South African Healthcare Sector Research Articles

Financial medicine: A multi-dimensional concept moving towards contextually specific working definitions for use in the South African prehospital setting

IntroductionThe phenomenon that has been described as Financial Medicine has been occurring within the South African Healthcare sector for at least the last decade. Despite the ongoing effect of this phenomenon, there is no organised body of knowledge or formulated working definitions to guide knowledge sharing and theorisation within this research focus area. The practice of Financial Medicine exerts a deleterious effect on the South African prehospital healthcare system, and represents an area in dire need of focused research efforts. Establishing appropriate working definitions and associated taxonomy is an important first step in supporting further research efforts into this aspect of South African prehospital healthcare systems. MethodsA qualitative research methodology following a constructivist grounded theory design was used. Participants voluntarily consented to be enrolled into one-on-one in-depth interviews, and were selected using purposive and theoretical sampling techniques. Data was subjected to validated coding procedures and analysed using the constant comparative analysis approach, analytical diagramming, and supported by researcher theoretical sensitivity. ResultsA working definition for Financial Medicine is provided. Six new terms are introduced, with associated working definitions, namely Financial Medicine Practices, Treatment-based profiteering, Cost-of-care-aversion, Personal-gain-at-patient-expense, Money-racketeering-in-healthcare, and Impoverishing-healthcare-earning. ConclusionThe working definitions and suggested taxonomy presented in this article are the first step in formally conceptualising and theorising the phenomenon of Financial Medicine, in order to support further research and collaboration in this space.

Estimated indirect costs of haemodialysis versus peritoneal dialysis from a patients’ perspective at an Academic Hospital in Pretoria, South Africa

In South Africa (SA), patients with kidney failure can be on either haemodialysis (HD), which is performed by a healthcare professional in a hospital thrice weekly; or peritoneal dialysis (PD), which can performed daily at home. There needs to be more studies within the South African healthcare sector on the cost of kidney failure and especially the indirect costs associated with patients being on dialysis to provide future guidance. This study aimed to determine and compare the indirect costs associated with HD and PD from the patients’ perspective at an Academic Hospital in Pretoria. The study used a cross-sectional prospective quantitative study design. The researcher used face-to-face interviews to collect data and the human capital approach to calculate productivity losses. The study population included all patients over 18 receiving HD or PD for over three months; 54 patients participated (28 on HD and 26 on PD). The study lasted seven months, from September 2020 to March 2021. Haemodialysis patients incurred greater productivity losses per annum ($8127.55) compared to PD (R$3365.34); the difference was statistically significant with a P-value of p < 0.001. More HD (96.4%) patients were unemployed than (76.9%) PD patients.

South African physiotherapists' attitudes to medicine prescription as an extension of practice.

The extension of medicine prescription rights to other healthcare providers was proposed to reduce pharmacotherapeutic service delivery challenges in the South African healthcare sector. The scope of practice of physiotherapists is being reviewed to possibly include prescription rights to promote service delivery. Our study assessed the attitudes of registered South African physiotherapists to the inclusion of prescription rights in their scope of practice, including enablers and challenges, and the drug classes they believe to be most relevant. A cross-sectional descriptive survey of South African registered physiotherapists was completed using an online questionnaire. A total of 359 participants completed the questionnaire, where 88.2% agreed that prescribing rights should be introduced, and 87.64% would want to be trained to prescribe. Participants identified several benefits: improved service delivery (91.3%); reduced healthcare delivery costs (89.8%); decreased need for multiple healthcare practitioner consultations (93.2%). Concerns included: inadequate training (55%); increased workload (18.7%); increased insurance premiums against medical liability claims (46.2%). Drugs of relevance included analgesics (95.6%) and bronchodilators (96.0%), while low preference was placed on drugs unrelated to physiotherapy. Chi-square analysis revealed associations between specific drug classes and fields of expertise. South African physiotherapists agree that prescribing and a limited formulary would benefit their scope of practice; however, educational concerns are evident. Findings support the drive to extend the South African physiotherapy scope of practice, however, investigation will be needed to determine the most appropriate way to capacitate future physiotherapists and current graduates should the extension be approved.

Language and culture in speech-language and hearing professions in South Africa: Re-imagining practice.

