scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Supply Chain ◽  
Chronic Disease ◽  
Supply Chain Management ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Chain Management ◽  
Participant Responsiveness ◽  
Moderating Factors

Abstract Background Chronic care models like the Integrated Chronic Disease Management (ICDM) model are innovative strategies to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to identify moderating factors of implementation fidelity of the ICDM model. Methods This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors on the implementation fidelity of the ICDM model. A total of 30 healthcare workers from four clinics with different levels of implementation fidelity of the ICDM model were interviewed. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically. Results The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3)years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that was said to compromise fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. Conclusion There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors of the implementation fidelity of the ICDM model. Augmenting some of the elements, like supply chain management and leadership support, could further improve the degree of fidelity during the implementation of the ICDM model.

scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Supply Chain ◽  
Chronic Disease ◽  
Supply Chain Management ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Chain Management ◽  
Participant Responsiveness ◽  
Moderating Factors

Abstract Background Chronic care models like the Integrated Chronic Disease Management (ICDM) model are innovative strategies to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to identify moderating factors of implementation fidelity of the ICDM model. Methods This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors on the implementation fidelity of the ICDM model. A total of 30 healthcare workers from four clinics with different levels of implementation fidelity of the ICDM model were interviewed. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically. Results The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3)years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that was said to compromise fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. Conclusion There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors of the implementation fidelity of the ICDM model. Augmenting some of the elements, like supply chain management and leadership support, could further improve the degree of fidelity during the implementation of the ICDM model.

scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Cross Sectional ◽  
Participant Responsiveness ◽  
Factors Influencing ◽  
Moderating Factors ◽  
Clinical Mentorship

Abstract Background: Chronic care models like the Integrated Chronic Disease Management (ICDM) model strive to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to assess moderating factors of implementation fidelity of the ICDM model. Methods: This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors influencing implementation fidelity of the ICDM model. We interviewed 30 purposively selected healthcare workers from four facilities (15 from each of the two facilities with lower and higher levels of implementation fidelity of the ICDM model). Data on facility characteristics were collected by observation and interviews. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically.Results: The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3) years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that seemingly compromised fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads.Conclusion: There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Augmenting facilitation strategies (training and clinical mentorship) could further improve the degree of fidelity during the implementation of the ICDM model.

scholarly journals Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Limakatso Lebina ◽  
Olufunke Alaba ◽  
Ashley Ringane ◽  
Khuthadzo Hlongwane ◽  
Pogiso Pule ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Support Systems ◽  
Patient Flow ◽  
Implementation Fidelity ◽  
Self Management ◽  
Fidelity Assessment ◽  
Supportive Management

Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model. Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr. Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test. Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685–2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00–9.33) vs 2.0 (IQR: 1.67–2.92)], and fewer medical officers per clinic [median 1 (IQR: 1–1) vs 3.5 (IQR:2–4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27–31)]; 77% [30/39 (IQR: 27–34)]; 77% [30/39 (IQR: 28–34)]; and 80% [35/44 (IQR: 30–37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR, 117–132); WR was 80% (126/158, IQR, 123–132) while DKK was 74% (117/158, IQR, 106–130), p = 0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2–5 h) waiting times and one stream of care for acute and chronic services. Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

scholarly journals Process Evaluation of Implementation Fidelity of the Integrated Chronic Disease Management Model in two districts, South Africa

2019 ◽  
Author(s):  
Limakatso Lebina ◽  
Olufunke Alaba ◽  
Ashley Ringane ◽  
Khuthadzo Hlongwane ◽  
Pogiso Pule ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Support Systems ◽  
Patient Flow ◽  
Implementation Fidelity ◽  
Self Management ◽  
Fidelity Assessment ◽  
Supportive Management

Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance efficiency and quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess implementation fidelity (adherence to guidelines) of the ICDM model.Methods A cross-sectional study in sixteen PHC clinics in two health districts in South Africa: Dr Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and a total maximum score of 158, was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was used to analyze waiting time and identify areas of inefficiencies. ICDM items were scored based on structured observations, records reviews and interviews with healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test.Results The monthly patient headcount over a six-months in these 16 PHC clinics was a median of 2430 (IQR: 1685-2942) individuals over 20 years. DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00-9.33) vs 2.0 (IQR: 1.67-2.92)], and fewer medical officers per clinic [median 1 (IQR: 1-1) vs 3.5 (IQR:2-4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27-31)]; 77% [30/39 (IQR: 27-34)]; 77% [30/39 (IQR: 28-34)]; and 80% [35/44 (IQR: 30-37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The lowest clinic fidelity score was 66% (104/158) while the highest was 86% (136/158). Patient flow analysis showed long (2-5 hours) waiting times and one stream of care for acute and chronic services.Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

scholarly journals Process Evaluation of Implementation Fidelity of the Integrated Chronic Disease Management Model in Two Districts, South Africa

