Ecole de Santé Publique <p>Université Libre de Bruxelles <p>Academic Year 2010-2011<p><p>Al-Awa, Bahjat<p><p>Impact of Hospital Accreditation on Patients' Safety and Quality Indicators<p><p>Dissertation Summary <p><p>I.\ / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

There is strong evidence from developing countries to support the hypothesis that physical accessibility of health services, particularly absolute distance from clinics, is a major determinant of health service utilization and health status. In South Africa, such evidence is very limited and as a result the relationship between absolute distance and health service utilization and health status is not fully understood. As an attempt to understand this relationship, a household survey of mothers with children aged 12-23 months was conducted in a rural district of KwaZulu-Natal province, South Africa. Maternal and child health (MCH) service utilisation and MCH status patterns were then compared at different absolute distances from PHC clinics. The find ings reveal that the study population is characterised by impoverished living conditions (86%), high functional illiteracy (67%), high fertility and unemployment rates . In comparison with other studies conducted previously in the same population, MCH service utilization rates are high. Based on mean distances of homesteads from PHC clinics in the entire study area before the Clinic Upgrading and Building Programme it has been concluded that the physical accessibility of fixed PHC clinics, when compared with the WHO recommendations, was suboptimal. When this assessment is based on clinic usage patterns, it is found that clinic usage decreased from 86.4% at 0-5 km to 79% at 6-10 km with a dramatic decrease to 37.8% at distances beyond 10 km. This decrease in usage at distances above 5 km translates into a considerable reduction in effective coverage of the target population by PHC clin ic services if it is considered that above 50% of the population live greater than 5 km from these clinics. An assessment of the effect of distance of homesteads from PHC clinics on specific MCH service utilization and MCH status has found very few or no significant differences between mothers and children living at 0-5 km, 6-10 km or > 10 km from these clinics. This observation is consistent even after adjustment for the effects of potential confounding. The fact that distance from clin ics has little or no effect on the indicators of MCH service utilization and MCH status is counter-intuitive. A few explanations can be provided. These include the fact that only 50% of the population, even in one of the most rural parts of South Africa access clinics on foot. Since the traditional assumption has been that this distance effect is a function of straight-line walking distances between homesteads and clinics, Euclidian distances alone may be a poor explanatory variable for health service utilization. Furthermore, if the hypothesis is valid that health status is a function of service utilization, it may also be a poor explanatory variable for health status of community members who are reliant on these services. Secondly, based on data from other sources, there is evidence that there have been steady declines in both mortality and fertility rates in the study population over the past 10-20 years suggesting that client communities are already benefiting quite substantially from health services in general and from MCH services in particular in spite of residual distance barriers. In other words, this distance effect on service utilization and health status may be more evident in populations with much higher background infant, child and maternal mortality rates. Thirdly, it is also possible that distance effect still exists, but that methodological limitations prevented this study from showing this effect. For instance, the fact that people use mobile clinics for some MCH services may have confounded the effect of distance from fixed clinics. It is also possible that people use different facilities for different services even though they are further away, and the assumption that all facilities have equal attraction for clients and that the only determinant of use is distance may be flawed. For example, it is evident from this and from other studies in South Africa that whereas most clients use fixed clinics for vaccinations, deliveries are now increasingly conducted at hospitals. Other methodological issues include the fact that certain health outcomes such as stunting are not an exclusive reflection of health service inputs, but are a function of social and economic determinants. Based on these findings, a number of recommendations are made. / Thesis (Ph.D.)-University of Natal, Durban, 2004.