South African speech-language and hearing (SLH) professions are facing significant challenges in the provision of clinical services to patients from a context that is culturally and linguistically diverse (CLD) due to historic exclusions in higher education training programmes. Over 20 years postapartheid, little has changed in training, research, as well as clinical service provision in these professions. In line with the Health Professions Council of South Africa’s (HPCSA) SLH Professional Board’s quest to transform SLH curriculum and in adherence to its recently published Guidelines for Practice in a CLD South Africa, in this review article, the authors deliberate on re-imagining practice within the African context. They do this within a known demand versus capacity challenge, as well as an existing clinician versus patients CLD incongruence, where even the clinical educators, a majority of whom are not African, are facing the challenge of an ever more diverse student cohort. The authors systematically deliberate on this in undergraduate clinical curriculum, challenging the professions to interrogate their clinical orientation with respect to African contextual relevance and contextual responsiveness (and responsibility); identifying gaps within clinical training and training platforms; highlighting the influencing factors with regard to the provision of linguistically and culturally appropriate SLH clinical training services and, lastly, making recommendations about what needs to happen. The Afrocentric Batho Pele principles, framed around the concept of ubuntu, which guide clinical intervention within the South African Healthcare sector, frame the deliberations in this article.

The Potential Role of Child Life Specialists in the South African Healthcare Sector

ABSTRACT INTRODUCTION: Child Life Specialists (CLS) are an integral component of paediatric health care services in many developed countries. They assist in bridging the communication between the healthcare team and the child's parents and family. Their primary aim is to minimise the potential trauma the child and their caregivers may experience from being hospitalised. This field of psychosocial support for ill and hospitalised children has been growing over the past six decades with CLS services currently being offered at most North American paediatric hospitals METHODS: By using developmentally appropriate techniques, and equipped with a foundation of medical knowledge, the CLS primarily uses play to relieve anxiety and to educate the child. Play is a meaningful activity that allows the healthy development of the child's emotional, behavioural and social development. The three forms of play that may be utilised by the CLS include therapeutic play, normative play and medical play. Non-pharmacological pain management is another vital area within which the CLS is involved CONCLUSION: The South African Department of Health recognises the importance of addressing the psychosocial welfare of the ill child and they have provided guidelines highlighting the psychosocial needs of children affected and infected with HIV. South Africa has many children accessing health services daily and is suitably positioned to initiate CLS in both public and private healthcare facilities. Improving the healthcare experience for the paediatric healthcare user population is crucial in ensuring their emotional and psychological well-being

Corporate sustainability: a focus on entrepreneurship, collaboration and regulation in the South African healthcare industry

The global business landscape is characterised by uncertainty that has compelled firms to look beyond traditional models of management, which are under scrutiny in terms of sustainability. Researchers have advocated entrepreneurship as a means for firms to transform themselves into flexible, more responsive units that provide enhanced services through ongoing innovation. The context and survey population for this study is the South African healthcare sector. Hypotheses are formulated to show how different variables operate through different pathways to increase overall sustainable corporate entrepreneurship activity. Instruments are first subject to validity and reliability testing, and hypotheses are tested statistically using correlational analysis, path analysis and multiple regression analysis. Results support a positive relationship between entrepreneurial orientation and sustainable corporate entrepreneurship in terms of increased internal corporate venturing (ICV), strategic entrepreneurship, and competitive capability. Moreover, the results indicate this relationship is influenced by alliances and moderated by strategic regulatory factors.

Corporate sustainability: a focus on entrepreneurship, collaboration and regulation in the South African healthcare industry

The global business landscape is characterised by uncertainty that has compelled firms to look beyond traditional models of management, which are under scrutiny in terms of sustainability. Researchers have advocated entrepreneurship as a means for firms to transform themselves into flexible, more responsive units that provide enhanced services through ongoing innovation. The context and survey population for this study is the South African healthcare sector. Hypotheses are formulated to show how different variables operate through different pathways to increase overall sustainable corporate entrepreneurship activity. Instruments are first subject to validity and reliability testing, and hypotheses are tested statistically using correlational analysis, path analysis and multiple regression analysis. Results support a positive relationship between entrepreneurial orientation and sustainable corporate entrepreneurship in terms of increased internal corporate venturing (ICV), strategic entrepreneurship, and competitive capability. Moreover, the results indicate this relationship is influenced by alliances and moderated by strategic regulatory factors.

