MAKERERE UNIVERSITY

ASSESSMENT OF RECORDS RISKS AT MENGO IN

BY

NAMATAKA AFUA

16/U/9237/PS

216014652

A PROPOSAL SUBMITTED TO THE EAST AFRICAN SCHOOL OF LIBRARY AND INFORMATION SCIENCE IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE AWARD OF BACHELORS DEGREE IN RECORDS AND ARCHIVES MANAGEMENT OF UNIVERSITY.

JUNE 2019

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iii ACKNOWLEDGEMENTS This research would not have been possible without the guidance and the aid of several individuals who were willing to contribute and extend their valuable assistance in the completion of this research. I would like to express my heartfelt thanks to the following people who played a great role in the completion of this project. First and foremost, my utmost gratitude goes to the Almighty God for his undeserved, favor, inspiration and guidance in my studies. In a special way, I extend my heartiest gratitude to my farther Mr. …………… for his support, encouragement, guidance and the academic foundation he laid for me. I extend my sincere gratitude to my supervisor Dr. ……………. who shared his professional knowledge with me and for the time and guidance he accorded to me. May the heavenly father bless him abundantly. Furthermore, I wish to convey my heartfelt thanks to my entire family; brothers, sisters and friends for their ultimate, moral, financial, friendly, parental and spiritual support through my academics.

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Table of contents

DECLARATION ...... Error! Bookmark not defined. APPROVAL ...... Error! Bookmark not defined. DEDICATION ...... Error! Bookmark not defined. ACKNOWLEDGEMENTS ...... iv 1.0Introduction ...... 8 1.1Background to the study ...... 8 1.2 Background of Cancer Institute...... 9 1.3 Statement of the problem ...... 10 1.4 Purpose of the study ...... 11 1.5 Objectives of the study ...... 11 1.6 Research questions ...... 11 1.7 Scope of the study ...... 11 1.7.1 Content scope ...... 12 1.7.2 Geographical scope ...... 12 1.7.3 Time scope ...... 12 1.8 significance of the study ...... 12 1.9 Operational terms...... 12 CHAPTER TWO ...... 13 LITERATURE REVIEW ...... 13 2.0 Introduction ...... 13 2.1 Different types of hospital records kept at Cancer Institute registry...... 13 2.2 Risks faced by records kept in the Cancer institute registry...... 14 2.3 Challenges experienced in managing risks facing records at Cancer Institute registry...... 15 2.4 Possible solutions to challenges in managing risks facing records at Cancer Institutes...... 16 References ...... 24 CHAPTER THREE ...... 20 METHODOLOGY ...... 20 3.0 Introduction ...... 20 3.1 Research Design ...... 20 3.2 Population for the Study ...... 20

v 3.4 Sampling size and Design ...... 20 3.3 Data Collection Instruments ...... 21 3.5 Data quality control ...... 22 3.5.1 Reliability ...... 22 3.7 Data Processing and management ...... 23 3.8 Data Analysis Techniques ...... 23 3.9 Ethical consideration ...... 23 Confidentiality will be ensured in order to protect the respondents and other third parties ...... 23

vi ABSTRACT

The study was aimed at assessment of records risks at in the department of records in Kampala. The study was based on 4 objectives i.e the different types of hospital records kept, the risks faced by records kept, the challenges experienced in managing risks and solutions to challenges in managing risks facing records. The study took a period of 3 months thus from May to July.

The study employed a case study design and was qualitative in nature. The study employed 9 respondents from a sample of 14 who were selected purposively. The selection of the respondents was based on entirely their knowledge about the subject matter.

The study found out that the hospital keeps a number of records which include: Appointment letters, Administrative records, contracts, financial records, vital records, personal records and legal records and some of the risks involved in keeping of these records were: less effective Automated records management system, improper retention and disposition policy, Under staffing, inadequate storage equipment and dust and some of the solutions to the to the challenges were some of the record risk management tools like indexes and Registers.

The study concluded that the fact that effective storage and risk management fosters efficient and reliable access to records and ensuring the timely decision making and accountability. The challenges in managing storage and risk management for effective services delivery can be managed and there are various ways of improving their management which was recommended.

