CHAPTER 8:DISCUSSION FROM THE QUALITATIVE STUDY
8.2 Discussion of Themes
8.2.2 Theme 2: Patient Experience Policies
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into consideration the various domains that influence the experience of care, but is rather designed to evaluate patient satisfaction which has been shown to be outdated and less valuable when the issue of quality is raised (National Institute for Health and Clinical Excellence, 2012:10). Based on the Picker Principles and the IOM Framework there is evidence to suggest that there are other domains that need to be included when evaluating the experience of the patient (Picker Principles,2014; IOM Framework,2001).
The questionnaire presently in use caters for just six domains that influence patient satisfaction and is lacking in this regard. The domains are as follows:
• Attitudes of staff;
• Waiting Times;
• Cleanliness of the facility;
• Availability of basic medicines/ supplies;
• Safety and security of the facility; and
• Quality of Care.
Questionnaires are given to patients as part of the service delivery evaluation process but the relevance of the questions included in the questionnaire is also questionable. The importance of the right questions being asked so that the right information can be obtained to aid in the QI process is key, to quality care. The present questionnaire in use is lacking in this regard which creates a gap in terms of obtaining the right information. Hence the need for this study has been further highlighted. Through the study, the domains of patient experience as deemed relevant by both the NSM and the patient is determined. Therefore patient experience is identified as a valuable measure for quality and the QI process within the healthcare environment. There is a definite agreement between the respondents that support the drive for QI and positive reform.
The literature presented also supports the need for incorporating patient experience in the drive for QI and positive reform.
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experience of care. The respondents agree on the use of the Ideal Clinic Policy and the Clinic Committee Policy to support service delivery at a level deemed appropriate for quality health care. Whilst the above policies are not specifically designed for the patient experience of care, respondents have identified the policies as the nearest to patient experience.
The Ideal Clinic Policy has been well identified by the respondents as the policy that is implemented within healthcare facilities in order to support good service delivery as per the Operation Phakisa initiative mandated by the former President Jacob Zuma. Respondents clearly stated that the Ideal Clinic policy is not as effective as was envisioned, due to resource constraints. The issue of resource constraints is a problem that is constantly raised and may well continue to pose as a potential problem in the near future especially in light of the NHI implementation (Jobson,2015:22). It is evident from the preceding statement, that merely developing initiatives that mandate good service delivery is insufficient to create the positive experience of care that is sorely needed in SA. One needs to bear in mind that the aim of such initiatives is directed towards providing a service to the masses rather than one unique patient.
Another point of concern that surfaced from the interviews remains, where the NSM does not subscribe to one policy and may favour the use of policies that are outdated or not in keeping with the current objectives of the NDoH. This lends itself to inconsistencies in the service delivery and the quality of care. Therefore the drive towards standardised service delivery with a positive patient experience of care across all nine provinces is clearly unmet. Evidently, the need for a patient experience policy of care is needed as a separate initiative to achieve this strategic objective as there are contrasting viewpoints on the effectiveness of the Ideal Clinic Policy as reflected by the respondents feedback.
Apart from the Ideal Clinic Policy, the respondents agreed on the use of the Clinic Committee Policy which ultimately serves as a vehicle to empower the community. This is in keeping with the Patients’ Rights Charter (No.1) which is as follows:
“The purpose and expected outcome of the Patients Rights’ Charter and complaints procedure is to deal effectively with complaints and rectify service delivery problems and so improve the quality of care, raise awareness of rights and responsibilities, raise expectations and empowerment of users, change attitudes by strengthening the relationship between providers
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and users, improve the use of services and develop a mechanism for enforcing and measuring the quality of health services.” (DoH,2016:28)
The Clinic Committee Policy seeks to actively engage and empower the community by providing a forum whereby members of the community can provide feedback on the experiences of patients that have received care at the same clinic. It also provides the community with an opportunity to participate in shared decision making processes regarding proposed changes at the clinic. Through this committee members of the public are afforded an opportunity to become involved in the decision making process which supports the Batho Pele Principle of Consultation whereby:
“Citizens should be consulted about the level and quality of the public services they receive and, wherever possible, should be given a choice about the services that are offered”. (DoH,2016:29) There is evidence that the respondents do not value the clinic committee policy because they are of the opinion that the general public are unable to productively contribute to the engagement process and as such the policy needs revision. Respondents indicated that due to the lack of training for these committees the meetings tend to be non-productive and do not support the objectives for which the policy was implemented. These challenges have contributed to a less than successful committee. This presents an opportunity for further research as there is a definite need to include the community in the governance of the clinics.
There is no Patient Experience Policy developed for SA. As such there is limited understanding of how to improve the patient experience to drive QI to support positive reform. Respondents also share conflicting approaches on the policies that they feel are relevant in the management of the clinic. This also expresses the inconsistencies that are prevalent within management teams and how the quality of service delivery can vary from one clinic to the next due to the lack of standardization. There is therefore an evident need for a Patient Experience Policy that promotes a consistent positive patient experience within public facilities in SA. This policy will also ensure that there is standardization in terms of the experience that a patient should have from one clinic to the next. The respondents are also in agreement that there needs to be a change in focus, which emphasises the role of a National Patient Experience Policy to drive QI and promote positive reform in the PHS in SA.
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