Submitted in fulfillment of the requirements for the Degree Mast in Technology: Public Management, Durban University of Technology, Durban, South Africa, 2017. / The South African healthcare sector stands at the threshold of major restructuring in an attempt to address inadequacies as a result of fragmentation of health services in apartheid South Africa. The level of health services, particularly in rural areas, has decreased and has led to reduced quality and productivity of health services. For individuals residing in rural communities, access to health services can be arduous. Delivery of essential services has to meet the needs of marginalised people who live in remote areas. In light of the above, the department of health is faced with growing expectations from citizens to use resources efficiently and effectively and to ensure that healthcare is affordable and accessible to all. National Health Insurance (NHI) is intended to bring about reform that will improve service provision. The researcher undertook this study to explore healthcare challenges faced by South Africa and its people and how far progressive realisation of access to healthcare, as enshrined in the 1996 Constitution, is being implemented. A case study using a mixed method approach was adopted. The literature reviewed indicated that issues of remuneration, ageing infrastructure and general management challenges, including financial management, are among the challenges that continue to hamper the public health system in South Africa. In addition, the HIV/AIDS epidemic has created more demand for healthcare as many more people become sick. The Green Paper outlining the government’s broad policy proposals for NHI, released in August 2011, makes it clear that NHI is a long-term project that will be rolled out over 14 years. It aims to promote efficiency and equity to ensure that all South Africans have access to affordable, quality healthcare. The findings of this study are useful not only to the case study institution, but to all District Hospitals, especially the department of health and the public management sector and may assist in taking the NHI forward. / M

PhD (Health Sciences) / Department of Advanced Nursing Science

MCur / Department of Advanced Nursing Science / Background: The heavy workload of hospital nurses is a major problem globally. Nurses are experiencing higher workloads than ever before due to four main reasons, increased demand for nurses, inadequate appointment of new nurses, reduced staffing and increased overtime and reduction in patient length of stay. It is necessary for South Africa to find ways to reduce nursing workload and improve patient safety particularly in rural areas, to understand these effects of nursing workload on patient safety, the study was conducted with professional nurses from selected hospitals in Vhembe district, Limpopo Province. Purpose: The purpose of this study was to determine and to assess the effects of nurses‘ workloads on patient safety in the selected public hospitals, Vhembe District, Limpopo Province, South Africa. Methodology: Quantitative, exploratory descriptive design was adopted. Self-administered questionnaires were used for data collection from the sampled hospitals in Vhembe district. Hospitals were sampled based on the statistics of admitted patients in medical and surgical wards. Target population were professional nurses with at least two years working in the sampled wards. Ethical considerations were maintained. Results: There are several important consequences of high nursing workload. Findings show that a heavy nursing workload adversely affects patient safety. The study also shows that majority 80 (79.0%) of the respondents were overloaded by nursing responsibilities and this negatively affects nursing job satisfaction. As many as 55 (54.4%) indicated that such v workload contributes to high turnover and the nursing shortage. In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses‘ workload: nurses are expected to perform non-professional tasks such as delivering and retrieving food trays; housekeeping duties; transporting patients; and ordering, coordinating, or performing ancillary services Conclusion: Nursing workload is affected by staffing levels and the patients‘ conditions, but also by the design of the nurses‘ work system. The study showed that a work situation above the assumed optimal level increases the risk for adverse events and patient mortality. However, the resources for nursing staff are limited in all public hospitals where the study focused. Professional nurses, therefore, must use available resources in the most optimal way. The study also recommended that there should be a creation of the nursing posts and the filling of all vacant positions in South Africa. Continuity of in-service training to empower professional nurses on patient safety was emphasised. / NRF

