An ergonomics approach to understanding perceived barriers to the provision of high-quality healthcare: a Sarah Baartman District clinics case study
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Date Issued: 2020
- Authors: Card, Jason
- Date: 2020
- Subjects: Medical care -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: text , Thesis , Masters , MSc
- Identifier: http://hdl.handle.net/10962/170536 , vital:41933
- Description: Background:The complex nature of healthcare systemsoftenresultsinthe emergence of context-specific barriers that limit the ability for healthcare stakeholders to ensure safe and effective care delivery. In low-to middle-income (LMIC) countries, such as South Africa (SA), limited financial, material and human resources coupled withpoor infrastructure and poor public health determinants, includingpoverty andpoor education, affectthe ability to maintain andimprove on quality care outcomes.Understanding what different stakeholders perceive as barriers, and if these barriers are understood at different levels, is therefore important when attempting to mitigate the risk for unsafe or inefficient care delivery. Human Factors and Ergonomics (HFE) adoptssystems and participatory approaches for the exploration, analysis, and design of socio-technical systems to optimize both human wellbeing and system performance.The barriers to safe and effective healthcare delivery, from an HFE perspective, are not known in the South African context, particularly in parts of the Eastern Cape Province. Elucidatingthesebarriers, even if self-reported,may guidefuture efforts aimed at mitigating risks.The purpose of this study, therefore,wasto explore and highlight the perceived systemic barriers to local and national healthcare delivery, within the Sarah Baartman District in the Eastern Cape Province of South Africa.Methods: Ashort discussion aimed at introducing HFE and components of the Work Systems Model, followed by a survey that captured participant demographics, job characteristics, the perceived national and local systemic barriers, and proposed solutions, was administered withhealthcare stakeholders from 14 primary healthcare facilities and 1 department office within the Sarah Baartman District.Participants (n=120) included management, pharmacy, administration, maintenance, community-and home-based care and nursing staff.Data from the surveys were thematically analysed and categorised according to components of the work system model (Carayon, 2009) and respective workgroup.Results: The findings revealed many overlapping,systemic barriersthat includedshortages of staff, poor management and leadership, a lack of equipmentand basic necessities, poor infrastructure, patient complexity,and high workloads. The results further indicate that the way in which the reported barriers affect worksystem interactionsand performance are unique to different workgroups. Stakeholders iiproposedthat,among others, the absorption of contract workers, the provision of training and adequate human and medical resources and the maintenance of facilities may mitigate the barriers and improve healthcare delivery.Conclusion: The findings highlight a myriad of perceived systemic barriers perceived in the Sarah Baartman district, some of which were fundamental for the effective function of any healthcare system. These barriers may have wide-spread implications for stakeholders at all levels, ultimately affecting the performance, satisfaction and safety and the quality of care. It is especially important to consider these barriers in light of the COVID-19 epidemic, which emerged throughout this study and the major threat it presents to South African healthcare systems. Future research should aim to explore how these barriers interact to contribute to processes and outcomes, as well as explore the perceptions at provincial and national levels in order to better identify areas and strategies for improvement.
- Full Text:
- Date Issued: 2020
Challenges experienced by the Sarah Baartman District Municipality in the rendering of environmental health services
- Authors: Somi, Zoleka
- Date: 2018
- Subjects: Environmental health -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/35469 , vital:33735
- Description: This study highlights challenges experienced by the Sarah Baartman District Municipality in the rendering of environmental health services. Although the Sarah Baartman District Municipality (SBDM) is primarily responsible for the rendering of environmental health services, the local municipalities that have environmental health practitioners within their areas of jurisdiction were appointed to act as its agents in the rendering of municipal health services. Sarah Baartman District Municipality therefore currently utilises the external service delivery mechanism. In 2004 the Sarah Baartman District Municipality was allocated powers and functions for the rendering of municipal health services which were previously a shared responsibility between the Eastern Cape Department of Health, the district municipality and local municipalities. In terms of section 78 (1) of the Municipal Systems Act, 2000 (Act 32 of 2000), on the allocation of new powers and functions, a municipality is required to assess conditions and capacity to deliver the service. In 2008 Sarah Baartman District Municipality appointed the Klyveld, Peat, Marwick and Groerdeler (KPMG) accounting firm to assess these conditions. The assessment identified a number of challenges regarding the current external service delivery mechanism. Based on the outcomes of this section 78 assessment, it was quite clear that the current external service delivery mechanism is the foundation for challenges in the effective rendering of Environmental Health Services at Sarah Baartman District Municipality. The aim of this study was to identify, explore and describe the challenges experienced by the Sarah Baartman District Municipality in the rendering of environmental health services in terms of its current external service delivery mechanism. The study was qualitative, with explorative and descriptive designs by nature. It was conducted at Sarah Baartman District Municipality which is made up of seven local municipalities. The target population for this study was 21 environmental health practitioners practicing within the SBDM (N=21). A purposive sample of eight (n=8) environmental health practitioners were identified to participate in the study. In-depth interviews and focus group discussions were used to collect data. A semi-structured interview guide was used to conduct the in-depth interviews and a focus group. Data was analysed using Tesch’s method of data analysis. The study revealed that the current external service delivery mechanism is the foundation for challenges in the effective rendering of environmental health services at SBDM. This study proposes that Sarah Baartman District Municipality should bring back the function of environmental health from the local municipalities and utilise the internal service delivery mechanism in the rendering of environmental health services.
