Project khaedu sms action learning programme
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Project Khaedu SMS Action Learning Programme. Port Shepstone Hospital - preliminary findings. 19 May 2006. Contents. Executive summary Situation Some suggestions. Executive summary and key message.

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Project Khaedu SMS Action Learning Programme

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Project khaedu sms action learning programme

Project KhaeduSMS Action Learning Programme

Port Shepstone Hospital - preliminary findings

19 May 2006


Project khaedu sms action learning programme

Contents

  • Executive summary

  • Situation

  • Some suggestions


Project khaedu sms action learning programme

Executive summary and key message

Port Shepstone hospital is a well-managed and resourced hospital with relatively high levels of customer satisfaction and staff morale.

Further improvement is constrained by the organisation structure, delegations of authority and physical space.

The patient administration process could be further enhanced with some relatively small changes.


Project khaedu sms action learning programme

Methodology

Due to time constraints a limited sample was used to perform the following:

  • Interviews

  • Observations

  • Data analysis


Project khaedu sms action learning programme

Areas of focus during situational analysis

  • Patient Administration and OPD Clinics

  • Information Systems

  • Human Resources

  • Finance / Systems


Project khaedu sms action learning programme

Current situation

Process

Finance/ Procurement/ Systems

Organisation

Physical

  • High patient volumes exacerbated by no district hospital close by

  • Bottlenecks in patient administration and OPD leading to long wait times

  • Very slow procurement when provincial head office involved in the process (e.g. IT over 8 months)

  • Sub-optimal use of IT in some areas, e.g.

    • Manual recording of file retrieval

    • Manual registration at OPD

    • Lack of an integrated HIS

  • Sub-optimal organisation structure in some areas, with a significant impact on service delivery

  • Delegation of authority

  • Inefficient Performance Management and Development System

  • Major space constraints in just about all areas of the hospital, but particularly severe in

    • Pharmacy

    • OPD

    • Medical Wards

  • Hospital maintenance department a constraint to service delivery

    (pharmacy, toilets, filing)


Ps hospital is swamped with high numbers of outpatients per day

PS hospital is swamped with high numbers of outpatients per day….

  • Patients start arriving at 5h00 in the morning and by 7h00 the entire area is overflowing with patients.

  • Patient screening starts between 6h45 and 7h15.

  • Patients are channeled to different counters (clinics, OPD)

  • The duplication of registration at Admissions and OPD result in bottlenecks


Which impacts on service delivery

…which impacts on service delivery


Ps hospital is swamped with high numbers of outpatients

PS hospital is swamped with high numbers of outpatients…

Average annual growth rate = 4.4%

2002

2003

2004

2005

2006

Average per day = 662

(Some are repeat patients and do not get seen by a Dr)


Project khaedu sms action learning programme

In general, patients are satisfied with the services, except for waiting time.


Project khaedu sms action learning programme

Delays due to shortage of key resources:

  • IT equipment

  • IT support

  • Shortage of staff nurses and nursing assistants


Project khaedu sms action learning programme

Staff is generally satisfied


Project khaedu sms action learning programme

However, the following areas need attention:

  • Training

  • Career progression

  • Quality of facilities

  • Performance management

    • Awareness and Training down to the lowest level

    • Budget for performance bonuses


Project khaedu sms action learning programme

What are staff saying?

“We are not happy with the performance management system…our KPA’s are handed down to us and we do not have a say in the matter”

“Batho Pele is just on paper…it is not practised enough”

“We work under very cramped conditions…space is a problem for everybody…we do not have a tea room or a canteen”

“There is no shelter outside and we get wet transferring patients in the rain”

“We are happy with the new management”

“There is a severe shortage of nursing staff but we are doing our best”


Project khaedu sms action learning programme

Many areas are very cramped; lack of space is a pervasive problem


Project khaedu sms action learning programme

Suggestions for Improvements

Options for decongesting the patient admin and OPD

  • Decentralising admin support in the early morning by:

    • Moving files to separate clinics the day before

    • Deploy patient admin. staff to clinic to handle cash collection at separate points.

  • Suggest later appointment times to local / urban patients

  • Ensure availability and function of printers

  • Consider one combined registration point


  • Project khaedu sms action learning programme

    Suggestions to improve procurement of IT

    • At present the Procurement process goes through three levels resulting in delays

    • Eliminate the District IT Committee level because it does not add value

    • Budget centralised at Head Office level – applications must be considered at that level

    • Fast track the implementation of a Provincial integrated hospital IT system


    Project khaedu sms action learning programme

    Human Resources

    Organisational structure e.g. nursing

    Span of control 1:1

    Span of control 1.4:1

    Span of control 1:1

    Very low span of control and we can’t attract more CPN’s

    “We could get through much more work if we had more NA’s and staff nurses…we just need more hands”


    Project khaedu sms action learning programme

    Human Resources

    Organisational structure e.g. nursing

    • Improve delegations with regard to the ODE function

      • E.G the ability to create and abolish posts, within available funds, should be delegated to the institution.

  • Convert professional nurses posts to staff nurse posts as they are easier to recruit and will relieve professionals from performing lower level work, e.g bathing patients


  • Project khaedu sms action learning programme

    Finance and Sytems

    • Fast track minor alteration requests (e.g pharmacy, archives)

    • Interim arrangements must be made in Casualty for patients waiting for beds (portable screens)

    • Shelter needed across casualty and OPD

    • Improvement of signage


    Project khaedu sms action learning programme

    THANK YOU


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