2019 ◽  
Author(s):  
Limakatso Lebina ◽  
Olufunke Alaba ◽  
Ashley Ringane ◽  
Khuthadzo Hlongwane ◽  
Pogiso Pule ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Support Systems ◽  
Patient Flow ◽  
Implementation Fidelity ◽  
Self Management ◽  
Fidelity Assessment ◽  
Supportive Management

Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model.Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test.Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685-2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00-9.33) vs 2.0 (IQR: 1.67-2.92)], and fewer medical officers per clinic [median 1 (IQR: 1-1) vs 3.5 (IQR:2-4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27-31)]; 77% [30/39 (IQR: 27-34)]; 77% [30/39 (IQR: 28-34)]; and 80% [35/44 (IQR: 30-37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2-5 hours) waiting times and one stream of care for acute and chronic services.Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

scholarly journals Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Ozayr H. Mahomed ◽  
Shaidah Asmall ◽  
Anna Voce
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Assessment Tool ◽  
Scale Up ◽  
Self Assessment ◽  
Health Care Clinics ◽  
Clinical Support ◽  
Supportive Management

Background: An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes.Aim: The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation.Setting: The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa.Methods: The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability.Results: Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55.Conclusion: The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.

A Conceptual Model on the Challenges Affecting the Growth, Sustainability, and Survival of Small, Medium, and Micro Enterprise

2021 ◽  
pp. 1-16
Author(s):  
Ayansola Olatunji Ayandibu ◽  
Irrshad Kaseeram ◽  
Elizabeth Oluwakemi Ayandibu
Keyword(s):  
South Africa ◽  
Supply Chain ◽  
Supply Chain Management ◽  
Human Resources ◽  
Conceptual Model ◽  
Human Resources Management ◽  
Global Market ◽  
Chain Management ◽  
Resources Management

This chapter addresses the changes (finance, human resources management, supply chain management, and regulatory) that affect the growth, sustainability, and survival of SMMEs world. These challenges are common among SMMEs in every country. In order for SMMEs to achieve growth, sustainability, as well as survive in the competitive global market, SMMEs must deal with these challenges. This chapter also creates a conceptual model that addresses these challenges and provides solutions that can be used to improve SMME challenges. SMMEs from South Africa, Nigeria, and Ghana were also discussed.

scholarly journals The impact of green supply chain management in small to medium enterprises: Cross-sectional evidence

2017 ◽  
Vol 11 ◽  
Author(s):  
Chengedzai Mafini ◽  
Asphat Muposhi
Keyword(s):  
South Africa ◽  
Supply Chain ◽  
Supply Chain Management ◽  
Green Manufacturing ◽  
Green Supply Chain Management ◽  
Green Supply Chain ◽  
Measurement Scale ◽  
Chain Management ◽  
Medium Enterprises ◽  
The Impact

Background: South Africa has a high rate of small to medium enterprises (SMEs) failure, especially in the manufacturing sector. The operational challenges confronting manufacturing SMEs are acknowledged by the Global Competitiveness Index that ranked South African SMEs as one of the lowest in emerging economies.Objectives: The aim of this study is to examine the association between green supply chain management (GSCM) practices, environmental collaboration and financial performance in SMEs.Method: The study is quantitative in nature and involves a convenient sample of 312 SMEs based in Gauteng Province, South Africa. Data analyses follow a two-step process involving a confirmatory factor analysis to test the psychometric properties of the measurement scale and Structural Equation Modelling to test the proposed hypotheses.Results: The study shows that three GSCM practices, namely, green procurement, green logistics and green manufacturing in SMEs exert a positive effect on environmental collaboration, with green manufacturing exerting a higher effect than the other two constructs. In turn, higher levels of environmental collaboration inspired higher levels of SME financial performance.Conclusion: The study advances that SMEs can succeed financially through the influence of enhanced environmental collaboration, which emanates, in part, from the adoption and implementation of GSCM practices.

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