- Full Text:
- Date Issued: 2018
- Authors: Somi, Zoleka
- Date: 2018
- Subjects: Environmental health -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MA
- Identifier: http://hdl.handle.net/10948/35469 , vital:33735
- Description: This study highlights challenges experienced by the Sarah Baartman District Municipality in the rendering of environmental health services. Although the Sarah Baartman District Municipality (SBDM) is primarily responsible for the rendering of environmental health services, the local municipalities that have environmental health practitioners within their areas of jurisdiction were appointed to act as its agents in the rendering of municipal health services. Sarah Baartman District Municipality therefore currently utilises the external service delivery mechanism. In 2004 the Sarah Baartman District Municipality was allocated powers and functions for the rendering of municipal health services which were previously a shared responsibility between the Eastern Cape Department of Health, the district municipality and local municipalities. In terms of section 78 (1) of the Municipal Systems Act, 2000 (Act 32 of 2000), on the allocation of new powers and functions, a municipality is required to assess conditions and capacity to deliver the service. In 2008 Sarah Baartman District Municipality appointed the Klyveld, Peat, Marwick and Groerdeler (KPMG) accounting firm to assess these conditions. The assessment identified a number of challenges regarding the current external service delivery mechanism. Based on the outcomes of this section 78 assessment, it was quite clear that the current external service delivery mechanism is the foundation for challenges in the effective rendering of Environmental Health Services at Sarah Baartman District Municipality. The aim of this study was to identify, explore and describe the challenges experienced by the Sarah Baartman District Municipality in the rendering of environmental health services in terms of its current external service delivery mechanism. The study was qualitative, with explorative and descriptive designs by nature. It was conducted at Sarah Baartman District Municipality which is made up of seven local municipalities. The target population for this study was 21 environmental health practitioners practicing within the SBDM (N=21). A purposive sample of eight (n=8) environmental health practitioners were identified to participate in the study. In-depth interviews and focus group discussions were used to collect data. A semi-structured interview guide was used to conduct the in-depth interviews and a focus group. Data was analysed using Tesch’s method of data analysis. The study revealed that the current external service delivery mechanism is the foundation for challenges in the effective rendering of environmental health services at SBDM. This study proposes that Sarah Baartman District Municipality should bring back the function of environmental health from the local municipalities and utilise the internal service delivery mechanism in the rendering of environmental health services.
- Full Text:
- Date Issued: 2018
A study to determine the motivational climate in the Department of Health
- Authors: Seitshiro, Tshidiso
- Date: 2013
- Subjects: Employee motivation , Job satisfaction -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MTech
- Identifier: vital:8916 , http://hdl.handle.net/10948/d1021090
- Description: The Department of Health, being a public entity, has a responsibility to provide quality health services to the community. The Department has experienced repeated negative feedback from the press with respect to job dissatisfaction and the quality of service. This could be the result of low employee motivation. The researcher was concerned and interested in investigating possible causes of these allegations by the press. The main purpose of this study was to analyse the motivational climate of employees in the Department of Health. The study included a literature study of employee motivation and organisational climate. The purpose of the literature was to determine how the Department of Health measures up to what the literature reveals. A questionnaire was used as an instrument to collect data. The questionnaire was formulated from the literature discussed in the research study. The major findings indicated that the level of motivation in the Department of Health was low. Findings also indicated the majority of employees were not trained in the Batho Pele principle. The researcher argued that if employees were trained in the Batho Pele principle and also practised, the negative press feedback would be minimal. The researcher suggested certain recommendations for those areas where findings indicated shortcomings in an attempt to increase the overall levels of employee motivation within the Department of Health.