7 CHAPTER ONE

INTRODUCTION

1.0Introduction

This chapter covered the back ground of the study, background of the organization, problem statement, purpose of the study, objectives of the study, research questions, and scope of the study, significance of the study and definition key terms

1.1 Background to the study

Records risk assessment is an essential part of risk management and is the overall process of risk identification, risk analysis and risk evaluation (ISO, 2009). The office of the national for Health information technology coordinator (USA) (2015) states that the risk assessment process identifies potential security weaknesses and flaws and there is a need to periodically conduct such assessments as there might be changing environments and the new challenges and developments. It further stresses that records risk assessments are critical to ensure that any healthcare facilities have proper records management systems and that they detect possible disasters and apply measures to ensure that records are secure and safe from harm. The importance of records risk assessment is highlighted by the medical insurance exchange of California (2008) which states that nothing is more devastating to an innocent physician’s defense against the allegations of medical malpractice than an inaccurate, illegible or skimpy record. World and Shriver (1997) highlights that organization, both large and small, fail to take effective measures to manage and protect their documents and records to mitigate the risks of hurricanes, terrorism attacks, extended power outages another business interruption. They further explain that risk assessment assists organizations to evaluate and assess the adequacy of the controls in relation to dealing with identified threats. Poba-Nzaou (2016) notes that the risk exposure as well as risk management are influenced by contextual factors: and these factors increase or decrease the exposure to risk. It implicitly assumes that risk management can be understood through the alignment or fit between a hospital’s level of exposure to risk and its risk management profile.

8 The Canadian medical protective association (2014) stresses that the advent of technology has greatly enhance health records and information management as it has become easy to share e- records and information between different health practitioners and healthcare facilities. However, on the other hand, it explains that ICTs are not exempt from risks as the new technologies should not be adopted or used before the privacy and security risks are fully analyzed, along with the measures that should be taken to enable physicians to comply with privacy legislation.

The medical protection society of South Africa (2014) postulates that there is a need to secure the integrity and confidentiality of personal information, prevent loss of damage to or unauthorized destruction of or unlawful processing or access to personal information.

Records are at the heartbeat of the healthcare delivery system which depends on the availability and timely provision of records. The most important reason for physicians to maintain accurate, credible medical records is that good documentation protects patients and medical records contain information required to inform physicians of past and present treatment decisions, and to provide evidence that such care was appropriate in all respects (The Medical Insurance Exchange of California, 2008).

The importance of records in the health sector therefore calls for measures to be put in place to guarantee that records are managed meticulously to avoid loses, theft, and other disasters. One of the most important measures is the clear identification of what is most at risk, and of what truly merits fully protection (Penn, Pennix and Coulson, 1994).

1.2 Background of Mengo Hospital Mengo Hospital is the oldest hospital in Uganda. It was established by Albert Ruskin Cook in 1897. At the beginning, the hospital belonged to the Church Missionary Society. In 1958, the hospital was handed over by the Church Missionary Society to an independent and autonomous Board of Governors and Registered Trustees. Today, the hospital is an urban community hospital with all the amenities of a modern hospital in sub-Saharan Africa. It houses the Ernest Cook Radiology Department, named after Ernest Cook, the nephew of Albert Cook, who brought the first X-Ray machine to East Africa in 1907 and installed it at Mengo Hospital. The X-Ray department is located within the Sr. Albert Cook Building. The Department houses the

9 Ernest Cook Ultrasound Research and Education Institute (ECUREI). ECUREI offers ordinary and advanced diploma courses in ultrasonography and degrees in medical imaging. The institute is affiliated with Thomas Jefferson University in Philadelphia, Pennsylvania, United States. It is also collaborates with Fontys University in the Netherlands in its training programs. In March 2016, the newspaper reported that Mengo Hospital was negotiating with Uganda Christian University, in Mukono to establish a medical school at the hospital. No time-frame was disclosed. The Church Missionary Society (CMS) of England sent a team of Missionaries to Uganda. In the team was a Physician, the late Sir Albert Ruskin Cook (RIP), who arrived in Uganda on 15th February 1807. Soon after his arrival, Dr. Cook realized that in order to minister to the spiritual lives of people of Uganda, he had to give attention to their enormous physical problems as well. Consequently, on 22nd February 1897, Sir Dr. Cook held his first outpatient clinic under a tree on . With that single event, the firs seed for the Christian Medical work in Uganda. Ever since, that work has continued to grow and to develop in size and scope uninterrupted for the last 117years. Determined to harness the local environment in order to offer whatever was practically possible at the time, in 1897 Sir Dr. Cook mobilized local manpower, other material resources and put up a 12- bed grass thatched ,mud and wattle building at Namirembehill, in which he treated tens of thousands

1.3 Statement of the problem Records are at the heartbeat of the healthcare delivery system which depends on the availability and timely provision of records. The most important reason for physicians to maintain accurate, credible medical records is that good documentation protects patients and medical records contain information required to inform physicians of past and present treatment decisions, and to provide evidence that such care was appropriate in all respects (The Medical Exchange of California, 2008). Without records, lives of patients are at stake, whereas physicians’ practice may suffer and lose credibility and efficiency.

