Project Title Reduction of Kiswa Hciii New Opd Attendants' Waiting Time in Nakawa Division Kampala District
Total Page：16
File Type：pdf, Size：1020Kb
PROJECT TITLE REDUCTION OF KISWA HCIII NEW OPD ATTENDANTS’ WAITING TIME IN NAKAWA DIVISION KAMPALA DISTRICT FELLOWS: JEROME MPAATA AJUNA ALBERT Medicines and Health Service Delivery Monitoring Unit (MHSDMU) Plot 21 Naguru Hill Drive P.O Box 25497 KampalaTel: 0414‐288442, 0414‐288445, 0800100447 (Toll free) 1 Table of Contents 1.0 Introduction ......................................................................................................................... 7 2.0 Literature review .................................................................................................................8 3.0 Problem statement............................................................................................................. 11 4.0 Objectives...........................................................................................................................12 5.0 Methodology......................................................................................................................13 5.1 Brainstorming ..................................................................................................................13 5.2 Motivating.......................................................................................................................13 5.3 Theme selection..............................................................................................................14 5.4 Fishbone Analysis............................................................................................................16 5.5 Countermeasure matrix ..................................................................................................16 6.0 Baseline survey...................................................................................................................18 7.0 Project Output……………………………………………………………………………….15 7.1 Challenges that led to long waiting before CQI intervention……………………………1.5 7.2 CQI interventions that led helped to reduce patients waiting time……………………..16 7.3 Comparison of current and previous patients waiting time………………………….…16 7.4 Graph showing current and previous patients waiting time………………………….…17 8.0 Lessons learnt …………………………………………………………………………….…17 9.0 Challenges faced ………………………………………………………………………….…18 9.1 How challenges were resolved………………………………………………………….…22 10.0 References......................................................................................................... ………...23 2 Declaration We, Jerome MpaataOwagage and Albert Ajuna, do hereby declare that this endofproject Entitled:REDUCTION OF KISWA HCIII NEW OPD ATTENDANTS WAITING TIME IN NAKAWA DIVISION KAMPALA DISTRICT has been prepared and submitted in fulfillment of the requirements of theMediumtermHIV/AIDS Fellowship Program at Makerere University Schoolof Public Health, and has not been submitted for any academic or nonacademicqualifications. Signed………………………………………………….Date………………… …………………… Jerome MpaataOwagage, Medium –term Fellow Signed………………………………………………….Date………………… & Albert Ajuna, Medium –term Fellow Signed………………………………………………….Date………………… …………………… Dr. Diana Atwine – Institutional Supervisor Signed………………………………………………….Date………………… …………………… Dr. Ibrahim Kirunda Academic Supervisor 3 Acknowledgement Special thanks go to, our supervisors Dr. I brahimKirunda and Dr. Diana Atwine for their positive criticism and guidance. We also wish to appreciate the entire CQI team at Kiswa HC III and staff for their commitment to the project. We owe a lot to Mak‐SPH for availing us the opportunity to participate in the medium term fellowship program. We cannot forget the entire staff of MHSDMU and our fellow Fellows who have been a source of inspiration. 4 Acronyms MHSDMU‐ Medicines and health Service Delivery Monitoring Unit KCCA‐ Kampala City Council Authority MakSPH – Makerere University School of Public Health CDC – Centers for Diseases Control and Prevention 5 Operational definitions For purposes of this intervention, the following definitions were adopted. Waiting time‐ is the time spent by the client from arrival at the site up to exit after receiving treatment. Quality improvement – Applying appropriate methods to close the gap between current and expected level of quality/performance as defined by standards. 6 1.0 Introduction The Medicines and Health Service Delivery Monitoring Unit (MHSDMU) was set up in October 2009 as a strategic response to existing challenges to service delivery in the health sector. MHSDMU is an independent unit under the President’s Office whose broad remit is to improve health services for the population by monitoring the management of essential medicines and service delivery. MHSDMU’s Mission is to monitor, support and sustain a national health care system that is efficient in operation; which provides affordable, high quality healthcare at all times and is cognizant of the right to health and dignity of the people of Uganda. Kiswa Health center is a government unit in Nakawa division under Kampala Capital City Authority (KCCA). The facility is currently the only functional unit in the division but is yet to be relieved by Naguru hospital which was originally a health center IV but was demolished two years ago to construct a government hospital. Kiswa has a catchment population of 333,840 people and serves all the suburbs in Nakawa division. The CQI fellows together with MHSDMU agreed to do a CQI project at this health center because of its patients load, and it was intended to improve service delivery at the unit so as to avoid patients from Nakawa division referring themselves to Mulago hospital which is already overwhelmed by patients. The amount of time a patient spends at a health facility has often been used as a measure of patient satisfaction with the service being provided. A patient’s experience of waiting can radically influence his/her perceptions of service quality (Afolabi&Erhun, 2003). The other implications of long waiting time leads to unnecessary delays in assessment leading to worsening conditions and death In a study carried out at the University of Southern California, Los Angeles, USA, it was shown that the overall satisfaction of patients with medical services is closely related to their satisfaction with waiting time (Trop J Pharm Res, June 2003). It was against the above introduction that MHSDMU proposed to implement a continuous quality improvement project at Kiswa Health Centre III to reduce patients waiting time at the facility as a way of improving health service delivery. The project ran from December 2011 to August 2012. 7 2.0 Literature review 2.1 Need for short waiting time to OPD clients The health facility system, but almost invariably, a high percentage of these patients arrive and leave the hospital at various times. The amount of time a patient waits to be seen is one factor which affects the utilization of health care services (Fernandes et al., 1994; dos Santos et al., 1994) and patients perceive long waiting times as barriers to actually obtaining services (Kurata et al., 1992). In a competitively managed health care environment, patient waiting time play an increasingly important role in a clinic’s ability to attract new business. It is difficult to sell services if individuals are dissatisfied with waiting time which is the length of time from when the patient entered the waiting room or the consulting room to the time the patient actually left the hospital (Mackey and Cole, 1997). Additionally, waiting time becomes a factor in retaining current users of the services. Patient satisfaction has Healthcare systems throughout the world face long and increasing wait times for medical services (Willcox et al. 2007; Siciliani and Hurst 2004; Hurst and Siciliani 2003; Blendon 2002 ). Sometimes these waits may have little medical impact, but excessive delays may be detrimental to patients' health (CIHR 2007). As a result, there is growing public and patient pressure on political leaders to reduce wait times to acceptable levels of quality of health care; hence, healthcare assessment. Facility performance can be best assessed by measuring the level of patient’s satisfaction. A completely satisfied patient believes that the organization has potential in understanding patient needs and demands related to health care (Net et al., 2007). A study in the United Kingdom concluded that, patient satisfaction is directly correlated with waiting times to see a doctor (Maitra and Chikhani, 1992) while another study found that, because of prolonged waiting times, a substantial number of patients left outpatient departments (Fernandes et al., 1994). A study of this nature is critical to public appreciation of the quality of health care operating environment; hence, this study was aimed at assessing patients’ waiting time and factors affecting waiting in the outpatients’ departments. Data generated from the study could be used by hospital administrators to address gaps in human resources, logistics, infrastructures and other internal procedures towards ensuring an effective health care delivery system. Long wait times for access to certain health care procedures are a concern in the Ugandan health care system. As governments in Uganda struggle to reduce health care wait times, most 8 government institutions are publishing the data on the wait times for specific procedures in their institutions. Wait times for health services arise because • capacity does not match demand, • capacity or demand is not well managed and • There is significant variability over time in the demand