published_or_final_version / Business Administration / Master / Master of Business Administration

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Social Work and Social Administration / Master / Master of Philosophy

Thesis (MCurr)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: The objectives of this study were to explore patients’ experiences about long waiting time at the Vanguard Community Health Care Centre in the Western Cape and to explore possible solutions for this problem from the patients’ perspective. A qualitative research approach was applied. A sample size of (n=12) was drawn from a total population of 2829 (N=2829) using a non-random convenient sampling technique. A semi-structured interview guide was designed based on the objectives of the study and validated by experts in the field before data collection took place. Approval for the study was obtained from the Ethics Committee at the faculty of Health Sciences, Stellenbosch University and from the facility manager of health centre where the study was to be undertaken. The presentation of the results was categorised into themes and sub-themes that emerged from the data analysis. According to the findings in chapter 4 the themes that emerged were: Causes of long waiting time Areas of concern where waiting occurs most Emotions experienced when waiting long for service Possible solutions to waiting long for service The findings support the conceptual framework developed for the purpose of this study which includes the Patient’s Bill of Rights, the Principles of Batho Pele, Quality Care, Patients’ Representation and Patient satisfaction. The results of the study suggests that the conceptual framework needs to be implemented as a guideline to address the problems of long waiting time with the input from the participants’ opinions about possible solutions to be incorporated to the problem of long waiting time at the community health centre. / AFRIKAANSE OPSOMMING: Die doelwitte van die studie was om pasiente se gevoelens oor lang wagtye by Vanguard Gemeenskapsgesondheidsentrum in die Wes-Kaap te ondersoek en om moontlike oplossings vir hierdie probleem vanaf die pasient se perspektief te bepaal ‘n Kwalitatiewe navorsingsbenadering is gebruik. ‘n Steekproefgrootte van (n=12) is verkry vanaf ‘n totale bevolking van 2829 (N= 2829) deur die gebruik van ‘n nie-ewekansige gerieflike steekproefneming tegniek. ‘n Semi-gestruktureerde onderhoudgids is ontwerp gebaseer op die doelwitte van die studie. Die onderhoudgids is geldig bevind deur spesialiste in die gebied voor data insameling plaasgevind het. Goedkeuring vir die studie is verkry van die Etiese Komitee by die Fakulteit Gesondheidswetenskappe, Stellenbosch Universiteit en van die bestuurder van die gesondheidsentrum waar die studie uitgevoer sou word. Resultate is rangskik in temas en subtemas wat afgelei is van die data analise. Die volgende temas is bepaal vanuit Hoofstuk 4 se bevindinge: Redes vir lang wagtye Areas waar lang wagtye voorkom Emosies ondervind wanneer lank gewag moet word vir diens Moontlike oplossings vir lang wagtye Die bevindinge ondersteun die konseptuele raamwerk ontwikkel vir die doel van die studie wat die Handves van Regte vir pasiente, die beginsels van Batho Pele, Kwaliteitsorg, Pasient verteenwoordiging en Pasienttevredenheid insluit. Die bevindinge van die studie dui aan dat die konseptuele raamwerk geimplementeer moet word as riglyn om die probleme wat ervaar word met lang wagtye aan te spreek. Die deelnemers se menings oor moontlike oplossings moet deel moet wees van die aanspreek van die probleem van lang wagtye in die gemeenskapsgesondheidsentrum.

