Healthcare today has become a competitive industry, not only locally, but on a global level as well. In the South African economy the healthcare sector presently offers healthcare seekers two options to satisfy their healthcare needs – either through private business enterprises in the private sector or public enterprises in the public sector. Likewise, in the healthcare sector's hospital environment, patients can receive treatment from either private or public hospitals. As private business enterprises offering a relatively 'pure', but generally unsought-after service, private hospitals compete aggressively to attract patients. Patients are a hospital's lifeblood and they rightfully expect a high standard of customer service throughout the stay. With today's consumers being better informed, more sophisticated and more demanding than in the past, experts agree that the key to survival in the service industry today, almost without exception, is the quality of the service. The cornerstone of the service industry is without doubt the ability to deliver superior service quality that results in customer satisfaction. And the healthcare industry is no exception. Most consumers will experience a need for healthcare services at some time in their lives, but in South Africa, escalating medical costs in general and private hospitals in particular, have made private healthcare increasingly more expensive for the majority of the country's healthcare seekers. This situation raises the question of customer service in the private hospital industry and how patients' perceive service quality and evaluate customer satisfaction after a hospital stay. There is a growing body of empirical evidence from United States studies to show that service quality and customer (patient) satisfaction positively influence patients' behavioural intentions to reuse the hospital or recommend it to others (word-of-mouth endorsements). However, in South Africa, empirical studies to investigate these relationships have not been adequately addressed. This study was therefore an attempt to address the lack of scientific evidence and debate in the area of patient satisfaction. Against this background, the primary objective of this study was to measure patients' perceptions of service quality and customer satisfaction with a private hospital experience and to estimate the effect that each of these constructs will have on future behavioural intentions. More specifically, the present study was an attempt to assess empirically the most important dimensions of service quality and transaction-specific customer satisfaction dimensions that drive both patient loyalty and ‘overall’ or cumulative satisfaction in the South African private hospital industry. For the purpose of this study, buying intentions was used as a surrogate measure of loyalty as measured by willingness to reuse the hospital and/or willingness to recommend it to others (word-of-mouth endorsements). Initial exploratory research was conducted with the aim of assessing the views of three private hospital stakeholder groups, namely former patients, doctors and management about what the quality of service and customer satisfaction meant to each individual interviewed. A service enterprise that specialises in patient satisfaction surveys in the US provided particularly useful information during this phase of the study. Several case studies of patient satisfaction programmes, mostly at US hospitals, provided additional insights in this area. The study was conducted nationally at private hospitals owned by one of South Africa's three major hospital groups. Five private hospitals in four major centres were selected on a non-probability convenience basis to participate in the study. The hospital group's senior management and the management at each selected hospital gave their full commitment to ensure that the survey was successfully conducted in their hospital wards. Data were collected by means of a quantitative study using a selfadministered, structured questionnaire. Patients had to meet certain qualifying criteria which included being of adult age, in the hospital for an operation and at least one overnight stay. A total of 3 800 questionnaires was distributed to patients on a random basis in selected wards at the five hospitals by senior hospital staff designated for this task. From this distribution, 425 questionnaires were returned of which a final sample of 323 could be statistically analysed. To confirm the internal reliability of the measuring instrument, Cronbach alpha coefficients were calculated for each of the factors identified by the exploratory factor analysis. In order to assess the discriminant validity of the measuring instrument used to measure both service quality and customer satisfaction, the items were subjected to an exploratory factor analysis. The factors that emerged after the exploratory factor analysis were then used as independent variables in the four subsequent multiple regression analyses to assess the study's four hypothesised relationships. The findings revealed that the service quality dimensions that impact positively on both loyalty and cumulative satisfaction are Empathy of nursing staff and Assurance. The customer satisfaction dimensions to impact positively on both loyalty and cumulative satisfaction are Satisfaction with the nursing staff, Satisfaction with meals, and Satisfaction with fees charged.

