Outpatients’ experiences of quality service delivery at a teaching hospital in Gauteng

Abstract

Quality service delivery to the consumer of health is a legal reality as it is emphasised in the White Paper on the Transformation of Public Service delivery (South Africa, 1997). The guiding philosophy adopted within this framework is that of Batho Pele, which means placing the consumer at the centre of healthcare service delivery. Increasing attention has been paid to hospital processes from a quality perspective. By analogy, outpatient departments can be viewed as industrial plants where technological know-how is transferred to patients through service delivery, which is a cornerstone of a hospital’s business. Outpatients, as consumers of healthcare, draw conclusions about the quality of service delivery based on their experiences of such services. In this vein, an outpatient’s experience of a particular service is an indicator of his/her level of satisfaction with the quality of that service. No South African study can be found in the literature on out-patients’ experiences of quality service delivery. This study’s purpose is to explore and describe outpatients’ experiences of the quality of service delivery at a teaching hospital in Gauteng. A qualitative, explorative, descriptive study that was contextual in nature was conducted to achieve this aim. Focus group interviews were conducted with outpatients who met the selection criteria. Open coding was used to analyse the contents from the transcripts and field notes typed verbatim. Strategies for trustworthiness, namely co-coding, prolonged engagement, triangulation and adequate referencing, were employed to ensure the credibility of the study and research findings. The results reflect themes that were reduced into two main categories, namely positive and negative experiences. The positive experiences reflect outpatients’ experience of their relationship with medical staff and their satisfaction with the quality of medical care. Negative experiences relate predominantly to a lack of service commitments, unethical context, and inter-personal relationship difficulties that render them powerless and dehumanised. Recommendations are made to improve the quality of service delivery at outpatient departments. Opsomming Gehalte dienslewering aan die verbruiker van gesondheidsorg is ‘n wetlike realiteit wat in die Witskrif op die Transformasie van die Openbare Dienste (South Africa, 1997) beklemtoon word. Die rigtinggewende filosofie wat in hierdie raamwerk aangeneem word is die van Batho Pele, wat beteken dat die verbruiker van gesondheidsorg op die voorgrond geplaas word. Vanuit ‘n gehalte perspektief word daar toenemend aandag aan hospitaalprosesse gegee. Analogies, kan ‘n buite-pasiëntdepartement gesien word as ‘n industriële area waar die tegnologiese kennis aan pasiënte oorgedra word deur dienslewering, wat ‘n hoeksteen van die besigheid van ‘n hospitaal is. Buitepasiënte as verbruikers van gesondheidsorg maak gevolgtrekkings oor gehaltedienslewering op die basis van hulle belewenisse van sodanige dienste. In dié opsig, is ‘n pasiënt se belewenis van ‘n bepaalde diens ‘n aanwysing van sy/haar vlak van tevredenheid met die gehalte van daardie diens. Geen Suid-Afrikaanse studie oor buite-pasiënte se belewenisse van gehaltedienslewering kon in die literatuur gevind word nie. Die doelstelling van die studie is om buite-pasiënte se belewenisse van die gehalte van dienslewering by ‘n opleidingshospitaal te verken en te beskryf. ‘n Kwalitatiewe, verkennende, beskrywende studie wat binne ‘n spesifieke konteks plaasvind, is uitgevoer. Fokusgroeponderhoude is gevoer met buite-pasiënte wat aan die seleksie-kriteria voldoen het. Oop-kodering is gebruik om die inhoud van die verbatim getranskribeerde transkripsies en veldnotas te analiseer. Strategieë vir vertrouenswaardigheid, naamlik mede-kodering, verlengde betrokkenheid, kruisvalidasie en voldoende verwysing is toegepas om die geloofwaardigheid van die studie en navorsingsbevin- dinge te verseker. Resultate reflekteer temas wat binne twee hoofkategorieë gereduseer is, naamlik positiewe en negatiewe belewenisse. Positiewe belewenisse reflekteer buite-pasiënte se belewenisse van hulle verhoudings met mediese personeel asook hulle tevredenheid met die gehalte van mediesesorg. Negatiewe belewenisse hou hoofsaaklik verband met ‘n gebrek aan diensleweringverbintenisse, ‘n onetiese konteks, asook interpersoonlike verhoudings-probleme wat hulle magteloos en verontmenslik laat voel. Aanbevelings word gemaak om die gehalte van dienslewering binne buite-pasiënte-afdelings te verbeter.