Submitted in fulfillment of the requirements of the degree of Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Aim The study evaluated the culture of patient safety and the factors that contribute and influence patient safety as a critical element, to healthcare in a public hospital in Kwa-Zulu Natal, through a predesigned questionnaire with the objectives of establishing the current status of the culture of patient safety in the said hospital, evaluating responses from nurses and doctors and other healthcare professionals, exploring the effectiveness of communication and teamwork within units and hospital. Methods The study evaluated the culture of patient safety and the factors that contribute and influence patient safety as a critical element, to healthcare in a public hospital in Kwa-Zulu Natal, through a predesigned questionnaire with the objectives of establishing the current status of the culture of patient safety in the said hospital, evaluating responses from nurses and doctors and other healthcare professionals, exploring the effectiveness of communication and teamwork within units and hospital. Results The resultant data from the predesigned questionnaire was divided into components of teamwork within and between units, hospital and supervisor management support for patient safety, communication openness and feedback regarding errors, non-punitive response to errors, hospital handover of information staffing and overall patient safety grade. The study was compared to the studies in the US and three other countries across the European continent, Netherland, Taiwan, and US [Wagner et al. 2013]. The findings as possible strengths of the study were teamwork within units, learning in the organization, feedback and communication, and manager and supervisor support for patient safety. The areas that needed attention were teamwork across units, communication openness, staffing, non-punitive response to errors and overall patient safety grade, handover of information between units. Conclusions The findings, reflective of a developing country, compared to the findings from similar studies in developed countries such as the USA and countries in transition such as Netherlands and Taiwan. In reference to the precincts that face a developing country such as South Africa, certain highlights emerged from the comparison, as areas of strength, areas requiring attention, and a preliminary insight into current practices within the South African context which can be viewed as an opportunity to sustain current good practices and inform future research. / M