Records are faced with a number of risks which usually are unidentified until such a time when disaster strikes, records are stolen, go missing, or chewed and cannot be salvaged. Mengo hospital may also not have purposely built structures for records storage and hence records are prone to water pipe leaks, termites, floods and other possible disasters. The major challenge is

10 that such risks go unidentified and organizations like Mengo hospital are struck by disasters and fail to respond or manage disasters.

Therefore, the study is intended to assess records risks at Mengo hospital in Kampala with a aim of proposing recommendations to address risks before serious damages happen to records, Since records are fragile and prone to damage, wear and tear, this prompted the researcher to carry out an assessment on records risks at Mengo hospital in Kampala.

1.4 Purpose of the study

The purpose of the study is to conduct an assessment of records risks at Mengo Hospital in Kampala with an aim of identifying possible risks which can affect the hospital’s records.

1.5 Objectives of the study

i. To find out the different types of hospital records kept at Mengo Hospital in Kampala. ii. To find out the risks faced by records kept in Mengo Hospital in Kampala. iii. To find out the challenges experienced in managing risks facing records at Mengo Hospital in Kampala. iv. To find out possible solutions to challenges in managing risks facing records at Mengo Hospital in Kampala.

1.6 Research questions

i. What are the different types of records kept at Mengo Hospital in Kampala? ii. What are the risks faced by records kept in Mengo Hospital in Kampala? iii. What are the existing risks affecting records at Mengo Hospital in Kampala? iv. What are the challenges encountered in managing risks facing records at Mengo Hospital in Kampala? v. What are the possible solutions to challenges in managing risks facing records at Mengo Hospital in Kampala?

1.7 Scope of the study

This includes the content, geographical and the time scope.

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1.7.1 Content scopes

Study will be carried out on assessing records risks at Mengo Hospital in Kampala and it will cover types of records, risks faced by records kept, challenges faced in managing records risks and making recommendations for risks faced at Mengo Hospital in Kampala.

1.7.2 Geographical scope

The study aims at assessing records risks. It is conducted at Mengo Hospital. The facility is located at Namirembe Hill in Division in northwestern Kampala. The travel distance, by road, from the city's central business district to Mengo Hospital is approximately 2 kilometers (1.2 mi). The coordinates of Mengo Hospital are 0°18'46.0"N, 32°33'30.0"E (Latitude:0.312778; Longitude:32.558333).

1.7.3 Time scope

The research will be carried out for a period of three months from May to June 2019.

1.8 significance of the study

The following will be significance of this study:

i. The findings of the study will help overcome the records risk faced at Mengo Hospital because it will help show the registry staff the records risks that affect records. ii. The findings from research about records risk assessment will lead to a better understanding of records risks as well as providing solutions. iii. The findings of the study will also provide relevant literature to other researchers who might want to conduct further research about records risk assessment in Mengo Hospital.

1.9 Operational terms.

Records:

Storage

Medical records:

12 CHAPTER TWO

LITERATURE REVIEW 2.0 Introduction

This chapter is aimed at to analyzing the literature from studies done elsewhere but related to the study at hand. The look at the positive and the negative effects of the internet usage in the learning process. This chapter comprises other author’s works in line with the study objectives answering the major objective of Assessment of records risks at cancer institute registry. This literature review attempts to provide a better understanding of the assessment of the records at Mengo Hospital.

2.1 Different types of hospital records kept at other .

The cancer registry involves quite a myriad of records and some of the data are collected by Cancer Registrars include (Arnold, 2015). Cancer Registrars capture a complete summary of patient history, diagnosis, treatment, and status for every cancer patient in the United States, and other countries. The Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute (NCI) was established in 1973 as a result of the National Cancer Act of 1971 (Arnold, 2015)

For the case of Sub-Saharan Africa Statistics captured at cancer registry include: Incidence and Mortality report. Demographic information, medical history, diagnostic findings, cancer therapy and follow up details (Kalonzo, 2009). The data is used to evaluate patient outcome, quality of life, provide follow-up information, calculate survival rates, analyze referral pattern, allocate resources at regional or state level, report cancer incidence as required under state law, and evaluate efficacy of treatment modalities (Kalonzo, 2009).

Population-based cancer registries monitor the frequency of new cancer cases (so-called incident cases) every year in well-defined populations and over time by collecting case reports from different sources (treatment facilities, clinicians and pathologists, and death certificates). Population-based registries can also monitor the effects of preventive measures. The aim is to recognize and to reduce risk (Sarens and De Beelde ,2006)

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According (Chernobai et al,(2007),Disease or patient registries are collections of secondary data related to patients with a specific diagnosis, condition, or procedure, and they play an important role in post marketing surveillance of pharmaceuticals. Registries are different from indexes in that they contain more extensive data.

