A quantitative descriptive approach was used to explore and document the evaluation of service delivery in public sector provincial hospitals by patients in selected wards in three public hospitals in KZN. The descriptive research design is appropriate for this study, as little research has been conducted on this phenomenon; description will allow for the identification of shortfalls in service delivery in the public sector hospitals (Burns & Grove, 2005:747).
1.6.1 POPULATION AND SAMPLING
Focus group interviews were conducted on different days in the three targeted hospitals.
These interviews were held with patients, doctors and nurses. The accessible population comprised more than 70 patients, 10 doctors and 30 nurses in each hospital. With a sample of 77 patients from Addington Hospital and 74 from King Edward VIII Hospital in the eThekwini Metropolitan Municipality; and 71 from Stanger Hospital in the Ilembe region, the total number of respondents who were patients was 222. Doctors and nurses were chosen as a sample because all public servants are required to care for their customers in line with Batho Pele in order to achieve the government mandate of excellent service delivery;
including them will enable an evaluation of whether or not these principles are being upheld.
The research sample was chosen by means of stratified random sampling. Non-probability sampling was used which means that not every element of the population has an opportunity to be included in the sample.
The 222 patients were selected from long-stay wards, namely the medical, surgical and orthopaedic wards in all three hospitals. It was assumed that patients who stay for at least three days would be able to share more information on the service received as opposed to patients who were admitted for a short-term stay. The inclusion criteria stated that patients should be adult male or female patients from the designated wards who are between 18 and 75 years old, fully mentally orientated, from all race groups, and skilled in reading and writing.
10 1.6.2 RESEARCH INSTRUMENTS
A structured interview schedule was developed, based on different policy documents (Batho Pele) and the literature review. The instrument included open and closed-ended questions and consisted of five sections, namely, the acuity level of the patient; demographic information;
service expectations; the Patients‟RightsCharter and perception-related questions.
1.6.3 PRIMARY DATA
Questionnaires
Questionnaires were administered to 222 patients at three hospitals in iLembe region and eThekwini Metropolitan Municipality in KZN that serve urban, rural and semirural communities, to obtain the required responses regarding service delivery in the two regions.
These questionnaires were designed to provide information relevant to the aims and objectives of this investigation noted earlier.
The questionnaires were pre-tested with 10 respondents to determine whether or not the respondents understood the instructions and questions and to monitor the amount of time needed by the researcher and the research assistant to complete the interviews and to capture the answers on the schedule.
1.6.4 SECONDARY DATA
The following documents were examined:
Department of Health hospitals‟ management reports;
Journal articles;
Conference papers;
Policy documents; and
Public service policy documents.
1.6.5 DATA COLLECTION
Data were collected in three wards in each hospital in consultation with the Unit Managers.
Respondents who met the inclusion criteria were identified with the assistance of the Unit
11
Managers and those respondents were approached personally. Respondents who agreed to participate signed an informed consent form before the interview was conducted by the researcher and research assistant and the responses were recorded. The process was repeated until the total sample size of 222 was reached in the three hospitals.
The return rate for the 222 questionnaires was 95%. An attempt was made to select categories of patients randomly; a high degree of illiteracy among patients was expected to make such an effort difficult. Where patients were unable to complete the questionnaire, substitute respondents were identified and solicited in order to overcome the problem of no or inaccurate responses which might have raised questions of validity.
1.6.6 DATA ANALYSIS
The SPSS 16 package or the MS Excel programme was used to capture and analyse the data and findings, which are presented in tables and graphs in Chapter Five. Responses to the open-ended questions were grouped, analysed and described.
1.6.7 SURVEY TOOL
A five-point Likert scale was used to test the expectations of the patients and theperceived performance of the hospitals as indicated by a number of predetermined items that formed the questionnaires. This measurement scale consisted of the following items:
(1) Very high expectations/ Excellent performance (2) High expectations/ Very Good performance (3) Neutral
(4) Low expectations
(5) Very low expectations/ Poor performance.
The scale used designates that the mean (0) closer to (1) may be regarded as a more desirable situation, contrasting with a mean closer to five (5), which would indicate the least desirable situation. A rank method was also used to compare significant findings. The empirical approach followed in this study was based on a model designed by Kotler and Andreasen (1996).
12 1.7 RELIABILITY AND VALIDITY
According to Brink, Van der Walt and Van Rensburg (2006), validity refers to the ability of an instrument to measure exactly what it is supposed to measure and nothing else. Accessible language was used in the interview schedule to ensure that respondents understood the questions. Face validity refers to whether the instrument is measuring the content desired for the study or not (Burns & Grove, 2005:737). This will enhance the concepts relevant to service delivery in terms of the representativeness of the concepts in measuring the variable being measured (Brink et al., 2006:160; Polit& Beck, 2004:423). In this study content validity was achieved by all aspects relevant to public sector hospital service delivery in the questions. An analysis was carried out to test the validity and the reliability of the questionnaire. This yielded on an overall Conbach AlphaCoefficient of 0.0, indicating a high validity measurement in terms of the scale questions expectations and perceived performance, and hence it may be considered reliable.
In order to determine whether or not significant differences existed between the experiences and expectations of patients in the three hospitals, an Analysis of Variance (ANOVA) was performed on the questions. This measures the expectations and perceived performance of the various service quality items measured and included in the questionnaire.