Thesis (MPhil)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: One of the main objectives of the new South African government who came into power in 1994 was to improve the daily living conditions of its citizens. To what extent did the government succeed in this objective? This is the basic research question informing the present study. In order to keep it within manageable proportions, the study investigated a very specific area of service delivery, namely the delivery of public health services. This was further narrowed down to the Western Cape and more specifically, to the role of public hospitals in the area. The Western Cape promised to be an interesting case, because although the government of national unity was dominated by the ANC, the Western Cape was ruled by a NNP dominated coalition. On the national level, the Province had to follow national policy guidelines, while on the provincial level it had more freedom to formulate and implement its own policies. The study itself consists of two parts. The first concerns policy formulation, the second policy implementation. As far as policy formulation is concerned, a study was made of basic documents articulating the fundamental values, national priorities and main objectives informing government policy. These included the Freedom Charter, the Constitution, and the Reconstruction and Development Program. It was found that these values and priorities were in general well translated into policy options on both the national and provincial level, especially in the various documents aimed at transforming the national health system. The second part of the study investigates the implementation of the broad policy guidelines in the area of public heath in selected public hospitals in the Western Cape. The main method of investigation was the use of structured interviews with representative employees from all different levels. The findings were therefore of a qualitative rather than a quantitative nature. The focal areas selected were personnel management issues, human resource planning, labour relation issues and human resource development issues. The main findings were that the formulation of policy both from basic values to the level of health care policies and from the national to provincial level in general was quite successful. On the other hand, there were serious shortcomings in the implementation of these policies on various levels. The investigation revealed a mixed and often contradictory picture. Although some hospitals made good progress in some respects, there is still a long way before quality health care will be delivered to all patients. A commitment to equity in the health services of the country implies a commitment to correcting the historical gender, class and racial imbalances in the development of human recourses for health care. Of necessity, a compassionate and caring health service will address the issue of corrective action. There is a real need to provide proper planning of those most disadvantaged by apartheid in managerial skills to fill managerial positions in the health sector. It is therefore is necessary to introduce as a matter of urgency new health management programmes, which will promote efficient and effectiveness management at all levels of health care service delivery. Current health managers need to be reoriented from the predominantly bureaucratic, rule-based approach towards a participative approach. The development of managerial capacity in areas such as participative and change management, leadership development, strategic planning, programme management and evaluation, and policy development and implementation is of crucial importance. The study concludes with a series of specific recommendations with regard to affirmative action, managerial and institutional capacity, human resource planning, and training needs for various sectors. / AFRIKAANSE OPSOMMING: Een van die hoofdoelstellings van die nuwe Suid-Afrikaanse regering wat in 1994 aan bewind gekom het, was om die leefomstandinghede van al die land se inwoners te verbeter. Tot watter mate het die regering geslaag in hierdie doelwit? Dit is die basiese navorsingsvraag onderliggend aan hierdie studie. Ten einde die ondersoek binne hanteerbare grense te hou, is op slegs een aspek van dienslewering gekonsenteer, naamlik die lewering van gesondheidsdienste. Hierdie terrein is verder vernou tot die Wes-Kaap en meer spesifiek tot die rol van openbare hospitale. Die Wes-Kaap was interessant omdat hoewel die regering op nasionale vlak deur die ANC beheer is, die Wes-Kaap basies deur die NNP in die periode van ondersoek geregeer is. Die provinsie was verplig om nasionale beleidsriglyne te volg, maar op provinsiale vlak het dit 'n sekere speelruimte geniet om eie beleid te formuleer en te implementeer. Die studie bestaan uit twee dele. Die eerste het te doen met beleidsformulering, die tweede met beleidsimplementering. Wat beleidsformulering betref, is 'n studie gemaak van die basisdokumente wat die kernwaardes, nasionale prioriteite en hoof doelstellings van die regering bevat. Dit het ingesluit die Vryheidmanifes, die Konstitusie en die Heropbou- en Ontwikkelingsprogram. Daar is bevind dat hierdie waardes en prioriteite in die algemeen suksesvol vertaal is in beleidsopsies op beide die nasionale en provinsiale vlak, veral in die dokumente wat gerig was op die transformasie van die nasionale gesondheidsektor. Die tweede deel van die studie het die implementering van die breë beleidsriglyne in die area van openbare gesondheid in geselekteerde publike hospitale in die Wes-Kaap ondersoek. Die hoof-ondersoekmetode was gestruktureerde onderhoude met verteenwoordigende werknemers van alle vlakke. Die bevindinge was gevolglik meer van 'n kwalitatiewe as kwantitatiewe aard. Die fokusareas waarop geskonsentreer is, was personeelbestuur, menslike hulpbronbeplanning, arbeidsverhoudinge en die ontwikkeling van menslike potensiaal. Die hoofbevindinge was dat die formulering van beleid beide van basiese waardes na gesondheidsbeleid en van die nasionale na provinsiale vlak in die algemeen suksesvol was. Aan die ander kant het ernstige gebreke aan die lig gekom sover dit die implementering van beleid op verskillende vlakke betref. Die resultaat was 'n gemengde en dikwels kontrasterende prentjie. Hoewel sommige hospitale goeie vordering gemaak het in sekere opsigte, laat die lewering van gehalte-diens aan alle pasiënte nog veel te wense oor. Die verbintenis to gelykheid in gesondheidsdienste veronderstel 'n verbintenis tot die regstelling van geslags-, klas- en rasse-ongelykhede in die ontwikkeling van menslike hulpbronne in die gesondheidsektor. Dienslewering gebaseer op sorg en empatie is van deurslaggewende belang in hierdie opsig. Daar is 'n groot behoefte aan behoorlike beplanning vir die verbetering van bestuur- en ander vaardighede van agtergestelde groepe. Die implementering van behoorlike bestuursopleidingsprogramme is van die uiterste belang, wat kan bydra tot effektiewe en goeie dienslewering. Die huidige oorwegend burokratiese en reëlsgebonde bestuurstyl behoort in 'n deelnemende benadering omgeskakel te word. Die ontwikkeling van bestuurskapasiteit in gebiede soos deelnemende veranderingsbestuur, leierskapsontwikkeling, strategiese beplanning, programbestuur en -evaluering en beleidsformulering is van die grootse belang. Die ondersoek sluit af met 'n reeks konkrete aanbevelings met betrekking tot regstellende aksie, verbetering van bestuurskapasiteit, menslike hulpbronontwikkeling en die opleidingsbehoeftes van die verskillende afdelings.

