementation of national core standards with specific reference to clinical leadership. RESEARCH AIM: This research seeks to explore the effectiveness of the implementation of NCSs with specific reference to Clinical Leadership in Frere Hospital. It also wants to assess if the Frere hospital upholds the national core standards METHOD: qualitative research design was used in this study. Semi-structured, individual interviews were conducted. CONCLUSION: The researcher concluded that it is quite evident that the public health sector is complex and that environmental influence affect the ECDOH Functions within the health system. There is a relationship between clinical leadership and service delivery; now, to improve service delivery within the Frere hospital, strong leadership is needed to drive the change towards implementing the NCS. Ultimately, Frere hospital does not uphold the NCSs, and the staff needs to be educated on what is and how it can improve the hospital’s service delivery. RECOMMENDATIONS: Effective public leadership development, high performing and accountable leadership behavioural measurement at the most senior level at the Frere hospital is very empirical in driving effective delivery of services to patients. Effective Performance management, visible leadership role at all management levels. Performance appraisal system needs to be engineered to focus on performance and results. Recognition and Implementation of clinical leadership. Establish a culture and implementation of good governance principles in health institutions. Establish an institution based OHSC office that is visible and implement NCS through Batho Pele Principles. , Thesis (MPH) -- Faculty of Health Sciences, Public Health, 2021
- Full Text:
- Date Issued: 2021-06
- Authors: Rasi, Wandisa
- Date: 2021-06
- Subjects: Health facilities -- Standards , Health services administration -- Standards
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/21914 , vital:51842
- Description: BACKGROUND: Generally, many people in South Africa have difficulty accessing quality health services due to poor public service. Over 42 million citizens do not have health insurance and are growing sicker as they age. Health facilities, such as public health centers, are their only recourse. Health authorities in South Africa fail to monitor patient care effectively, as evidenced by their uninspiring record on patient experience. Anecdotes of poor patient experiences are extensive with the health ombudsman. The Office of Health Standards Compliance (OHSC) reports horrifying stories of patients sleeping on hospital floors due to the shortage of beds, patients unable to receive critical surgical treatment due to shortage of doctors, medical supplies and equipment failure or lack thereof. A few union protests have highlighted the poor quality of public healthcare. But it is not uncommon for South Africans to voice their displeasure over poor public healthcare. Health services are individualised and there is no specific interest group or community that is affected by this overall unpleasant experience. Indications of the growing public campaign against the deteriorating healthcare system may be as simple as the increasing number of medical legal claims. This study focuses on the implementation of national core standards with specific reference to clinical leadership. This study focuses on the implementation of national core standards with specific reference to clinical leadership. RESEARCH AIM: This research seeks to explore the effectiveness of the implementation of NCSs with specific reference to Clinical Leadership in Frere Hospital. It also wants to assess if the Frere hospital upholds the national core standards METHOD: qualitative research design was used in this study. Semi-structured, individual interviews were conducted. CONCLUSION: The researcher concluded that it is quite evident that the public health sector is complex and that environmental influence affect the ECDOH Functions within the health system. There is a relationship between clinical leadership and service delivery; now, to improve service delivery within the Frere hospital, strong leadership is needed to drive the change towards implementing the NCS. Ultimately, Frere hospital does not uphold the NCSs, and the staff needs to be educated on what is and how it can improve the hospital’s service delivery. RECOMMENDATIONS: Effective public leadership development, high performing and accountable leadership behavioural measurement at the most senior level at the Frere hospital is very empirical in driving effective delivery of services to patients. Effective Performance management, visible leadership role at all management levels. Performance appraisal system needs to be engineered to focus on performance and results. Recognition and Implementation of clinical leadership. Establish a culture and implementation of good governance principles in health institutions. Establish an institution based OHSC office that is visible and implement NCS through Batho Pele Principles. , Thesis (MPH) -- Faculty of Health Sciences, Public Health, 2021
- Full Text:
- Date Issued: 2021-06
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:
- Date Issued: 2018
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:
- Date Issued: 2018
Approach to National Health Workforce Planning for health service delivery in South Africa
- Authors: Mahlathi, Malixole Percival
- Date: 2009-12
- Subjects: Health planning , Rural health services , Labor turnover
- Language: English
- Type: text
- Identifier: http://hdl.handle.net/10353/25216 , vital:64058
- Description: Although South Africa educates and trains many health professionals of various categories, it continues to experience relative and critical shortages of these professionals especially at its rural health facilities. It boasts more than 15 Faculties of Health Sciences which train a variety of health professionals. In addition to training for its own purposes, it also offers training for several countries in the Southern African Development Community. The burden of disease is considered to be high and increasing, complicated by the HIV and AIDS epidemic. In the light of these challenges it is necessary that South Africa engages in careful health workforce planning as a long term approach to solve shortage of health professionals and improving the delivery of health services. This study examines the health workforce planning approaches by the various Provincial Departments of Health and the student planning approaches by the Faculties of Health Sciences of the Higher Education Institutions that train health professionals. , Thesis (PhD) -- Faculty of Health Sciences, 2009
- Full Text:
- Date Issued: 2009-12
- Authors: Mahlathi, Malixole Percival
- Date: 2009-12
- Subjects: Health planning , Rural health services , Labor turnover
- Language: English
- Type: text
- Identifier: http://hdl.handle.net/10353/25216 , vital:64058
- Description: Although South Africa educates and trains many health professionals of various categories, it continues to experience relative and critical shortages of these professionals especially at its rural health facilities. It boasts more than 15 Faculties of Health Sciences which train a variety of health professionals. In addition to training for its own purposes, it also offers training for several countries in the Southern African Development Community. The burden of disease is considered to be high and increasing, complicated by the HIV and AIDS epidemic. In the light of these challenges it is necessary that South Africa engages in careful health workforce planning as a long term approach to solve shortage of health professionals and improving the delivery of health services. This study examines the health workforce planning approaches by the various Provincial Departments of Health and the student planning approaches by the Faculties of Health Sciences of the Higher Education Institutions that train health professionals. , Thesis (PhD) -- Faculty of Health Sciences, 2009
- Full Text:
- Date Issued: 2009-12
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