Background
Methods
Setting
Study approach, sampling and data analysis
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the patient's perspective of the quality of healthcare delivery and
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the patient’s satisfaction with services in the Medical Department
Tools for data collection
Interviews
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awareness and practice of a culture of quality improvement in the Medical Department
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stakeholder views, perception and expectations of quality of care
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pattern of patient flow and utilization of services within the department
Document review and observation
Ethical considerations
Results
Structured patient interviews
Item | Yes (%) | No (%) | Respondents |
---|---|---|---|
Privacy given
| 99 | 1 | 97 |
Health conditions told
| 88.7 | 11.3 | 97 |
Treatment implications told
| 79.4 | 20.6 | 97 |
Opportunity to ask questions
| 62.8 | 37.2 | 78 |
Your preferences considered
| 91.1 | 18.9 | 56 |
Told how to take your medication
| 95.7 | 4.3 | 92 |
Treated with respect
| 97.9 | 2.1 | 97 |
Informed on staying healthier
| 70.1 | 29.9 | 97 |
Physical exam performed
| 90.6 | 9.4 | 96 |
Informed to come for check-up
| 60.5 | 39.4 | 76 |
Stakeholder in-depth interviews
Respondent group | Strengths/existing quality model | Weaknesses/challenges hindering quality improvement in healthcare delivery | Areas for improvement |
---|---|---|---|
1. Affiliate respondents (n = 5)
| - Existence of treatment protocols | - Staffing- related issues: shortage, underperformance and poor attitude | - Procure essential resources for patient care |
- Quality control and assurance measures are in place | - Scarcity of resources | - Use resources efficiently | |
- Improved patient care practicies | - Patient care | - Enhance team work with supporting departments | |
(Additional file 1: Appendix 1, Section 1.1) | - Lack of some patients taking responsibility for their own care | (Additional file 1: Appendix 1, Section 1.3) | |
(Additional file 1: Appendix 1, Section 1.2) | |||
2. Patient respondents (n = 4)
| In-patients described their overall satisfaction of the care they receive as | - Poor amenities and services in the department | - Strengthen staff attitude and performance |
• 'very good’ (1 view) | - Weak adherence to treatment protocol | - Involve patients in their treatment and management | |
• 'good’ (2 views) | - Patients not involved in their own care | - Improve amenities in the department | |
• 'poor’ (1 view) | (Additional file 1: Appendix 1, Section 2.2) | (Additional file 1: Appendix 1, Section 2.3) | |
(Additional file 1: Appendix 1, Section 2.1) | |||
3. Staff respondents (n = 4)
| - Staff attitude and performance is good | - Workload | - Provide supervision and training |
- Existence of treatment protocols | - Poor patient care | - Encourage patient-centred care | |
- Availability of some logistics like the computer for e-learning | - Lack of adherence to treatment protocol by some staff | - Ensure accountability of and by staff | |
(Additional file 1: Appendix 1, Section 3.1) | - Staff-related issues: inadequate training and supportive supervision, low incentives for work | - Encourage effective communication among staff | |
(Additional file 1: Appendix 1, Section 3.2) | |||
4. Management respondents
| 1. Effort to maintain quality | • The medical department is perceived to be the weakest department in KCH for quality of health care delivery(Additional file 1: Appendix 1, Section 4.1) | 1. Civil society should be involved in sensitizing patients and holding health staffs accountable to patients |
4.1 Current state of quality of healthcare | (Additional file 1: Appendix 1, Section 4.1) | • Inadequate human resource | |
• Lack of some essential diagnostic tools | |||
• Limitation in the use of the few available diagnostic tools | |||
4.2 Patient care and patient focus | 1. Patients appreciate staffs when satisfied with service given | 1. Patients complaint about wrong prescription or delayed treatment | |
2. Weak patient involvement in their treatment plan | |||
3. Self referrals and weak patient referral system among referring facilities | |||
4.3 Treatment protocols | • Treatment protocols are available and accessible to all staffs | 1. Non-compliance due to personal preferences among prescribers; ignorance on the relevance of protocol use; lack of drugs to prescribe | |
• There is a planned review of the current protocols | |||
4.4 Change management | 1. Emergency cases are attended to in the MSS ward before transferring to intensive care | 3. No defined human resource plan to cater for staff who leave | |
2. Team system for focused patient care and ward rounds | |||
4.5 Management-related issues | • Shortage of staff | ||
• Lack of training and proper orientation for staff | |||
• Poor staff attitude (Additional file 1: Appendix 1, Section 4.5.1) | |||
• Weak accountability by staff (Additional file 1: Appendix 1, Section 4.5.2) | |||
• Weak leadership structures | |||
(Additional file 1: Appendix 1, Section 4.5.3) | |||
• KCH as a tertiary hospital wastes resources by attending to many primary level cases | |||
(Additional file 1: Appendix 1, Section 4.5.4) | |||
• Disintegrated data management system in the hospital | |||
• No strategic plan for the hospital (Additional file 1: Appendix 1, Section 4.5.5) |