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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Assessing factors influencing professional nurses' attrition in South Africa : a case study of private hospitals in Johannesburg
- Authors: Mbobo, Angelina Pretty
- Date: 2018
- Subjects: Intensive care nursing
- Language: English
- Type: Thesis , Masters , Public Health Leadership
- Identifier: http://hdl.handle.net/10353/11181 , vital:37200
- Description: South Africa faces an immense shortage of healthcare professionals, especially trained and experienced critical care nurses. This thesis assesses factors influencing professional nurses ‘attrition in two selected private hospitals. This results in an HR risk; loss of skills, task shifting and the use of less skilled nurses, and not limited to the high workloads in intensive care units together with the job dissatisfaction consequently. To confirm this, a case study making use of a qualitative approach, follows the definition of a social constructivism framework. The study assessed 40 trained and experienced critical care nurses in focus groups of 5, with which a stratified purposive sampling technique was used and the focus group interviews were 90 minutes Seven structured interviews were undertaken, (using a narrative summary) with hospital operational managers working directly with the critical care nurses. Audio-recorded data were analysed by thematic content analysis using Creswell’s steps content analysis method. Multiple reasons, as given by nurses, to discontinue their services in private hospitals emerged. These were: Heavy workloads, shortage of trained staff, medico-legal risks; lack of supervision, support and teamwork, physical and emotional exhaustion, fatigue, stress and burnout, differential salary scales, non-competitive retirement packages role ambiguity, inadequate equipment, unresolved conflict with colleagues or management, personal financial crisis, lack of recognition and Lack of career development or promotion. These factors make use of themes, which include issues related to line management, administration, subjective and uncertainty of roles. Operational managers confirmed such reasons for the discontinuation of services offered by critical care nurses in private hospitals. Management views to the attrition of critical care nurses were that: (a) The staffing crisis was a serious matter of concern, (b) the use of less skilled staff resulted in negative effects on patient care and (c) the low number of critical care nursing staff negatively affected organisational goals.
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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.
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