A quality framework for radiographic service delivery in regional hospitals in the eThekwini District, KwaZulu-Natal

Abstract

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 services