A Thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy
December 2015
Johannesburg. / Introduction
There has been little published in South Africa regarding quality improvement in health and
in particular the involvement of patients in this intervention. There is evidence globally that
both quality improvement efforts and particularly the engagement of the users adds value to
health services.
Three projects were conceived around this core concept as explained below.
1. Systematic review. Patients’ involvement in improvement initiatives: a qualitative
systematic review
After a search was done of databases, 5121 papers were found to be potentially
relevant. After screening and critical appraisal for eligibility, it was found that 31
articles qualified for analysis. These were then assessed using JBI software and 5
categories and 2 metasynthesised findings were documented. In summary, there
were enablers and barriers to involving patients. The five categories which lead to
these 2 findings were the following: (1) although patient participation in QI is
acknowledged and encouraged by many policies and documents globally, it is
difficult to implement; (2) there are differing views between patients and providers as
to the process; (3) on the positive side, different levels of involvement of patients in
QI were demonstrated; 4) practical, appropriate and innovative results emerged; (5)
individual or group support and incremental development through skills and
enablement contributed towards success
2. The Integration of Non Communicable Chronic Diseases (NCDs) and HIV/Aids and
mental health care through the involvement of chronically ill patients using
Empowerment Evaluation (EE).
At 9 primary care clinics, the process of EE was followed with chronically ill stable
patients and appropriate healthcare workers. This was an additional intervention in
an ongoing QI cycle on the integration of all chronic illnesses into one model, based
on Lean principles.
Steps followed were ‘’taking stock’’ ie assessing patients’ and HCWs’ impressions of
the services at the clinic in a measured way, creating a vision and using this as a
yardstick for the project and then problems and solutions being co-managed by the
collaborative team. A total of 37 interventions were discussed and 23 implemented in
the time frame. Innovative solutions were implemented and teams were empowered
by the potential they experienced.
3. An exploration of childhood nutrition and wellness in a subdistrict by patient
inclusivity in QI using experience based codesign (EBCD) with mothers/caregivers of
malnourished children .
Following the steps of EBCD, staff and patients exposed to health services regarding
ill children, were interviewed, feedback was given of the findings separately and then
in a combined meeting and co-design teams were created to work with the
prioritised quality improvement interventions. Touch points in the system were
examined through emotional mapping, video interviews and observations. Within the
10 month period of the project, 38 interventions were identified and 25 accepted and
implemented at different levels.
Conclusion
The methodologies were chosen to fit with the qualitative aspect of the research.
There were concrete appropriate improvement outcomes due to the engagement of
service users in both the primary care clinics serving chronically ill patients and the
paediatric system in one subdistrict eg the flow of patients improved, logistical
improvements like direct admissions for very ill children, school and library
opportunities for admitted ill children etc occurred. Subjective gains like the
acknowledgement of their power role by patients and a flattening of the healthcare
worker hierarchy were also experienced in the research. Other findings were that
unexpected roleplayers were identified, the timeframe of such QI cycles needs to be
considered especially regarding the resilience of patients and resources were not an
importatn limitation. However some modifications would have to be considered to
make these research approaches common practice.
The particular research methodologies have not been published in a South African
context before and have also not been used for paediatric or integrated chronic
illness research and therefore contribute both content and process information to
health systems research in South Africa. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23158 |
| Date | January 2016 |
| Creators | Van Deventer, Claire |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | Online resource (ix, 144 leaves), application/pdf |
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