PART 1: LITERATURE REVIEW
3.3 SERVICE DELIVERY IN PUBLIC AND PROVINCIAL HOSPITALS
Health care organizations and hospitals have an important role to play in this growing service industry. They are the only organizations that directly provide human health care. Because of their importance, hospitals should deliver a good quality, „zero defect‟ service to their customers. Numerous and varied service measures and indicators exist for measuring the quality of health care, of which one of the most important indicators is patient (customer) satisfaction. Customer satisfaction drives future profitability and is a vital measure of performance for firms, industries and national economies (Anderson &Fornell, 1994).
Satisfying patients can save hospitals money by reducing the amount of time spent on resolving patients‟ complaints (Press et al., 1991).The quality of health care can be improved by eliciting patient preferences and customizing care, to meet the needs of the patient (Macarioet al., 1999). The patient‟s voice must begin to play a greater role in the design of health care service delivery processes. In addition, the emerging health care literature suggests that patient satisfaction is a dominant concern that is intertwined with strategic decisions in the health service (Andaleeb, 2001). Research has shown that the services provided by a company or institution can be measured by determining the discrepancy between what the customer wants (customer expectations) and how the customer experiences
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the service (customer perceptions). Customer expectations are formed by word-of-mouth communication, personal needs, past experience and what and how the staff communicates to the customer (Zeithamlet al., 1990).
The citizens of SA deserves efficient and effective delivery of services and this demand has increased in recent years as the country has witnessed service delivery protests. In line with the government‟s key priorities in achieving service delivery, the government published the White Paper on Transforming Public Service Delivery (WPTPSD) in 1997. This formed part of the policy document, commonly termed „Batho Pele‟ (“People First” in Sotho), that reflects the customer-centric nature of SA‟s service delivery reforms and contained eight guiding principles for public sector institutions in their efforts to deliver services efficiently and effectively.
Public health care provision must promote innovation in medical facilities, cost containment and the promotion of domestic medical technology. According to Bovens, Hart and Peters, (2001), South African health care institutions and government are bound together in a symbiotic relationship within the health sector that includes health care costs, institutional arrangements consisting of professional medical associations, medical aid schemes, hospital and clinics and improvements in public sector service delivery in government hospitals (Antonsen and Greve, 1999; Bovens, Hart et al., 2001).
3.3.1 Organization of Work and Outcomes in Healthcare
The study of the effect of patient-centred care on patients and employees draws on a growing body of literature on the organization of work in healthcare. Although the direct assessment of work practices and performance in healthcare follows similar inquiries in other industries, researchers have examined the relationship between a variety of work arrangements and patient care indicators. For example, researchers have studied the relationship between human resources management (HRM) practices, teamwork and relational coordination, and the quality of patient care (e.g., see Gittellet al., 2010; Gittelet al., 2008; West et al., 2006;
Preuss, 2003; West et al., 2002; Borrillet al., 2000; Aiken et al., 1994). West et al.
(2002:1305) provided one of the first comprehensive analyses of the link between work practice and healthcare-related performance outcomes.
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3.3.2 The Effects of Patient-Centred Care on Quality of Care and Patient Satisfaction The overarching goal of the patient-centred care model is to provide care that is the most conducive to patients‟ preferences, needs, and desires (Robinson et al., 2008; Wolf et al., 2008; Davis et al., 2005). This approach departs from the physician- or institution-centred model, which places almost all the power and authority regarding patient care in the hands of the treating professionals, primarily the physicians, and the organizations in which treatment is provided (e.g., see Robinson et al., 2008; Wolf et al., 2008; Bergeson and Dean 2006;
Epstein et al., 2005; Flachet al., 2004).
Patient-centred care is founded on the nation that information should be shared between physicians and patients and, more importantly, that decision-making is based on patient involvement so that viable treatment or medication options take into account patient preferences and perspectives (Davis et al., 2005; Corrigan et al., 2001). The model also entails a restructuring of work-place practices in order to facilitate greater levels of interaction between frontline staff- primarily nurses and nurse aides- and clinicians. The primary mechanism used to deliver patient-centred care is the organization of work around interdisciplinary teams (Wolf et al., 2008; Lemieux-Charles and McGuire, 2006).
The literature has identified five dimensions of the patient-centred delivery care model: 1).
Access to care; 2). Patient engagement in care or patient preferences; 3). Patient education through information systems; 4). Coordination of care across hospital staff; and 5). Emotional support for patients (Audetet al., 2006; Bergeson and Dean 2006; Davis et al.,2004; Fiachet al., 2004; for similar dimensions, see Corrigan et al., 2001:49).
Despite the increased use of patient-centred care methods, empirical research has not kept pace with them, and the evidence regarding their effectiveness is limited (Charmel and Frampton 2008; Wolf et al., 2008). What evidence there is supports a positive relationship between the adoption of the model and improved care outcomes (Stewart et al., 2000; Rathert and May 2007; see Wolf et al., 2008).
3.3.3 The Role of Employee Turnover
One of the ways in which patient-centred care can have an indirect effect on quality of care is through its emphasis on employees‟ working conditions (Rathert and May 2007;
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Rathertetal.,2009). Patient-centred care places the patient at the centre of process. Huselid (1995) provided strong empirical support of the mediating role of turnover in the relationship between high performance work systems and financial performance. This evidence suggests that the effects of dramatic workplace innovation were delivered, in part, through decreasing employee turnover. In a study of work practice in the telecommunications industry, Batt (2002) also found support for the argument that lower turnover rates arise from the effects of work restructuring on organizational outcomes.
Although researchers believe that turnover plays a similar role in the indirect relationship between patient-centred care and medical errors and patient satisfaction, the theoretical foundation for this relationship cannot rest on the simple cost of turnover argument, since the reduction of medical errors and the increase in patient satisfaction are not as responsive to turnover cost reduction as sales and financial performance might be.
3.4 PROBLEMS EXPERIENCED BY PROVINCIAL HOSPITALS IN SOUTH