In its simplest form, a cancer registry could consist of a collection of paper cards kept inside "a shoe box" by an individual physician. Most frequently cancer registries vary in sophistication from simple spreadsheets that only can be accessed by a small group of physicians and patients to very complex databases that are accessed online across multiple institutions. They can provide health providers (or even patients) with reminders to check certain tests in order to reach certain quality goals.

2.2 Risks faced by records kept in the different Hospitals.

The relationship between cancer records management and registry risk management contend that there is a historical relationship between medical risk management and their records management, even though the cancer registry risk management field has its origin in the insurance industry Chernobai et al.,(2007). From time immemorial, human beings have striven to understand risk affected by factors such as storm, fire or flood (Graham & Kaye, 2006:1). Very few Hospitals take a wide-angle view of medical registry risks and controls beyond storage McNeil et al.,(2010). Even in these cases, as postulated by Lemieux (2010:210), attention is generally focused on mammography risks. It was only in the 1990s that the field of health risk record management received greater recognition McNeil et al.,(2010).

Risk commentators such as Fraser and Henry (2007:393), Hiles (2002), Lemieux (2010:211) and Sarens and De Beelde (2006:64) argue that the incident on the roots of modern health risk management are much older and were already deeply embedded in the management of many organisations long before that fateful day. Cancer Record Risk is rarely projected and it is only when Health records are kept that an opportunity presented itself to scrutinise these records to offer prediction of the future (Hsiao et al, 2010). Today, most organisations have, as part of their

14 corporate executive staff, an individual with the title of chief risk officer. As a result, risk management to many is synonymous with good governance.

Fraser and Henry (2007:393) argue that historically no unit within organisations has been charged with risk management. As a result, internal audit departments and audit committees took the opportunity to fill the gap simply because many risks have an obvious Health dimension. According to Isa (2009:4), cancer records management ensures the availability of records for cancer risk assessment and as such should be involved in or incorporated into the risk management process. He further alleges that Cancer registry record-keeping practice and risk management elements must be nurtured and embedded in all business activities across the organisation (Isa, 2009). This can be realized by forming a working committee comprising the audit committee, archivist and records manager and risk management team to implement such an approach across the board. Therefore, records management professionals should embrace the opportunity to contribute to the achievement of corporate governance. (p. 258)

2.3 Challenges experienced in managing risks facing records at Mengo Hospital.

Both public and private organisations face different kinds of risks that affect the reliability of records and effectiveness of internal controls daily, such as losses, negative cash flows and, ultimately, bankruptcy, which can lead to liquidation. According to Ebaid (2011:108), it is difficult for organisations to avoid risk. However, what matters most is the identification and management of risks that the organisation is exposed to. Records management is one of the functions that can play a vital role in identifying and assessing risks and leading to effective risk management. Effective risk management plays an integral part in the development of the control environment which, in turn, provides management with the necessary assurances that the organisation will achieve its objectives within an acceptable degree of residual risk.

Despite the role that cancer records management can play in identifying risks within organisations, it is clear from the literature that the role has not been clearly articulated, particularly in the public sector in South Africa as compared to elsewhere in the world (Bhana 2008). Lemieux (2001; 2004:57) contends that risks associated with records are often dealt with

15 on an ad-hoc basis via internal audits, legal processes, information technology and in few instances records management. Akotia (1996:6) has also observed that ‘a major defect in Health administration arises from failure to integrate accounting and records management process, with the result that essential information is lost or becomes subject to inaccuracies’. Palmer (2000:63) points out that the chaotic and collapsed state of records management systems is one of the primary reasons why accounting standards will not easily be implemented in developing countries. Indeed, when accounting systems are weakened due to poor record-keeping, management is unable to access records for decision-making. In this light, it is essential that records are managed properly throughout their entire life cycle to enable identification of risk and management thereof.

Willis (2005:88) is of the view that a robust records management programme in the cancer institutes should form part of the Hospitals ’s record risk management process, as records and the management of risk are considered inseparable. In this regard, proper records management can be used as a tool to identify risks in the organisation. Fraser and Henry (2007:393) identify two contexts in which the inseparability of and nexus between records and risks can be considered: records for identifying business risk and business risks associated with managing records. Furthermore, Lemieux (2010) provides a typology between records management and risk management:

2.4 Possible solutions to challenges in managing risks facing records at Mengo Hospital.

It is clear from literature that that a strong cancer records management can be one of institutes’s primary tools in identifying risks and can therefore leads to proper cancer risk management by risk management authority at the registry Lage et al.,(2008), Ramsey et al.,(2008) and Duh et al, (2008) . Therefore, records management should be integrated with risk management and record-keeping must be viewed by organisations as a risk management function, thereby leveraging its status in the public sector. The integration of risk and records management has a bright future as its synergy enables the identification of not only risk but also business opportunities, maintains competitive advantage and facilitates the achievement of the strategic objectives of the organisation. Therefore, as Isa (2009:257) would attest, a risk-based approach to records management identifies and gives priority to risky records and in the process ensures

16 that records are protected against destruction and damage, retrieved when needed and disposed of at the end of their life cycle.

