scholarly journals Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Logandran Naidoo ◽  
Ozayr H. Mahomed
Keyword(s):  
District Hospital ◽  
Waiting Times ◽  
Rural District ◽  
Management Approach ◽  
Lean Implementation ◽  
Cycle Times ◽  
Lean Principles ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
The Impact

Background: Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload.Aim: The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital.Setting: The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa.Methods: This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times.Results: All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention).Conclusion: The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

scholarly journals Investigating competencies needed by European-trained doctors in rural South African hospitals

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
James R. Barnacle ◽  
Oliver Johnson ◽  
Ian Couper
Keyword(s):  
South Africa ◽  
South African ◽  
Online Survey ◽  
Rural District ◽  
Eastern Cape ◽  
Rural Medicine ◽  
Rural South ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Postgraduate Diploma

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

Histopathology Services in a Rural African Hospital: How Audit Can Improve Service

1997 ◽  
Vol 27 (3) ◽  
pp. 131-132
Author(s):  
H Kettle ◽  
D Wilkinson
Keyword(s):  
Developing Countries ◽  
District Hospital ◽  
Rural District ◽  
Regional Laboratory ◽  
District Hospitals ◽  
Wide Range

Audit is about doing things right. We undertook a detailed audit of the histopathological service at a rural district hospital in Africa because delays in obtaining biopsy results had been noted by clinicians. A wide range of serious pathology was found in the 100 consecutive biopsies reviewed. It took 26 days on average from the time a biopsy was taken to the time the result was returned to the clinician, and most of this delay was administrative in nature, occurring after the pathologist had reviewed the specimen at the regional laboratory. Because of these delays, only 22% of patients biopsied were ever informed of their results. By performing this audit, reporting the results, and acting against the problems discovered, the service rapidly improved. This study illustrates the importance of simple, routine audit in district hospitals in developing countries.

scholarly journals Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Dawie Du Plessis ◽  
Paul Alfred Kapp ◽  
Louis S. Jenkins ◽  
Laurel Giddy
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Postgraduate Training ◽  
District Hospital ◽  
Learning Opportunities ◽  
Rural District ◽  
Procedural Skills ◽  
District Hospitals ◽  
National Unit ◽  
Unit Standards

Background: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital.Methods: A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data.Results: Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills.Conclusions: Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.Keywords: Post Graduate Training, Family Medicine, Procedural Skills, Rural, District hospitals

scholarly journals Management of cryptococcal meningitis in a district hospital in KwaZulu-Natal: A clinical audit

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Benjamin O. Adeyemi ◽  
Andrew Ross
Keyword(s):  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
District Hospital ◽  
Action Plan ◽  
Routine Practice ◽  
Urban District ◽  
Kwazulu Natal ◽  
Context Specific ◽  
Clinical Records ◽  
The Impact

Background: Despite the development of context-specific guidelines, cryptococcal meningitis (CCM) remains a leading cause of death amongst HIV-infected patients. Results from clinical audits in routine practice have shown critical gaps in clinicians’ adherence to recommendations regarding the management of CCM.Aim: The aim of this study was to review the acute management of CCM at an urban district hospital in KwaZulu-Natal, South Africa with a view to making recommendations for improving care.Setting: An urban district hospital in KwaZulu-Natal, South Africa.Methods: A retrospective audit was performed on clinical records of all patients (age > 13 years) admitted to the hospital with a diagnosis of CCM between June 2011 and December 2012.Results: Measurement of cerebrospinal fluid opening pressure at initial lumbar puncture (LP) was done rarely and only 23.4% of patients had therapeutic LPs. The majority of patients (117/127; 92.1%) received amphotericin B, however, only 19 of the 117 patients (16.2%) completed the 14-day treatment target. Amphotericin B-toxicity monitoring and prevention was suboptimal; however, in-patient referral for HIV counselling and testing was excellent.Conclusions: The quality of care of CCM based on selected process criteria showed gaps in routine care at the hospital despite the availability of context-specific guidelines. An action plan for improving care was developed based on stakeholders’ feedback. A repeat audit should be conducted in the future in order to evaluate the impact of this plan and to ensure that improvements are sustained.

scholarly journals Blood pressure control amongst patients living with hypertension presenting to an urban district hospital outpatient clinic in Kwazulu-Natal

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Folafolu A. Adebolu ◽  
Mergan Naidoo
Keyword(s):  
South Africa ◽  
Blood Pressure ◽  
Side Effects ◽  
Blood Pressure Control ◽  
District Hospital ◽  
Pressure Control ◽  
Urban District ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
Poor Blood Pressure Control

Background: The prevalence of hypertension in South Africa has been estimated to be 20% of the adult population with over six million people being affected. Poor adherence to treatment plans lead to inadequate blood pressure control and high morbidity. Many studies have looked at factors contributing to poor blood pressure control in South Africa but few studies actually focus on district hospitals in Kwazulu-Natal in particular, despite the fact that the province has the most heterogeneous population in South Africa.Method: The study was a descriptive cross-sectional study conducted at the chronic out patient clinic of an urban district hospital involving 370 participants aged 18–90 years.Result: The study showed poorly controlled blood pressure in 58% of the participants. Only 35% knew their blood pressure results on the day of interview and 19.2% were aware of their target blood pressure. Good adherence was self-reported by 95% of the participants, whist 51.4% reported significant side-effects to medication.Conclusion: The majority of patients had poor knowledge about blood pressure and little awareness of their blood pressure reading. These may be precursors to poor blood pressure control and this needs further investigation. A high level of self-reported adherence to medication did not translate into effective blood pressure control. A significant number reported medication side-effects which may have contributed to the poor blood pressure control. The high adherence rate may therefore have been over reported. An objective way tomeasure adherence will be necessary for future research.

scholarly journals Staffing levels at KwaZulu-Natal district hospitals: is the University of KwaZulu-Natal training for the needs of the province?

2018 ◽  
Vol 60 (2) ◽  
pp. 58-62
Author(s):  
Andrew Ross ◽  
Dumsani Gumede ◽  
Solange Mianda
Keyword(s):  
Staff Retention ◽  
Staffing Levels ◽  
Medical Graduates ◽  
Healthcare Needs ◽  
District Hospitals ◽  
Kwazulu Natal ◽  
The University ◽  
Staffing Needs ◽  
The Impact

Background: Universities have a social responsibility to ensure that they select and train healthcare professionals (HCPs) who can meet the healthcare needs of local communities. The aim of this study was to assess the extent to which the University of KwaZulu-Natal (UKZN) contributes to the training of HCPs working in district hospitals (DHs) in KwaZulu-Natal Province, and the impact that the funding source for their training has on DH staffing.Methods: This was an observational descriptive study, with all doctors, dentists, dental therapists, pharmacists, physiotherapists and radiographers working at DHs in KZN in November 2016 being invited to participate. Data were collected through a validated questionnaire.Results: A total of 514 HCPs working in 29 DHs participated in the study; over half (57%) of the South African medical graduates had trained at UKZN, as had 62% of pharmacists, 64% of physiotherapists and 92% of dental therapists. Some 87% of the HCPs had worked in DHs for five years or less, 65% planned to leave in the near future, and 29% planned to leave at the end of 2016.Discussion: UKZN plays a significant role in training for the short-term needs of DHs in KZN. Much of the workforce is young and transient, which has implications for service provision and expanding the teaching platform to DHs. The lack of long-term staff retention suggests that UKZN needs to continually monitor the selection of students, as well as the content and context of the training, if it is to contribute to the province’s long-term staffing needs.

Sign in / Sign up

Export Citation Format

Share Document