Critical success factors for the successful initiation of Lean in public hospitals in KwaZulu-Natal: a factor analysis and structural equation modelling study

BackgroundLean thinking is one of several operations-management techniques which have yet to be fully embraced in the South African health care sector. In most health care managers’ service delivery mandates, what needs to be done might be known, but it is how it should be done which might be alien to most managers. In order to recognise the “how”, one needs to know the critical success factors for Lean initiation.MethodsThe research took the form of an observational descriptive study with quantitative methods. The objectives were to identify the key variables for the successful initiation of Lean and then to conduct factor analysis and structural equation modelling (SEM) on these variables leading to the identification of critical success factors (CSFs) for Lean initiation. Simple random sampling was applied to select the participants from various categories of 500 senior managers across 73 KwaZulu-Natal (KZN) public hospitals. The sample size was 218, with a response rate of 96.8% (n = 211). For the purpose of identifying key variables for the successful initiation of Lean and then of conducting factor analysis and SEM on these variables, a self-administered, structured questionnaire was used. Data were reduced using exploratory factor analysis (EFA) to identify latent constructs. Confirmatory factor analysis (CFA) was used to determine the reliability and validity of these factors. Structural equation modelling (SEM) fit indices were then applied to assess acceptability of the measurement model.ResultsCertain variables were eliminated during EFA if they cross-loaded onto more than one factor, since this caused discriminant validity problems. In addition, if variables loaded weakly onto a factor, they were not retained. Three critical success factors (CSFs) were identified in this study: strategic leadership and organisational attitude; integration of Lean elements, tools, and techniques; and basic stability in operational processes. All reliability and validity conditions have been met (RMSEA = 0.085; CFI = 0.956 and χ2/df = 2.513), consequently rendering the model reliable and valid.ConclusionNone of the three CSFs can be viewed in isolation, as they all have significance at different dimensions of capability within the organisation. The use of these CSFs and the context, content, application, and outcome of Lean should be viewed in light of the organisation’s strategic, technical, structural, and cultural environment. Further research in the effectiveness of these CSFs for the rollout of Lean in South African hospitals would be of benefit to the Lean body of knowledge.

PRACTITIONER ETHICS, MEDICAL SCHEMES AND FRAUD IN THE SOUTH AFRICAN PRIVATE HEALTHCARE SECTOR

The biggest healthcare funders in South Africa are the South African Government and medical aid schemes and they operate in a highly-regulated environment. Unfortunately, the pervasiveness of healthcare fraud concerning collusion between medical aid members and healthcare providers such as physicians is swelling. Health care fraud is invariably a method of white collar crime that could be carried out by a number of stakeholders, inter alia , health care providers, customers, firms providing medical goods or services, and also health care organizations such as medical aid schemes. This article introduces the South African healthcare sector, the numerous ethical challenges for the healthcare providers and the notion of ethics education. The objective of this article is thus even in small measure, to seek to instil a positive ethical mind-set in all medical practitioners and health sector employees. It seeks to support industry initiatives to reduce fraud and ethical misconduct, and offers ethical guidance to practitioners and medical aid schemes and proposes a Medical Practitioner Ethical Guidelines Framework.

Still lost in translation: language barriers in South African health care remain

The patient-centred model of health care, which recognises patients’ autonomy, promotes their active participation in decisions concerning their own health, and strives to treat patients holistically, improves health outcomes but relies on effective communication between healthcare providers and patients. In a multilingual society, a major barrier to effective communication arises when healthcare providers and their patients do not share the same first language. This review aims to explore the impact of the language barrier on the effective rendering of healthcare services in South Africa, and to raise awareness that studies regarding language barriers within the South African healthcare sector are currently limited to isiXhosa in the context of English and Afrikaans, and has been conducted almost exclusively in the Western Cape. Research, therefore, needs to be extended to healthcare settings in the rest of the country, and needs to include all the languages and cultures protected under the South African...