M.Cur. / A staffing programme does not exist in a private hospital that compiles with the criteria cost effectiveness and quality nursing care. For this reason a study was undertaken to develop a staffing programme that would facilitate cost-effectiveness as well as quality nursing care. The nursing managers' role is not only to maintain cost-effectiveness but also to facilitate wholeness in patients and nursing staff. To achieve wholeness an exploratory. descriptive instrumental study was conducted and the Nursing Theory of Wholeness was used as a foundation for this study. Various research techniques were used such as scheduled observation, a structured questionnaire, nursing audit and a semi structured interviewing technique to quantify results. An analysis was conducted retrospectively to verify the statistical significance of a cost effective staffing programme. A staffing programme was designed consisting of seven steps to provide a basis for validity and reliability of the programme. The staffing programme proved to be cost-effective and proved to be statistically significant and shows a significant difference on a I% significance level (p = <0,003). The most important conclusion made is that valid, reliable staffing programme was designed for a nursing service in the private hospital. The staffing programme proved to be easily comprehended, useful, and relevant to its purpose. Cost-effectiveness was proved. A patient questionnaire was implemented to test the construct quality nursing. Partial validity of the construct quality nursing was confirmed.

The purpose of this study was to investigate challenges experienced by nurses in the use of electronic whiteboards at one private hospital in the Gauteng province in South Africa. The researcher had observed a continuation of use of the manual dry-erase patient whiteboards in parallel to the use of new the electronic whiteboards in a ward, yet the electronic whiteboard had been implemented to replace the manual system in order to improve service delivery. A descriptive, quantitative study design was used for the study, with n=83 participants being voluntarily surveyed at the hospital over a one month period. The major findings were that the new electronic whiteboards were not always online which necessitated a parallel manual system as backup. Secondly, 47.5% of the respondents requested more training on the whiteboards. A needs assessment to determine training requirements and further investigation into the frequent unavailability of the electronic whiteboards is recommended / Health Studies / M.A. (Public Health - with specialisation in Medical Informatics)

The concept of sustainability has become imperative for any organisation in order to survive and prosper in the long term. As such, the management of fraud risk has become an important component for organisations in order to achieve this objective. The purpose of this study was to explore the management of fraud risk within the South African private hospital sector. The study endeavoured to ascertain how private hospitals in South Africa manage fraud risk. In this regard, problem areas in the management of fraud risk were identified, and recommendations are provided in order to improve the management of fraud risk in the South African private hospital sector. Primary data was collected by means of survey research, which involved management staff at head office level and at hospital level, as these two groups were identified to have the required expertise and experience with regard to risk management procedures and practices within South African private hospitals. The findings suggested that South African private hospitals could improve their current risk management practices, in particular with regard to fraud risk. By implementing the recommendations provided by the study, private hospitals will be able to manage fraud risk more effectively. These recommendations will not only be beneficial to private hospitals, but will also have a positive effect on numerous external stakeholders, because the effective management of fraud risk could lead to considerable cost savings. The public hospital sector of South Africa would equally find the research findings and recommendations of value because it could also be applied to their fraud risk management practices. / Business Management / MCOM (Business Management)

The concept of sustainability has become imperative for any organisation in order to survive and prosper in the long term. As such, the management of fraud risk has become an important component for organisations in order to achieve this objective. The purpose of this study was to explore the management of fraud risk within the South African private hospital sector. The study endeavoured to ascertain how private hospitals in South Africa manage fraud risk. In this regard, problem areas in the management of fraud risk were identified, and recommendations are provided in order to improve the management of fraud risk in the South African private hospital sector. Primary data was collected by means of survey research, which involved management staff at head office level and at hospital level, as these two groups were identified to have the required expertise and experience with regard to risk management procedures and practices within South African private hospitals. The findings suggested that South African private hospitals could improve their current risk management practices, in particular with regard to fraud risk. By implementing the recommendations provided by the study, private hospitals will be able to manage fraud risk more effectively. These recommendations will not only be beneficial to private hospitals, but will also have a positive effect on numerous external stakeholders, because the effective management of fraud risk could lead to considerable cost savings. The public hospital sector of South Africa would equally find the research findings and recommendations of value because it could also be applied to their fraud risk management practices. / Business Management / M. Com. (Business Management)

In recent years, South Africa has seen increasing cultural diversification with regard to the appointment of managers in private healthcare facilities. However, research conducted in this area remains extremely limited. The aim of the present study was to explore and describe cultural values and leadership styles of middle managers at a private sector hospital in the Eastern Cape. Hofstede’s (1980, a ) model of cultural values served as a theoretical framework to conceptualise this study. The study was qualitative in nature and made use of in-depth research interviews conducted with a diverse sample of middle managers. The researcher made use of homogeneous and convenience sampling and utilised five participants. The qualitative data was analysed using Tesch’s (1990, in De Vos, 2002) method of analysis. Results revealed that despite the differences in personal culture, most of the managers are similar in their leadership styles and are also affected by the organizational culture. The results of the study contribute to a better understanding of the influence of cultural values and leadership styles in South Africa and will thereby benefit health institutions in their dealings with their modern day multi-cultural management staff.