An effective records management programme covering the full life cycle of a record will ensure that records are not merely kept, but are kept well, as a resource and an asset to increase the organisation’s efficiency. As part of risk management, organisations should develop business continuity plans and contingency measures to ensure that records that are vital to the continued functioning of the organisation are identified as part of risk analysis, protected and recoverable when needed. As Isa (2009:91) would attest, to limit the risks associated with records, records need to be protected. Furthermore, organisations need to ask the following questions:

In view of all of the identified risks, record-keeping must be approached by governmental institutions as a risk management function. In this regard, the records management unit should be involved in the management of risks associated with records. Furthermore, records management practitioners should be included in risk committees. Effective risk management is the cornerstone of good governance and can lead to improved performance, resulting in better service delivery, more efficient use of resources, as well as helping to minimise waste and fraud. The risk assessments in governmental bodies should also review record-keeping, so that government entities’ records management priorities do not pose any legislative or business risk to the organisation. Applying the principles and practices well is no guarantee for success, as other factors can influence and determine outcomes. Nevertheless, failure to do so would most likely lead to less than desired results and, probably, even failure.

2.4.1 Medical devices registries

The use of joint registries has proven beneficial abroad. In Australia, regulators use such data to force manufacturers to justify why poorly performing cancer treating medicine should remain available, and products have been withdrawn as a result. This is ultimately a national database for most of the permanent implanted medical devices, which stays in the human body, it will be a National program covering all the hospitals doing implants(Cardio, Ortho, Craniofacial, Cosmetic , Spine & Simulators and other implants),

2.4.2 Cost-effectiveness

17 The cost-effectiveness of a cancer registry is related with the cost-effectiveness of prevention of specific medical conditions. Hence Increasing compliance through a registry with preventive measures like cancer screening or colonoscopy screening can actually be a cost-saving measure. "A mammogram every 2 years for women aged 50–69 costs only about $9,000 per year of life saved. This cost compares favorably with other widely used clinical preventive services."

2.4.3 Pay-for-performance (P4P)

Registries can be associated with pay-for-performance (P4P) quality based contracts for individual doctors, groups of doctors or even all doctors in a country. For example, the United Kingdom, rewards physicians according to 146 quality measures related with 10 chronic diseases that are tracked electronically.

2.4.4 Technical aspects of data tracking

The quality of any disease registry is based on the quality of data fed into it and all the processes involved in updating it and keeping its integrity. Hence in the cancer registry there is always a risk of "garbage in, garbage out". Issues that can affect a registry and its acceptance by a physician group

2.4.5 Update of registry

A centrally updated registry by a physician update For example, if a physician doesn't want to get reminders from a registry regarding cancer patients that died, moved to another hospital s or left her/his practice.

Cancer records management programme can be an effective record keeping policy for an a hospital to identify risks. Ngoepe (2011:33) contends that organisations without proper records management run the risk of destroying records too soon and consequently of not being able to produce the records when legally required. Alternatively, organisations adopt the costly practice of keeping everything forever, a practice that can also backfire in legal proceedings. The organisation is then required to produce everything it has relating to the proceedings, not just what it is legally required to provide. At the very least, producing all related records is time-

18 consuming and expensive (Ngoepe 2012:84). Therefore, it is appropriate to manage records to enable identification and assessment of risks within organisations.

2.5 Research Gap

2.6 Conclusion

In conclusion the strength and effectiveness of a record-keeping system mainly depend on the effectiveness of risk management that priorities and identifies risks across any organisation. For the case of cancer registries allocating the identified risks into an organisational directory or a file plan structure enables the identification of contextual information, which in turn ensures that the authenticity and integrity of cancer registry records . As risk is associated with avoiding or mitigating obstacles to achievement, from a liability standpoint, cancer registry records are necessary to demonstrate that Hospital has conducted itself reasonably. If nothing is recorded, it difficult to prove that it happened. Relying on human memory is dangerous due to its elusiveness, frailty and the tendency of people to remember things that never happened (Jimerson 2003:90; Ngoepe 2012:44). This can lead to records and information management risks, which encompass any threat to the problems arising from inadequate records management (Lemieux 2004:56).

19 CHAPTER THREE

METHODOLOGY

3.0 Introduction This chapter provides an overview of the methodology used in the research. This is basically the procedures adhered for the entire research. Thus, it provides a detailed discussion of the research design, study population, sampling design and technique, data collection method, quality control, data management and analysis techniques.