Managing fraud risk: A study of the private hospital sector of South Africa

Ethical and legal decisions are made daily by healthcare professionals and personnel in the performance of their regular duties. However, fraud risk has become a threat to the sustainability of industries and organisations, including the healthcare sector. In the South African healthcare sector, losses due to fraud risk amounted to R13 billion during 2015(Bateman, 2015). The purpose of the study on which this article reports, was to assess whether private hospitals managed fraud risk effectively and in a cohesive manner. Failure to manage fraud risk threatens the sustainability of any hospital. Primary data was collected by means of a survey, which involved management staff at head office level and at hospital level. The findings suggested that South African private hospitals appreciate the significance of the management of fraud, but there is room for improvement. It is recommended that private hospitals follow a decentralised business model and decentralising risk ownership in order to manage fraud risk more effectively. Risk management training should be provided to staff members on a regular basis and a King-type regime should be adopted by private hospitals with regard to the management of risks.

Guidelines to facilitate self-care among older persons in South Africa

Background: The number of older persons is growing at an alarming rate, yet the South African healthcare sector is not giving this issue the required attention. Moreover, the healthcare sector serves four-fifths of the country's population and primary healthcare (PHC) facilities are overcrowded, and thus professional nurses are prevented from providing sufficient self-care health education to older persons.Aim: To develop guidelines for the three role players — the public health sector, professional nurse and older person — to facilitate self-care among older persons in South Africa.Design: Quantitative, descriptive, explorative and contextual research design.Methods: A literature review followed by a self-care assessment of a sample of older persons using the Appraisal of Self-care Agency (ASA-A) and Exercise of Self-care Agency (ESCA) questionnaires which led to the identification of conclusions and self-care deficits.Results: Based on Menon's psychological health empowerment model, and from the conclusions and self-care deficits, nine self-care guidelines were developed for the public health sector, professional nurses and older persons.Conclusion: This is the first systematic development of guidelines to facilitate self-care among older persons in South Africa.Implications for practice: The implementation of the self-care guidelines by the public health sector, professional nurses and older persons will improve the healthcare of older persons at home which will in turn improve their quality of life, reduce unintentional self-neglect, as well as assist in alleviating overcrowding in clinics because unnecessary visits to the clinic will drop.

Exploring corruption in the South African health sector.

Recent scholarly attention has focused on weak governance and the negative effects of corruption on the provision of health services. Employing agency theory, this article discusses corruption in the South African health sector. We used a combination of research methods and triangulated data from three sources: Auditor-General of South Africa reports for each province covering a 9-year period; 13 semi-structured interviews with health sector key informants and a content analysis of print media reports covering a 3-year period. Findings from the Auditor-General reports showed a worsening trend in audit outcomes with marked variation across the nine provinces. Key-informants indicated that corruption has a negative effect on patient care and the morale of healthcare workers. The majority of the print media reports on corruption concerned the public health sector (63%) and involved provincial health departments (45%). Characteristics and complexity of the public health sector may increase its vulnerability to corruption, but the private-public binary constitutes a false dichotomy as corruption often involves agents from both sectors. Notwithstanding the lack of global validated indicators to measure corruption, our findings suggest that corruption is a problem in the South African healthcare sector. Corruption is influenced by adverse agent selection, lack of mechanisms to detect corruption and a failure to sanction those involved in corrupt activities. We conclude that appropriate legislation is a necessary, but not sufficient intervention to reduce corruption. We propose that mechanisms to reduce corruption must include the political will to run corruption-free health services, effective government to enforce laws, appropriate systems, and citizen involvement and advocacy to hold public officials accountable. Importantly, the institutionalization of a functional bureaucracy and public servants with the right skills, competencies, ethics and value systems and whose interests are aligned with health system goals are critical interventions in the fight against corruption.

