Faculty of Health Sciences
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Item A quality framework for radiographic service delivery in regional hospitals in the eThekwini District, KwaZulu-Natal(2021-12-01) Gam, Nkululeko Phalson; Sibiya, M. N.Background Generally, diagnostic imaging services in Africa are challenged by many factors including lack of equipment and personnel, quality assurance and quality control measures, quality management and monitoring and evaluation frameworks. These challenges are further compounded by a lack of understanding of the factors responsible for poor imaging service delivery and the mitigation strategies. Furthermore, there is paucity of context specific research on diagnostic imaging service delivery in African counties including South Africa. A practice framework was deemed necessary to guide quality of services in diagnostic imaging services in regional hospitals within the eThekwini district of KwaZulu-Natal. Aim The aim of this study was to explore the factors affecting quality in diagnostic imaging departments of the regional hospitals in the eThekwini District of KwaZuluNatal in order to develop a framework that can be used to improve quality. Method A convergent parallel mixed methods design was employed to explore factors affecting quality in medical imaging departments in regional hospitals in the eThekwini District of KwaZulu-Natal in South Africa. In addition, a stratified random sampling strategy was used for quantitative data collection whilst a purposive sampling strategy was used for the qualitative strand. The quantitative strand of the study used a questionnaire administered to patients to measure their levels of satisfaction with service delivery rendered by the diagnostic imaging departments. Data in the quantitative strand were analysed using Version 26.0 of the SPSS and tests such one sample t-test, univariate analysis, Analysis of Variance (ANOVA), Levene's Test for Equality of Variances, Spearman’s rho and independent sample t-tests were used. Furthermore, the quantitative strand consisted of an image reject analysis to investigate rates at which images were rejected and reasons for rejection. The qualitative strand involved in-depth one-on-one interviews with doctors, radiographers, Radiography Managers and hospital wide Quality Assurance Managers. Questions regarding quality of service delivery, possible areas and strategies to improve quality were posed to participants. Responses were recorded through notes made by the primary researcher together with voice recordings. Content analysis was used to analyse qualitative data. Findings The construct that emerged from analysis of results from the patient satisfaction survey were cleanliness, staff, comfort, communication and booking times. There was significant agreement that all the aspects investigated were acceptable to the patients (M>3.5, SD>7). However, although patients were satisfied with comfort in the imaging departments in general, they were dissatisfied with the comfort of the waiting area. Reject rate analysis was conducted in three regional hospitals and the reject rates were different for each hospital (Hospital A = 12.67%, Hospital B = 10.67% and Hospital D = 4%). The average reject rate for all the hospitals was higher than the WHO benchmark of 10%. Twenty eight participants including nine doctors, 13 radiographers, three QA Managers and three Radiography Managers were interviewed across the four regional hospitals during the qualitative strand. Four themes emerged following analysis of qualitative data and these included definition of quality of imaging services by the participants, inadequacy of clinical provisions, leadership and management of medical imaging departments as well as facilities and resources. Issues expressed by the participants regarding inadequacy of clinical provisions included patient referral protocols, communication, image quality and radiology reports. Furthermore, regarding leadership and management participants expressed opinions on roles and responsibilities, accountability, monitoring of working hours and National Core Standards. Lastly, facilities resources included issues such as inadequacy of imaging equipment, inadequacy of staffing, and inservice training. Conclusion The findings reported in the current thesis and the resulting framework are highly relevant to policy and practice particularly in the eThekwini District. The involvement of patients and healthcare professionals in identifying challenges and solutions is a major strength of the current research. The current study has also uncovered the deficiencies in diagnostic imaging services in the eThekwini district around radiographers’ knowledge of the National Core Standards. Finally, if implemented, the framework developed can be used to enhance equipment testing and maintenance policies and improve staff and patient satisfaction as well as staff development. These should increase quality in diagnostic imaging servicesItem Occupational stressors in diagnostic radiographers working in public health facilities in the eThekwini district of KwaZulu-Natal(2015-06) Gam, Nkululeko Phalson; Puckree, Threethambal; Naidoo, SubhadranaleneIntroduction Occupational stress has negative effects on both the organisation and individuals employed by the organisation. In the organisation it can result in high levels of absenteeism, reduced productivity and compromised levels of patient care. Furthermore individuals affected by stress may suffer from raised levels of tension, mental fatigue, insufficient sleep, anxiety, and anger. Interventions to prevent both organisational and individual effects of occupational stress may only be implemented once stressors in an occupa-tional group have been identified hence the need for the current study. Purpose The purpose of the study was to investigate occupational stress in diagnostic radiographers working in public healthcare institutions in the eThekwini District of KwaZulu-Natal using a quantitative research approach. Method A cross sectional survey using a validated questionnaire with some open and closed-ended questions was utilised. Radiographers working in public hospitals in the eThekwini District of KwaZulu-Natal were invited to parti-cipate in the study. Respondents were asked to answer 60 closed ended and four open ended questions. Open ended questions afforded the respondents an opportunity to express their opinions. Quantitative data was analysed using the Statistical Package for Social Sciences (SPSS) version 21.0. Inferential statistics included the use of reliability coefficients, correlations and chi square test at a 95% confidence level. Open ended questions were analysed using thematic analysis. Results One hundred and one questionnaires were administered and forty three were returned which resulted in a 43% response rate. The mean age of respondents was 31.7 years and 88.4% were females. The majority (67.4%) were in possession of a National Diploma in Radiography. Seventy two percent worked in regional hospitals. The majority (41.8%) were employed as chief radiographers. Most radiographers affected by stressors were those working in regional hospitals. The three main sources of stress in order of response were workload, faulty equipment and staff shortages. In addition, bullying, long and strenuous shifts as well as training of students were also found to be stressors. Physical exercises, counselling and wellness days were used to reduce stress whilst employment of more staff, attending to faulty equipment, team building, reducing workload, and improved working conditions were suggested as methods of reducing stress amongst radiographers. Conclusion Radiographers working in the eThekwini District were stressed by a number of factors in their work places. Radiographers suggested ways that can be employed to reduce stress in their departments. A close cooperation between radiographers; radiography supervisors; institutional, district and provincial managers is recommended in order to address the challenges faced by radiographers.