- Full Text:
- Date Issued: 2013
- Authors: Seitshiro, Tshidiso
- Date: 2013
- Subjects: Employee motivation , Job satisfaction -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MTech
- Identifier: vital:8916 , http://hdl.handle.net/10948/d1021090
- Description: The Department of Health, being a public entity, has a responsibility to provide quality health services to the community. The Department has experienced repeated negative feedback from the press with respect to job dissatisfaction and the quality of service. This could be the result of low employee motivation. The researcher was concerned and interested in investigating possible causes of these allegations by the press. The main purpose of this study was to analyse the motivational climate of employees in the Department of Health. The study included a literature study of employee motivation and organisational climate. The purpose of the literature was to determine how the Department of Health measures up to what the literature reveals. A questionnaire was used as an instrument to collect data. The questionnaire was formulated from the literature discussed in the research study. The major findings indicated that the level of motivation in the Department of Health was low. Findings also indicated the majority of employees were not trained in the Batho Pele principle. The researcher argued that if employees were trained in the Batho Pele principle and also practised, the negative press feedback would be minimal. The researcher suggested certain recommendations for those areas where findings indicated shortcomings in an attempt to increase the overall levels of employee motivation within the Department of Health.
- Full Text:
- Date Issued: 2013
A cross-sectional study to ascertain the prognostic factors and symptoms associated with cryptococcal meningitis cases treated at the East London Hospital complex
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Date Issued: 2012
- Authors: Okorie, Ikechukwu Obinna
- Date: 2012
- Subjects: Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MSc (Biostatistics and Epidemiology)
- Identifier: vital:11782 , http://hdl.handle.net/10353/d1016194 , Meningitis -- South Africa -- Eastern Cape , Tuberculosis -- South Africa -- Eastern Cape , Public health -- South Africa -- Eastern Cape , Hospitals -- South Africa -- Eastern Cape
- Description: The focus of this study is to identify the potential prognostic factors and symptoms that are associated with Cryptococcal Meningitis and to establish a statistical model for the prediction of outcomes (survival and mortality) among in-hospital patients. Materials and Method: The hospital admission books in the medical wards and pharmacy of the East London Hospital Complex were searched to identify the folder numbers of all the patients that were admitted, diagnosed and or treated for Cryptococcal Meningitis at the hospital between the 1st of January 2009 and the 31st of August 2012. 237 folders out of 519 folders reviewed had confirmed cases of Cryptococcal Meningitis. Data on patients’ demographics, In-hospital care, and Concurrent infection/health condition were collected and analysed in a cross-sectional study, using the univariable and multiple logistic regression. Analysis of data was done with SAS version 9.1.3 and NCSS version 2007 software. Results: In a multivariable logistic analysis of variables found to be significantly associated with Cryptococcal Meningitis in a univariable logistic regression, Being Conscious (i.e. a Glasgow Coma score of 15) (OR= 5.34,CI=2.85-9.99 p =<0.000); Having no history of TB infection (OR=28.91, CI= 3.68-226.89, p = <0.001); No Fits (OR = 2.59, CI= 1.18-5.68 p = 0.017); Being a non-smoker (OR =2.22,CI=1.13-4.34 p = 0.020); and Adhering to treatment instruction and guidelines (OR = 2.38, 1.15-4.89, p = 0.019) were the variables found to be significantly associated with the survival of a Cryptococcal Meningitis patient. The uninterrupted use of Amphotericin B (OR=3.04, CI=1.06-8.72, P=0.038) as a first line regimen was also found to be significantly associated with survival.On the other hand, being unconscious (i.e. Glasgow Coma score <15) (OR =5.34, CI=2.85-9.99, p = < 0.000), Currently having a TB infection (OR = 9.20, CI=2.77-30.57, p = < 0.000), Not adhering to treatment guidelines (OR=2.38, CI=1.15-4.89, p=0.019 ); Being a smoker (OR = 2.22, CI=1.13-4.34, p = 0.020) and having Fits (OR=2.59 CI=1.18-5.68 p=0.017 ) were found to be significantly associated with mortality. Headache (p= 0.505) was found not to be a significant predictor of survival contrary to the findings in many publications on Cryptococcal Meningitis. Owing to time constraint, testing data was not collected to validate the prognostic models. However, model diagnostics was done and the relevant statistics confirmed the goodness of fit and the predictive ability of the model Conclusion: It has been established in this study that certain baseline variables can be helpful in the prognosis of Cryptococcal Meningitis infection. It is therefore believed that these variables will help in improving the prognosis of the infection especially at the East London Hospital Complex. Though the statistical models will work well in predicting the outcome of Cryptococcal Meningitis infection for patients admitted at the East London Hospital Complex, adequate precaution must be exercised while attempting to apply it in other geographical areas.
- Full Text:
- Date Issued: 2012
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