Guidelines to facilitate self-care among older persons in South Africa

BackgroundThe number of older persons is growing at an alarming rate, yet the South African healthcare sector is not giving this issue the required attention. Moreover, the healthcare sector serves four-fifths of the country's population and primary healthcare (PHC) facilities are overcrowded, and thus professional nurses are prevented from providing sufficient self-care health education to older persons. AimTo develop guidelines for the three role players – the public health sector, professional nurse and older person – to facilitate self-care among older persons in South Africa. DesignQuantitative, descriptive, explorative and contextual research design. MethodsA literature review followed by a self-care assessment of a sample of older persons using the Appraisal of Self-care Agency (ASA-A) and Exercise of Self-care Agency (ESCA) questionnaires which led to the identification of conclusions and self-care deficits. ResultsBased on Menon's psychological health empowerment model, and from the conclusions and self-care deficits, nine self-care guidelines were developed for the public health sector, professional nurses and older persons. ConclusionThis is the first systematic development of guidelines to facilitate self-care among older persons in South Africa. Implications for practiceThe implementation of the self-care guidelines by the public health sector, professional nurses and older persons will improve the healthcare of older persons at home which will in turn improve their quality of life, reduce unintentional self-neglect, as well as assist in alleviating overcrowding in clinics because unnecessary visits to the clinic will drop.

Policy Implementation And The Promotion Of Service Delivery Within The Public Health Sector In South Africa

The South African healthcare sector stands at the threshold of major restructuring in an attempt to address inadequacies as a result of fragmentation of health services in apartheid South Africa. The level of health services, particularly in rural areas, has decreased and has led to reduced quality and productivity of health services. For individuals residing in rural communities, access to health services can be arduous. Delivery of essential services has to meet the needs of marginalised people who live in remote areas. The health sector is reputed to be good at formulating policies, discussing ideas, making recommendations, and spending resources, but poor on implementing policies. The government insists that the policy framework is transparent and well-defined and that what is needed is effective implementation. Regrettably, the transition of policy into practice is more complex than the perceived judgement of government. Critical concerns regarding issues about how policy can be effectively implemented and who should be responsible for implementation is one of major concern.

A South African perspective on factors that impact on the adoption and meaningful use of health information technologies

AbstractObjective: Various benefits are associated with the adoption and meaningful use of health information technologies (HITs) in the healthcare sector. Despite the associated advantages with the adoption and use of HITs, the South African healthcare sector has been slow to adopt HITs, such as electronic record systems. The purpose of this study was to identify factors that should be addressed to encourage the adoption and meaningful use of HITs in the South African healthcare landscape.Design: A three-round Delphi study was conducted to identify such factors.Setting and subjects: The Delphi panel included 21 participants who were considered to be suitably knowledgeable about the acceptance and significant use of HITs in the context of the South African healthcare setting.Results: A total of 58 factors were uncovered by the participants. Consensus was reached on 42 factors that were considered to have a direct to significant impact on the adoption and meaningful use of HITs in the South African healthc...

Improving continuity of care through the use of electronic records: a South African perspective

AbstractThe fragmented nature of modern healthcare provision makes it increasingly difficult to achieve continuity of care. As a result, strong emphasis is placed on the informational dimension of continuity of care. The importance of keeping medical records is noted. Paper-based methods of recordkeeping are inadequate with regard to supporting informational continuity of care. This has led to increased interest in electronic recordkeeping methods. This article describes the role that various electronic records, such as personal health records (PHRs), electronic medical records (EMRs) and electronic health records (EHRs), could play in improving informational continuity of care. A scalable approach, based on the adoption of standards-based PHRs and EMRs, with a standards-based health information exchange to enable the exchange of health information, is recommended for the South African healthcare sector. The possible impact of the envisaged National Health Insurance (NHI) on current, mostly paper-based re...

The Care Coordination Program: a virtually integrated care delivery model for complex, high-needs patients