Text in English / This study investigated practices, motivations, perceived benefits and barriers to outsourcing of support services by general hospitals in Uganda. The aim was to contribute to the evidence base to increase adoption and effectiveness of outsourcing by hospitals in Uganda. An explanatory sequential mixed methods design was used. Quantitative data was collected from hospital managers in 32 randomly selected hospitals using a self-administered questionnaire. Qualitative data was collected through in-depth interviews from 8 purposively selected hospital managers using an interview guide. Quantitative data was statistical analysed (frequencies, contingency tables and Wilcoxon-Mann-Whitney tests) using SAS 9.3. Qualitative data was managed using ATLAS ti 7, coded manually and content analysis conducted to identify emerging themes, subthemes and categories. A cost benefit analysis was conducted for outsourcing cleaning services in a selected hospital using financial data provided by the managers. Quantitative findings indicate that many (72%) hospitals were outsourcing some of their support services; many were satisfied with their outsourcing (>60%). The key motivation for outsourcing was to gain access to quality service (68%). Most hospitals have a system for monitoring outsourcing (71%). Managers perceive improved productivity and better services as the main benefit from outsourcing (90%). The main barrier to outsourcing is limited financing. A key challenge encountered during outsourcing was limited number of service providers (57%). Managers perceive regulatory violations as a key risk during outsourcing (87%). Hospital location is a determinant of outsourcing (p=0.0033). Managers’ perceptions towards outsourcing have no impact on outsourcing (p>0.05). These findings were confirmed and explained by the qualitative data. Qualitative findings reveal masquerading, impersonation and extortion of patients by outsourced staff as an outsourcing risk. They reveal a concern that outsourcing may lead to job loss for community members. The cost benefit analysis indicates that outsourcing in the studied hospital for the year considered was cheaper than insourcing by UGX 669,575.00. The savings increase to UGX 48,753,689.94 when adjusted for quality differences between insourced and outsourced services. Sensitivity analysis shows that the assumptions used in the analysis were robust. Recommendations, interventions and guidelines are proposed for increasing outsourcing and its effectiveness. / Health Studies / D. Litt. et Phil. (Health Studies)

The purpose of this study was to gain information about the community health care needs through a comprehensive assessment. This information will allow providers to identify services and groups of people where the biggest gap exists in receiving needed health care services. This may provide the basis for the design of an advanced practice preventative health intervention for the community.

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015. / Background The current health care system in South Africa and its diverse settings of health care delivery system require a nurse who can make decisions, think critically, solve problems and work effectively in a team. Traditional nursing education teaching strategies have over the years relied on didactic and often passive approaches to learning. In pursuit of quality, academics and students must be continually engaged in a process of finding opportunities for improving the teaching and learning process. Purpose of the study The purpose of this study was to evaluate the structure and the process in case based learning at the University of Technology. Methodology This study is qualitative in nature, governed by an interpretive paradigm. This is a case study, which enabled the researcher to merge student interview data with records in order to gain insight into the activities and details of case based learning as practised at the University of Technology under study. Most importantly, the case study method was deemed appropriate for the current study, since case-based learning as a pedagogical approach (and a case) cannot be abstracted from its context for the purposes of study. Case based learning is evaluated in its context namely, the undergraduate nursing programme, using the Donabedian framework of structure, process and product. Results The study recorded that students were positive towards case based learning though some identified dynamics of working in groups as demerits of case based learning. The structures that are in place in the programme and the CBL processes are adequate and support CBL. There are however areas that need attention such as the qualification of the programme coordinator, the size of the class-rooms and the service of the computer laboratory. Conclusion The study found that apart from a few minor discrepancies, case based learning is sufficiently implemented, and experienced as invaluable by students, at the University of Technology under study.

Indiana University-Purdue University Indianapolis (IUPUI) / A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services Research, and (4) Organizational Change/Theory. The study design builds upon the constructs of a conceptual framework developed by Jane Zapka, namely, (1) organizational and/or practice settings, (2) provider characteristics, and (3) patient population characteristics. These constructs have been operationalized as measures in a 2005 HRSA/NCI Health Disparities Cancer Collaborative inventory of 44 community health centers. The first, statistical models will use: sequential, multivariable regression models to test for the organizational determinants that may account for the presence and intensity-of-use of clinical decision support (CDS) and information systems (IS) within community health centers for use in colorectal, breast, and cervical cancer screening. A subsequent test will assess the impact of CDS/IS on provider reported cancer screening improvement rates. The second, computational models will use a multi-agent model of network evolution called CONSTRUCT® to identify the agents, tasks, knowledge, groups, and beliefs associated with cancer screening practices and CDS/IS use to inform both CDS/IS implementation and cancer screening intervention strategies. This virtual experiment will facilitate hypothesis-generation through computer simulation exercises. The outcome of this research will be to identify barriers and facilitators to improving community health center facility-level cancer screening performance using CDS/IS as an agent of change. Stakeholders for this work include both national and local community health center IT leadership, as well as clinical managers deploying IT strategies to improve cancer screening among vulnerable patient populations.