3.1 Research Design The study employed a cross section survey because it is a type of observational study that involves the analysis of data collected from a population or a representative subject at one specific point in time. A Cross sectional survey is neither longitudinal nor experimental and it has advantages like it doesn’t need an assumption that the nature of the relationships between variables in stable over time and it can investigate the effects of various demographic factors like age on individual differences. 3.2 Population for the Study Population is defined by McMillan and Schumacher (2001) as a group of elements or cases, whether individuals, objects or events that conform to specific criteria in research. In this study, the target population is record keepers at the cancer institute, administrators and patients at. Studying the whole population would greatly enhance the outcome of the study. However, this is often most impracticable owing to the limited academic period for the study. Sampling therefore becomes the only effective means for conducting the study. 3.4 Sampling size and Design Sampling Size

A sample is a proportion of the population whose results can be generalized to the entire population as defined by Amin (2005). The sample size of the study was will be 16 respondents.

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Sampling Technique

This research will use a systematic sampling technique in order to have questionnaires filled by 16 respondents without bias. That is all data clerks at the Cancer Institute the patients who access these records and the administrators.

3.3 Data Collection Instruments The most appropriate research instruments considered and employed will be a questionnaire and interview which are informant-completed instruments (Frankel and Wallen, 1996). Data from multiple choice sources will be collected with the aim that all would converge to establish a particular theory or an opinion (Leedy and Ormrod, 2002).

Questionnaire

In view of Leedy and Ormrod (2005), questionnaires offer participants the advantage of answering questions with the assurance of anonymity for their responses. Questionnaires are fast and convenient and given the level of education of both the teachers and students in the schools, it does not misinterpret the questions and give misleading answers. The use of questionnaires will ensure that quantifiable responses are obtained for the purpose of establishing relationships between the identified variables and the responses. The closed and open-ended questions will be applied in the study. Close-ended questions will be used to control responses and open-ended questions to supply in-depth information relevant to the study. The questionnaire seeks to answer questions on socio-demographic data, availability of resources, teaching and learning methods, preparation before, during and after examination.

Interviews

Frankel and Wallen (1996) explain that interviews are taken to find out from people things that we cannot directly observe or notice. They point to the fact that one cannot observe everything, for instance feelings, thoughts and intentions. One cannot observe the behaviour

21 that took place in the past. In light of this, the researcher structured informal face - to - face interviews with the sampled students. The interviews will be used as follow-ups to the questionnaire. This will be used to enable participants who can’t express themselves well in the questionnaire to provide the needed information. Review of documents.

Some of necessary secondary data information were obtained through documentary review. Information was got from documents like; school's strategic plans, performance reports among others.

3.5 Data quality control Data quality control involves application of efforts and procedures that researchers use to ensure the quality and accuracy of data being collected using the methodologies chosen for a particular study. Bowen (2009) 3.5.1 Reliability The reliability of a research instrument concerns the extent to which the instrument yields the same results on repeated trials. Although unreliability is always present to a certain extent, there will generally be a good deal of consistency in the results of a quality instrument gathered at different times. The tendency toward consistency found in repeated measurements is referred to as reliability (Carmines & Zeller, 1979).Best and Kahn (1993:208) also laments that reliability is the degree of consistency an instrument or procedure demonstrates. The concept of reliability in relation to a research instrument has meaning if a research instrument is consistent and stable, hence predictable and accurate, it is said to be reliable. To overcome factors which may affect reliability on the administered interview guides, simple language will be used to avoid ambiguity because ambiguity in wording of phrases or questions can in turn affect the reliability of the instrument.

3.6 Validity Validity can be defined as the degree to which a test measures what it is supposed to measure. There are three basic approaches to the validity of tests and measures as shown by Mason and Bramble (1989). These are content validity, construct validity, and criterion-related validity. Validity is the most important consideration in developing and measuring instruments. It is also

22 defined as the extent to which an instrument measures what it is supposed to measure (Ary et al., 2010:225). 3.7 Data Processing and management

Before all data can serve the purpose of being analysed, it has to undergo a series process. Data processing is a process that includes questionnaire checking, data editing, and cleaning before the analysis is made (Zikmund, 2003). This all was done using the SPSS software v20. Questionnaire checking is a process to discover, correct, and resolve any error or problem that may occur in the questionnaire, the purpose of performing data editing is to ensure high accuracy of the data and checking process is enhanced to ensure consistency.