The purpose of this study was to investigate challenges experienced by nurses in the use of electronic whiteboards at one private hospital in the Gauteng province in South Africa. The researcher had observed a continuation of use of the manual dry-erase patient whiteboards in parallel to the use of new the electronic whiteboards in a ward, yet the electronic whiteboard had been implemented to replace the manual system in order to improve service delivery. A descriptive, quantitative study design was used for the study, with n=83 participants being voluntarily surveyed at the hospital over a one month period. The major findings were that the new electronic whiteboards were not always online which necessitated a parallel manual system as backup. Secondly, 47.5% of the respondents requested more training on the whiteboards. A needs assessment to determine training requirements and further investigation into the frequent unavailability of the electronic whiteboards is recommended / Health Studies / M.A. (Public Health - with specialisation in Medical Informatics)

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)

Thesis (MCurr)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: Nurse managers are responsible to staff different hospital units and departments with sufficient, trained and experienced personnel. Most critical care units in the private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. Current staffing management strategies comprises the application of the patient acuity score, the utilisation of contracted agency staff and ward staff who assist occasionally in the critical care unit (CCU). The aim of the study was to explore the experiences of critical care nurses regarding staffing management within critical care units in private health care institutions in the Western Cape. The following objectives were set to: - explore the experiences of CCNs regarding staffing management strategies such as o the patient acuity score o the employment of ad hoc agency staff and o the utilization of ward staff A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. A pilot-test was also completed. The trustworthiness of this study was assured with the use of Lincoln and Guba’s criteria of credibility, transferability, dependability and confirmability. All ethical principles were met. The findings of the study demonstrated that nurses perceive the workload in critical care units as heavy. The utilisation of the acuity score does not really assist in relieving the workload as managers tend not to consider the staffing requirements as predicted by the acuity score due to budget constraints. The enrolled nurses who assist occasionally in the critical care unit require supervision as well as ongoing development to ensure safe and quality patient care. Yet agency nurses were perceived as either extraordinary good or incompetent. / AFRIKAANSE OPSOMMING: Verpleegbestuurders het die verantwoordelik om verskillende hospitaaleenhede en departemente met voldoende opgeleide en ervare personeel te voorsien. Die meeste kritieke sorgeenhede in Suid-Afrika word met minder as dan die maksimum werkladingsvlak beman en addisionele personeel word aangevul wanneer nodig. Huidige personeelbestuurstrategieë behels die toepassing van die pasiënt akuïteit telling, die gebruik van ingekontrakteerde agentskap-personeel en saalpersoneel wat per geleentheid in die kritiekesorgeenheid help. Die doel van die studie was om die ervaringe van kritieke-sorgverpleegsters ten opsigte van personeel bestuur binne die kritiekesorgeenhede in die privaat gesondheidsorginstellings in die Weskaap, te ondersoek. Die volgende doelwitte is gestel: - Om die ervaringe van kritieke-sorgverpleegsters aangaande personeelbestuur-strategieë te ondersoek, soos: o die pasiënt akuïteit telling o die gebruik van agentskapverpleegpersoneel en o die gebruik van saal personeel, te ondersoek ’n Beskrywende kwalitatiewe studie is toegepas. ’n Steekproef van n=15 is uit ’n totale populasie van N=377 getrek deur die doelgerigte steekproeftegniek te gebruik. ’n Loodstoetsing van die semi-gestruktureerde vraelys is ook gedoen. Die betroubaarheid van hierdie studie was verseker deur van Lincoln en Guba se kriteria vir geloofwaardigheid, oordraagbaarheid, betroubaarheid en bevestigbaarheid gebruik te maak. Daar is aan alle etiese vereistes voldoen. Die bevindings van die studie toon dat die verpleegpersoneel die werklading in die kritiekesorgeenheid as veeleisend ervaar. Die aanwending van die pasiënt akuïteit-telling dra nie werklik by tot verligting van die werklading nie, aangesien bestuurders weens begrotingsbeperkings neig om nie die personeelbenodigdhede soos deur die akuïteit-telling voorspel in ag neem nie. Die ingeskrewe verpleegsters wat per geleentheid in die kritieke-sorgeenheid hulp verleen, benodig toesig asook volgehoue ontwikkeling ten einde veilige en kwaliteit pasiëntsorg te verseker. Die agentskapverpleegpersoneel is egter as baie bekwaam of onbevoeg beskou.

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)