Background The South African healthcare sector is fragmented. The increasing prominence of non-communicable, or chronic, diseases in both the private and public healthcare sectors contributes to the country’s complex and costly “quadruple burden of disease” (the others being HIV/AIDS, tuberculosis, maternal and child mortality, and violence). These chronic diseases, once they have progressed, are inherently difficult to manage due to their underlying psychosocial components and their characteristically complex co-morbidities. High costs, without the desired improved clinical outcomes, are common. Elsewhere in the world, such as in the United States, where similar fragmented systems exist, new care-delivery models have emerged to better manage patients with complex conditions. These include vertical payerprovider integration, patient-centered medical homes, and accountable care organizations. Enablers of similar structural reforms are lacking in South Africa, however, where regulatory rules bar the employment of salaried doctors by hospital networks. Moreover, a looming nation-wide dearth of healthcare professionals diminishes the potential for systemic structural changes to the status quo. Discovery Health (DH) is the country’s largest private healthcare payer, providing health insurance coverage to over 2.5 million people. The Care Co-ordination Program (CCP) is DH’s response to the fragmented care received by its members who present with complex healthcare needs, including psychological and social vulnerabilities. Methods The target DH population of members likely to benefit in the CCP is identified geographically using the Johns Hopkins Adjusted Clinical Group tool. This tool categorizes members into Resource Utilization Bands. Further, a Disease Burden Index (DBI) is employed to narrow the focus of the CCP to DH members with the greatest complexity and highest disease burden. The DBI for the CCP population is 17.071 compared to a significantly lower DBI for the general DH population of 1.024 (see Figure 1). Sub-acute service providers in the identified highneeds geographic areas who meet structural, service and management criteria are contracted with DH to participate in a CCP network. At the time of a patient’s admission into an acute facility, a DH care recruiter employs pre-set clinical, social, and psychological entry criteria combined with a FIM (Functional Independence Measure) score to identify patients at risk of sub-optimal quality of care associated with repeated costly admissions. The identified patients are voluntarily enrolled in the CCP and, at this point, a DH care co-coordinator joins the care team of the contracted service provider. The care co-coordinator ensures that the patient’s unique needs are carefully and methodically addressed by the service provider’s interdisciplinary care team. Integrating the family into the care plan is central to ensuring a successful transition to the home. The care co-coordinator shares the transition plan and the patient’s electronic medical record with all involved providers, thus ensuring the co-ordination of care following discharge. The co-coordinator is a valuable resource for the patient, managing vulnerabilities during the transition to home and community. * Correspondence: roshinin@discovery.co.za Risk and Quality Management, Discovery Health, Sandton, 2146, South Africa Naidoo and Steenkamp BMC Health Services Research 2011, 11(Suppl 1):A18 http://www.biomedcentral.com/1472-6963/11/S1/A18

Choosing, changing or adhering to a registered doctor in a managed care plan: what will it take? A qualitative survey in rural Mpumalanga, South Africa

Background: The phenomenon of doctor shopping has not yet attracted the attention of managers in the South African healthcare sector. Satisfaction with services is known to be mediated by the personal connection inherent in interpersonal continuity with the provider. Such a connection hinges on the fulfilment of expectations of what a good doctor should be at a relational level. With the advent of managed care in South Africa, the restriction on doctor choice and use is being enforced. There is evidence that adherence to one doctor has clinical and financial benefits. Clinical benefits are related to continuity of care, whilst financial gains to the patient and the healthcare system are acquired mainly through better co-ordination of care to avoid inefficiency and wastages. This study explores the concept and context of a ‘good doctor’, a prerequisite for adherence to one doctor, among members of a health plan targeting the low income community in South Africa. Methods: This qualitative enquiry of what constitutes a ‘good doctor’ took place in the form of focus group discussions and key informant interviews and was conducted among members of a managed care health plan in Piet Retief, South Africa. The plan was designed specifically for the employed but uninsured population, a population group of strategic importance in the South African healthcare market. The participants in this study were purposively sampled to include a wide range of opinions about the characteristics of a good doctor. Results: The respondents looked for values in a doctor that range from fairness, lack of discrimination, autonomy, dignity, warmth and taking time to do a job properly. Generally, the participants expressed willingness to adhere to one registered doctor on condition that the doctor was a ‘good doctor’. The definition of a good doctor as provided by the participants was not based on strict technical/clinical criteria, but rather on the patients’ and the community’s recent experiences of care under that particular doctor. The typical good doctor is a popular, friendly person who does not discriminate along racial lines, listens seriously to anything presented to him or her and examines the patient properly. He/she takes the patient’s illness seriously, refers when necessary and gives sick leave that can be used to see a traditional healer. The determinants of the choice of doctor were practical (e.g. the cost), although many were humanistic and difficult to quantify (e.g. word of mouth from fellow patients; the attitude of the doctor toward people; the popularity of the doctor in the community). The specific needs of the respondents relating to traditional healing, migration and sick leave are not readily captured in a standard medical aid contract.