3.8 Data Analysis Techniques

Its common knowledge that analyzing qualitative data in case studies is one of the most challenging stages in a research process. Yin (2009) further recommends that data analysis for case studies should be done by categorizing, tabulating, and testing both quantitative and qualitative evidence to address the initial proposals of a study. Since this study is based on a single case study aspect, the researcher will conduct a qualitative analysis of data attained from the data collection process. This will involve refining data during and after collection to sort out mistakes, coding the data by building themes and sub themes, systematic description of the contents of the data in a reduced form. Finally, explanations of meanings, interpretation in relation to research objectives, discussions, and conclusions from the emerging information, were drawn and presented thematically as per the propositions of this study

3.9 Ethical consideration Confidentiality will be ensured in order to protect the respondents and other third parties The researcher will ensure confidentiality and anonymity as promised to the respondents in order to increase the validity of the responses. The researcher will get a research introductory letter from the East African School of Library and Information Science (EASLIS) and the research will be done that the Cancer institute of Headquarters

23 References

Akotia, P., 1996, ‘The management of public sector Health records: The implications for good government’, University of Ghana, Legon, viewed 10 April 2019, from http://ww4.msu.ac.zw/elearning/material/1174370018Pino%20Akotia%201996%20on% 20governance.pdf

Amin, M.E. (2005). Social science research conception, methodology and analysis. Kampala, Printery

Bhana, P., 2008, ‘The contribution of proper record-keeping towards auditing and risk mitigation: Keeping towards auditing and risk mitigation Auditor General Perspective.pdf

Carmines, E. G. & Zeller, R.A. (1991). Reliability and validity assessment. Newbury Park: Sage Publications.

Chassin MR, Gavin RW. The urgent need to improve health care quality. Institute of Medicine National Roundtable on Health Care Quality. JAMA. 1998;280(11):1000–1005.

Chernobai, A.S., Rachev, S.T. & Fabozzi, F.J., 2007, Operational risk: A guide to Basel II capital requirements, models and analysis, John Wiley & Sons, New Jersey.

Cohen, Joshua T.; Neumann, Peter J.; Weinstein, Milton C. (14 February 2008). "Does Preventive Care Save Money? Health Economics and the Presidential Candidates". New England Journal of Medicine. 358 (7): 661–663. doi:10.1056/NEJMp0708558. PMID 18272889.

Creswell, J. W., Hanson, W. E., Plano, V. L. C., & Morales, A. (2007). Qualitative research designs selection and implementation. The Counseling Psychologist, 35(2), 236-264.

Dean BB, Lam J, Natoli JL, Butler Q, Aguilar D, Nordyke RJ. Use of electronic medical records for health outcomes research: A literature review. Med Care Res Rev. 2010;66(6):611–

DesRoches CM, Campbell EG, Rao SR, et al. Electronic records in ambulatory care – A national survey of physicians. N Engl J Med. 2008;359(1):50–60. [PubMed] [Google Scholar]

Duh MH, Reynolds WJ, Lefebvre P, Neary M, Skarin AT. Costs associated with intravenous chemotherapy administration in patients with small cell lung cancer: a retrospective claims database analysis. Curr Med Res Opin. 2008;24(4):967–974.

24 F.J. Fraenkel and N.E. Wallen, How to Design and Evaluate Research in Education. Qualitative Research (7th ed.). McGraw-Hill Higher Education, 2009.

Graham, J. & Kaye, D., 2006, A risk management approach to business continuity: Aligning business continuity with corporate governance, Rothstein Associates, Brookfield.

Harris, V. & Merrett, C., 2007, ‘Toward a culture of transparency: Public rights of access to official records in South Africa’, in V. Harris (ed.), Archives and justice: A South African perspective, pp. 269–288, The Society of American Archivists, Chicago.

Hsiao CJ, Beatty PC, Hing ES,2010. Electronic medical record/electronic health record system of office-based physicians:; December2010Available from: http://www.cdc.gov/nchs/data/hestat/emr_ehr_09/emr_ehr_09.htmAccessed on may v29, 2019 [Google Scholar]

Isa, A.M., 2009, ‘Records management and the accountability of governance’, PhD thesis, Humanities Advanced Technology and Information Institute, University of Glasgow, Glasgow, Scotland, viewed 15 May 2019, from http://www.theses.gla.ac.uk/1421/

Jha AK, Ferris TG, Donelan K, et al. How common are electronic health records in the United States? A summary of the evidence. Health Aff (Millwood) 2006;25(6):w496–w507. [PubMed] [Google Scholar]

KPMG, 2011, Records risk management diagnose, viewed 10 may 2019, from http://www.kpmg.com/US/en/IssuesAndInsights/ArticlesPublications/Documents/records -risk-management-diagnostic.pdf

Lage MJ, Barber BL, Harrison DJ, Jun S. The cost of treating skeletalrelated events in patients with prostate cancer. Am J Manag Care. 2008;14(5):317–322. [PubMed] [Google Scholar]

Leedy, P. D., & Ormrod, J. E. (2005). Practical research: Planning and design (8th ed.). Upper Saddle River, NJ: Prentice Hall

Lemieux, V.L., 2010, ‘The records-risk nexus: Exploring the relationship between records and risk’, Records Management Journal 20(2), 199–216. http://dx.doi.org/10.1108/95656981080001362

McMillan, J. H., & Schumacher, S. (2001). Research in education: A conceptual introduction (5th ed.). New York: Longman

25 Ngoepe, M., 2011. Records management practices in the South African public sector: Challenges, trends and issues, Lambert Academic Publishing, Saarbrücken.

