Department of Health Works on Improving Patient Flow at Hospitals
Long waiting times and queues, coupled with bad staff attitudes form the majority of patient complaints and result in a negative and poor patient experience at Western Cape Government Health facilities.
Western Cape Minister of Health, Theuns Botha, told media at a briefing at Tygerberg Hospital on Thursday, 31 October 2013 that a sample of 23 000 clients surveyed in this financial year showed that our clients are satisfied with the way they are treated by doctors (87%) and nurses (88%).
Seventy-six percent felt they wait a long time before getting their folder and their medication.
“At present our staff at hospitals and emergency centers are buckling under the pressure. Our emergency centers are treating much more patients than they were designed for – in fact the increase is 30% more patients every year. We are looking at a way forward. We are hoping and will be making a representation to National Health and Treasury that the province will be compensated adequately in the equitable share allocation of the budget for the significant increase in population growth of the province.”
“The emergency centres are the entry point into the public hospitals and therefore face the brunt of the pressure. For this reason the health department has in the past few years systematically improved the infrastructure within emergency centres – new Somerset Hospital, Khayelitsha Hospital and the new Mitchells Plain Hospital are cases in point. The emergency centre at Mitchells Plain Hospital will open on 1 November 2013. Emergency medicine specialists have been permanently placed in emergency centres to strengthen clinical governance and quality of care.
“The condition of the patients coming through the doors of the emergency centres are a direct result of the burden of disease within the larger population, which, in itself, is a function of upstream factors such as inter-personal violence, road traffic accidents, risk factors for chronic diseases such as smoking, alcohol abuse, lack of exercise and unhealthy diets, substance abuse, lack of proper housing and overcrowding.
“We also know that the Western Cape is one the largest recipients of in migration from other provinces and beyond. The Census 2011 has confirmed this. Staff also inform us that there is an increasing proportion of foreign-speaking patients attending facilities, although this is not quantified. It is difficult to quantify this challenge owing to the fact that patients provide local addresses. The growth from 2001 to 2011 for the Western Cape is 28,7% and is only second to Gauteng.
“We are working on a plan to improve the patient flow. The participating hospitals include Groote Schuur Hospital, Khayelitsha Hospital, GF Jooste Hospital, Eersteriver Hospital and Worcester Hospital. This project has just started and it’s still too early to measure the impact. Each of the teams is being creative in addressing specific aspects of the emergency centres and related functions.”
Western Cape Government Health will transform the health service through its Healthcare 2030 strategy. Access to patient-centred, quality care is the key vision of Healthcare 2030, with the first objective being to deliver a quality patient experience within a world class public sector health service.
One of the ways used to measure how satisfied clients and patients are with the level of health service is through the complaints and compliments system.
In the 2012/2013 financial year, there were 4 011 complaints reported through standard, facility-based mechanisms and the SMS Hotline. This means that only three out of every 10 000 patients submitted a formal complaint. Ninety-two percent of complaints were reported as being resolved.
Most complaints were about waiting times and staff attitudes. There were 7 498 compliments submitted during this period, almost double the number of complaints.
Since the inception of the Complaints Hotline, 1 728 complaints were registered from 3 August 2012 to 31 August 2013 – 13 months); 1 108 (64%) were due to complaints about waiting times and 486 (28%) were about staff attitudes.
The department also conducts annual satisfaction surveys to determine what clients think of the quality of service they received.
With this in mind, the department developed a comprehensive set of strategies to address waiting times:
- Measure waiting times through electronic methods on a daily basis.
- Reduce waiting times by better management of patient flux through appointment systems, reduction of congestion through alternate sites of medicine delivery, effective triage and queue management, better signage and communication with patients.
- Improve the experience while waiting through electronic noticeboards and announcements.
- Manage the systems that create an enabling environment through extending opening times, where appropriate.
The department has also put in place a change management process to be facilitated by Ernst and Young, which will address organisational culture, including staff attitudes.
Thirty-eight facilities are part of a pilot programme, which will run over 12 months, but eventually all facilities will be part of the programme. This programme will focus on behavioural change to achieve a stronger focus on preventive care, pro-active management of workload and burnout risk, and strengthening frontline staff skills to build trust and empathy.
Legislation that will see the implementation of the Independent Health Complaints Committee is in the process of finalisation. That means that there is now an additional channel for the minister and the head of the department to refer difficult cases for further investigation.