Submitted in fulfilment of the requirements of the Master's Degree in Technology: Radiography, Durban University of Technology, 2013. / ABSTRACT Escalating current healthcare needs coupled with the dire shortage of radiologists created a climate in countries abroad to extend the role of the radiographer (Williams 2006). The South African radiography profession demonstrates similar if not worse challenges within the radiology services (Gqweta 2012). The human resource needs in the healthcare sector creates a gap in the provision of radiology services (Brandt et al 2007). Often under these circumstances radiographers are asked by emergency department's personnel to comment on radiographic appearances (Hardy and Snaith 2007). Radiographers do provide opinions in order to facilitate patient management (Gqweta 2012). Since the chest x-ray is the most commonly performed x-ray examination in x-ray departments (Manning, Leach and Bunting, 2000), it is assumed that most requests for an opinion may be directed for the clarification of this x-ray examination. Therefore radiographers need to have an in-depth understanding of the knowledge and skills related to the identification of patterns on chest images. The aim of the study was to establish and describe the current chest image interpretation skills, knowledge and perceptions of diagnostic radiographers in eThekwini Health District of KwaZulu-Natal (KZN) with regard to image interpretation. METHOD: A quantitative study using a descriptive design with a qualitative aspect using an interpretive design was employed. A simple random sample of hospitals within the eThekwini health district that have x-ray departments was drawn. All diagnostic radiographers that met the inclusion criteria from within these hospitals were invited to partake in the study and all were registered with the Health Profession Council of South Africa (HPCSA). A questionnaire was utilised to collect data on the perceptions and knowledge of diagnostic radiographers on radiographic appearances. A reporting template was provided for the respondents to report on ten (10) chest images and to standardise responses . Accuracy , specificity and sensitivity measurements were utilised to determine the image interpretation knowledge and skills of radiographers without formal training on image interpretation. The SPSS (Statistical Package for the Social Sciences) version 21 was utilised for the raw data capture and analysis. RESULTS Forty two (42) radiographers participated in the study. Almost half (46%) of the respondents were chief radiographers and twenty four point four percent (24.4%) of the respondents were senior radiographers . X-ray department managers and community service radiographers each had twelve (12%) percent representation. The majority of the respondents frequently performed chest x-rays. Furthermore they regularly observe Pulmonary Tuberculosis (PTB) abnormal patterns more than those of pneumonia and lung cancer on chest radiographs. The respondents indicated that there is a need for them to extend their roles to include image interpretation. This will ensure that radiographers are responsive to current health care needs perpetuated by the absence of radiologists and the ever rapidly increasing population. The majority of the respondents were able to identify abnormal appearances on the radiographs (high sensitivity). However there was a proportional decrease on the identification and recognition of the normal appearances (specificity). There was no respondent that obtained a mark of eighty (80%) on the image interpretation knowledge assessment section. CONCLUSION Radiographers are able to identify abnormal patterns on chest images. However they are unable to adequately exclude an abnormality (low specificity). Furthermore they lack the ability to adequately describe abnormal radiographic/radio logical appearances. The image interpretation knowledge base of radiographers is limited and specific. Therefore there is a need for an intensive education and training for prospective reporting radiographers.

Submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2009. / Objective: The majority of information available on chiropractic patients originates from private practices in developed countries. However, recently reports describing chiropractic patients in South Africa have emerged, reporting on private practices and teaching clinics. Therefore, the overall purpose of this study was to determine the characteristics of patients presenting to a public chiropractic facility at the Kimberley Hospital Complex (KHC) in South Africa; and compare to the local and international private practices and teaching clinics. Methods: The period prevalence was three months in which information was extrapolated from patient files of the patients that presented to the KHC Chiropractic Clinic (KHCCC). Information that was collected included demographic data, common presenting complaints, patient history and common management protocols. Results: Data for 157 patients were recorded. The mean age of patients was 47.5 years, majority of the patients were female (70%), comprised of coloured and black patients (85%), where the greater part had a primary education level. Less than half the patients were employed in manual type of occupation, whilst almost one quarter of the patients were pensioners. By far, the greatest reason that patients visited chiropractors within the public health care sector at the KHCCC in South Africa was for chronic musculoskeletal complaints (68%). Majority presented with spinal complaints of the lower back (n=144), the most common diagnosis made was sacroiliac syndrome (48%). X-rays were the most common special investigation requested by KHCCC. The most common co-morbidities reported were hypertension, followed by diabetes and allergies. More than half the sample had undergone previous surgery. Thirty seven percent of patients received treatment for fewer than six visits. Contraindications to chiropractic treatment were indicated in only three patients. The treatment protocols that were predominantly used at the KHCCC were joint manipulation, followed by dry needling, kinesiotape and soft tissue therapy. Two thirds of all patients that were referred to the KHCCC were referred from within the medical profession. With regards to the chiropractic patients globally, similarities respect to patients in the public sector in South Africa to all sectors both locally and internationally, include factors such as majority female patients, top five anatomical locations of complaint, common usage of x-rays as a special investigation, similarities with co-morbidities including cardiovascular and endocrine, the repeated number of visits for the same complaint and manipulation remained treatment of choice. Conclusion: Although this was purely a demographic and descriptive study in nature, it gave a better understanding of patients that presented to a public hospital in a developing country like South Africa. With this demographic and descriptive information obtained in this study, it confirmed that although there is a unique population utilising chiropractic services within the public sector of South Africa, meaningful similarities have been found between patients in the different sectors in South Africa and internationally.

M. Tech. Human Resources Development / The aim of this research is to establish whether there is a significant relationship between employee engagement and discretionary effort at a hospital in KwaZulu-Natal. It also investigates the factors that relate to employee engagement and discretionary efforts and also to determine how different demographic groups perceive employee engagement and discretionary effort at a hospital in KwaZulu-Natal.

<p>Aggressive and violent behaviour in inpatient mental health facilities is found worldwide and is a frequent and serious clinical and nursing care problem. Despite the importance of international research findings and recommendations, it appears that patients perceptions of the possible contributing factors toward aggressive and violent behaviour in mental health facilities is an area of enquiry that has not been widely explored in South Africa in general, or in the Western Cape, in particular. It is against this background that this study endeavoured to investigate the external and situational contributing to patients aggressive and violent behaviour in mental health facilities in Cape Town, as seen from patients perspectives.</p>

Submitted in fulfillment of the requirements for the Degree of Master of Technology Hospitality and Tourism, Durban University of Technology, Durban, South Africa, 2014. / It has been accepted that health care within provincial hospitals has deteriorated. For most it has become routine to visit provincial hospitals and wait for majority of the day for basic treatment. Service delivery in provincial health care are confronted with challenges such as staff shortages, inadequate medical supplies and reduced budgets. The media contributes with letters and articles about poor patient treatment, the increase in deaths and diseases due to poor service delivery and weak hospital management. However, with the growing rate of poverty and unemployment, resources have become scarcer hence, adding to an already crippling economy. The rationale behind this research is to evaluate the role of hospitality within a Provincial Hospital in the southern area of Durban KZN that’s offering treatment to patients with more than just basic health care. And to establish a more effective and efficient delivery of services offered with scarce resources which enhances patient encounters within a provincial hospital. The aim of this research is to evaluate the current legislation around provincial hospitals for the efficient and effective practise of hospitality. In the form of a literature review a theoretical perspective was formulated around the study and an operational chapter detailing the Provincial Hospital in the southern area of Durban, KZN. The rationale was tested by research in the form of questionnaires and interviews with the Provincial Hospital. A target sample was selected with managers, senior management and patients. The major findings may be gravitated towards serious service delivery issues. The Provincial Hospital should therefore, consider the introduction of a hospitality approach in its attempts to improve the delivery of patient care. The study also found that hospitality management influences may improve employee output which impacts on the delivery of patient care. / M