Raghunathan TE, Solenberger PW, Van Hoewyk J. IVEware: Imputation and variance estimation software user guide. University of Michigan; 2002. [Accessed on July 2, 2011]. Available at: http://www.isr.umich.edu/src/smp/ive/ [Google Scholar]

Ramsey SD, Martins RG, Blough DK, Tock LS, Lubeck D, Reyes CM. Second-line and third-line chemotherapy for lung cancer: use and cost. Am J Manag Care. 2008;14(5):297–306. [PubMed] [Google Scholar]

Ries LAG, Young JL Jr, Keel GE, et al., editors. National Cancer Institute, SEER Program, NIH Pub. No.07–6215. Bethesda, MD: 2007. [Accessed on May 2, 2019]. SEER survival monograph: Cancer survival among adults: U. SEER Program, 1988–2001

Sampson, K.L., 2002. Value added records management: protecting corporate assets, reducing business risks, 2nd edn., Quorum Books, New York.

Sarens, G. & De Beelde, I., 2006, ‘Internal auditors’ perception about their role in risk management: A comparison between US and Belgian companies’, Managerial Auditing Journal 21(1), 63–80. http://dx.doi.org/10.1108/02686900610634766

Yin, R. K. (2005). Case study research: Design and methods. Thousand Oaks, CA: SAGE Publications.

Zikmund, W.G. (2003), “Business Research Method”, 7th edn., Cengage Learning, India

Appendices

MAKERERE UNIVERSITY

26 AN INTERVIEW SCHEDULETO BE USED AT MENGO HOPITAL REGISTRY

Dear respondent My name is NAMATAKA AFUA a student at Makerere University, East African School of Library and information Science [EASLIS] pursuing my Bachelor’s Degree of Records and Archives Management, am undertaking research about Assessment of Records Risks at Mengo Hospital In Kampala). I have found you as a resourceful person and I therefore request to conduct an interview with you NOTE The responses given will be treated with much confidentiality.

SECTION A: DEMOGRAPHIC INFORMATION

What is you gender?

What is your age? What is your Title/ Position at Mengo Hospital ? What is your academic Qualification? For how long have you worked at Mengo Hospital ? Section A: Different types of hospital records kept at Mengo Hospital in Kampala. 1. What are the types of records kept at Mengo Hospital ?

2. What record formats do you keep at the school? 3. what is the state of the health registry?.

Section B: Risks faced by records kept in Mengo Hospital in Kampala.

3. Do you have a standard filing system followed while filing different records at Mengo Hospital ?

4. What methods of filing do you use in the registry?

5. What are the storage equipments used to store different records in the registry? 6. What safety measures are in place in the storage areas of records. 7. How often do you record risk?

27 8. What are the challenges faced in managing records storage at Mengo Hospital ?

9. Are there any recommendations to give for effective of Records storage and retrieval Mengo Hospital 10. What are the consequences of poor record keeping?

Section C: Challenges experienced in managing risks facing records at Mengo Hospital in Kampala. 1. Do you use records retrieval tools at Mengo Hospital ? 2. Why is record keeping in the risk management process so important? 3. What Retrieval Method do you use at Mengo Hospital ? 4. What is the records retrieval Procedure at Mengo Hospital Who is responsible for retrieving different types of records at Mengo Hospital . 5. What are the challenges faced in managing records Retrieval at Mengo Hospital ? 6. Are there any recommendations to give for effective of Records storage and retrieval Mengo Hospital? Section D: Possible solutions to challenges in managing risks facing records at Mengo Hospital in Kampala. 1. How do you Review document retention schedules of the records 2. How often Do you Properly dispose of expired files 3. How often do you Reduce clutter for an aim of regaining space where health records are kept. 4. How is your records management program monitored? 5. How often do you protect your records from damage?

28 APPENDIX 2: OBSERVATION GUIDE SECTION A 1. Types of records stored and retrieved at Mengo Hospital

2. Records Storage equipment at Mengo Hospital

3. Records retrieval tools used at Mengo Hospital .

4. Retrieval mechanisms at Mengo Hospital

5. Who is responsible for Records retrieval at Mengo Hospital ?

6. Time taken when retrieving records.

7. Cleanliness of records storage areas.

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