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Challenges in Quality Care Delivery in Tertiary Health Facilities in North-Central Nigeria

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Challenges in Quality Care Delivery in Tertiary Health Facilities in North-Central Nigeria Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Challenges in Quality Care Delivery in Tertiary Health Facilities in North-Central Nigeria Thomas Terlumun Torkula Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Medicine and Health Sciences Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Thomas Terlumun Torkula has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Warren McDonald, Committee Chairperson, Health Services Faculty Dr. David Duncan, Committee Member, Health Services Faculty Dr. Tina Cunningham, University Reviewer, Health Services Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Challenges in Quality Care Delivery in Tertiary Health Facilities in North-Central Nigeria by Thomas Terlumun Torkula MPH, University of Glasgow, 2010 MBBS, University of Jos, 2006 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University January 2020 Abstract The increasing mortality rates in tertiary healthcare hospitals in developing countries, such as Nigeria, have given growing concerns about the quality of healthcare services delivered in these hospitals. The purpose of this study was to examine the challenges of quality healthcare delivery in tertiary healthcare hospitals in North Central Nigeria, using a quantitative method. A total of 255 respondents, comprising medical, paramedical staff, and patients, from 3 tertiary hospitals were included in the study. The Healthcare Quality Assessment Questionnaire was used to collect data. Chi-square and analysis of variance were used to test the hypotheses. Results of the study showed that the major challenges confronting the delivery of quality healthcare services in the studied health facilities were the inadequate but fairly good condition of medical equipment, inadequate staff training, fairly good salaries, delayed diagnostics and treatment procedures and long wait times of patients. Also, the chi-square statistics indicated a significant association between medical facilities and the quality of healthcare services of tertiary hospitals (p = 0.034). The analysis of variance results indicated no significant difference in the challenges confronting tertiary healthcare hospitals with the delivery of quality healthcare services in the study area. The study shall affect social change by gathering information needed to formulate public policies on quality improvements in tertiary health facilities. It is therefore recommended that the government of Nigeria and hospital boards take steps to improve on healthcare service delivery in the tertiary hospitals. Challenges in Quality Care Delivery in Tertiary Health Facilities in North-Central Nigeria By Thomas Terlumun Torkula MPH, University of Glasgow, 2010 MBBS, University of Jos, 2006 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University January 2020 Dedication This dissertation is dedicated to the Almighty God whose grace saw me through the research work in the midst of daunting challenges. His grace over my life prevailed over daunting academic, social, financial and emotional challenges associated with the program that almost overwhelmed me. You alone deserve the glory, adoration and honor. Acknowledgments I hereby acknowledge and appreciate my Dissertation Chairman, Professor Warren McDonald who painstakingly guided and gave purposeful direction throughout the program; I wish there was a better way to show my appreciation. I am grateful to my entire dissertation team for their steadfastness and constructive reviews in the course of my studies, may God bless you all. I also appreciate in earnest my late father, Dr Torkula Alfred Akawe who prepared me mentally and emotionally for the academic journey; and whose demise remain a void nearly impossible to fill. My sincere appreciation also goes to my mother Chief Mrs Torkula Helen Onmata, who took the place of my father in my life. Mummy, I remain eternally grateful to you. To my wife Mrs Torkula Yenniag Vanessa, I shall not forget your kind words of encouragement and emotional support to the success of the program. Lastly, I appreciate my friends especially Dr. Godwin Akaayar Songu for all your support and encouragement; God bless you all. Table of Contents List of Tables ......................................................................................................................v List of Figures ................................................................................................................. vii Chapter 1: Introduction to the Study .............................................................................1 Introduction .................................................................................................................1 Background of the Study ............................................................................................2 Statement of the Research Problem .........................................................................4 Purpose of the Study ...................................................................................................5 Research Questions .....................................................................................................6 Research Objectives ....................................................................................................6 Research Hypothesis ..................................................................................................7 Hypothesis 1 ......................................................................................................... 7 Hypothesis 2 ......................................................................................................... 7 Hypothesis 3 ......................................................................................................... 7 Hypothesis 4 ......................................................................................................... 8 Theoretical Framework ..............................................................................................8 Nature of the Study ...................................................................................................11 Assumptions ..............................................................................................................12 Scope and Delimitations ..........................................................................................13 Limitations .................................................................................................................14 Significance of the Study ..........................................................................................15 Significance to Theory ....................................................................................... 15 i Significance to Practice ..................................................................................... 15 Significance to Social Change ........................................................................... 15 Summary and Transition .........................................................................................15 Chapter 2: Literature Review ........................................................................................17 Introduction ...............................................................................................................17 Literature Search Strategy .......................................................................................17 Theoretical Framework ............................................................................................18 Literature Review.........................................................................................................21 The Effects of Medical Facilities on the Quality of Healthcare Services Delivery in Tertiary Healthcare Hospitals .......................... 21 The Impacts of Organizational Factors on Quality of Healthcare Services .................................................................................................... 27 Variation in Medical Facility and Organizational Challenges of Quality Healthcare Service delivery among Tertiary Healthcare Hospitals ............................................................................. 37 Patient’s Perception of the Quality of Healthcare Services in Tertiary Hospitals .................................................................................. 40 Summary of Reviewed Literature ...........................................................................48 Chapter 3: Research Methodology................................................................................52 Introduction ...............................................................................................................52 Research Design and Rationale...............................................................................52
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