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Delivering health care services in an efficient and effective way has become a great challenge for many countries due to the aging population worldwide, rising health expenses, and increasingly complex healthcare delivery systems. It is widely recognized that models and analytical tools can aid decision-making at various levels of the healthcare delivery process, especially when decisions have to be made under uncertainty. This thesis employs stochastic models to improve decision-making under uncertainty in two specific healthcare settings: inpatient flow management and infectious disease modeling. In Part I of this thesis, we study patient flow from the emergency department (ED) to hospital inpatient wards. This line of research aims to develop insights into effective inpatient flow management to reduce the waiting time for admission to inpatient wards from the ED. Delayed admission to inpatient wards, also known as ED boarding, has been identified as a key contributor to ED overcrowding and is a big challenge for many hospitals. Part I consists of three main chapters. In Chapter 2 we present an extensive empirical study of the inpatient department at our collaborating hospital. Motivated by this empirical study, in Chapter 3 we develop a high fidelity stochastic processing network model to capture inpatient flow with a focus on the transfer process from the ED to the wards. In Chapter 4 we devise a new analytical framework, two-time-scale analysis, to predict time-dependent performance measures for some simplified versions of our proposed model. We explore both exact Markov chain analysis and diffusion approximations. Part I of the thesis makes contributions in three dimensions. First, we identify several novel features that need to be built into our proposed stochastic network model. With these features, our model is able to capture inpatient flow dynamics at hourly resolution and reproduce the empirical time-dependent performance measures, whereas traditional time-varying queueing models fail to do so. These features include unconventional non-i.i.d. (independently and identically distributed) service times, an overflow mechanism, and allocation delays. Second, our two-time-scale framework overcomes a number of challenges faced by existing analytical methods in analyzing models with these novel features. These challenges include time-varying arrivals and extremely long service times. Third, analyzing the developed stochastic network model generates a set of useful managerial insights, which allow hospital managers to (i) identify strategies to reduce the waiting time and (ii) evaluate the trade-off between the benefit of reducing ED congestion and the cost from implementing certain policies. In particular, we identify early discharge policies that can eliminate the excessively long waiting times for patients requesting beds in the morning. In Part II of the thesis, we model the spread of influenza pandemics with a focus on identifying factors that may lead to multiple waves of outbreak. This line of research aims to provide insights and guidelines to public health officials in pandemic preparedness and response. In Chapter 6 we evaluate the impact of seasonality and viral mutation on the course of an influenza pandemic. In Chapter 7 we evaluate the impact of changes in social mixing patterns, particularly mass gatherings and holiday traveling, on the disease spread. In Chapters 6 and 7 we develop agent-based simulation models to capture disease spread across both time and space, where each agent represents an individual with certain socio-demographic characteristics and mixing patterns. The important contribution of our models is that the viral transmission characteristics and social contact patterns, which determine the scale and velocity of the disease spread, are no longer static. Simulating the developed models, we study the effect of the starting season of a pandemic, timing and degree of viral mutation, and duration and scale of mass gatherings and holiday traveling on the disease spread. We identify possible scenarios under which multiple outbreaks can occur during an influenza pandemic. Our study can help public health officials and other decision-makers predict the entire course of an influenza pandemic based on emerging viral characteristics at the initial stage, determine what data to collect, foresee potential multiple waves of attack, and better prepare response plans and intervention strategies, such as postponing or cancelling public gathering events.

The systems development life cycle (SDLC) has been the traditional method of decision support systems design. However, in the last decade several methodologies have been introduced to address the limitations arising in the use of the traditional method. These approaches include Courban's iterative design, Keen's adaptive design, prototyping and a number of mixed methodologies incorporating prototyping into the SDLC. Each of the previously established design methodologies has a number of differing characteristics that make each of them a more suitable strategy for certain environments. However, in some environments the current methodologies present certain limitations or unnecessary expenditures. These limitations suggest the need for an alternative methodology. This dissertation develops a new methodology, priority design, to meet this need. To determine what methodology would be most effective in a given situation, an analysis of the operating environment must be performed. Such issues as project complexity, project uncertainty, and limited user involvement must be addressed. This dissertation develops a set of guidelines to assist in this analysis. For clarity, the guidelines are applied to three, well-documented case studies. As an application of the priority design methodology, a decision support system for nurse scheduling is developed. The development of a useful DSS for nurse scheduling requires that projected staff requirements and issues of both coverage and differential assignment of personnel be addressed. / Ph. D.