South African Public Hospitals Research Articles

Contraceptive Coercion in Pre-Abortion Counseling: A Conversation Analysis

We explored how contraception is addressed in pre-abortion counseling, with a focus on the conversational strategies used by healthcare providers. We recorded 28 pre-abortion counseling sessions at three South African public hospitals and analyzed them using conversation analysis. In discussions about past contraceptive use, patients were often positioned as irresponsible and required to account for assumed inadequate contraceptive practices. This framing laid the groundwork for the coercive provision of post-abortion contraception, particularly long-acting reversible contraceptives (LARCs). Short-term users and younger patients were singled out, receiving repeated warnings about daily adherence or parental enforcement. Providers’ efforts to prevent the perceived “mistake” of abortion led to the use of coercive conversational tactics.

Electronic health records model to improve the quality of patients' healthcare.

Electronic health records (EHR) has been acknowledged for bringing down healthcare costs and enhancing hospital service standards. The aim of this study was to develop an EHR model to lower patient treatment costs and enhance healthcare quality in South African public healthcare. In this study, a cross-sectional quantitative methodology was used. The research data for this study were provided by medical healthcare professionals, at Dr. George Mukhari Academic Hospital (DGMAH). This included doctors, nurses, pharmacists, radiologists, and radiographers who completed a semi-structured questionnaire. The final model's findings show that the use of EHR significantly improves information quality (IQ) and positively influences medical errors reduction (MER). Knowledge quality (KQ) has a positive significant impact on MER, whereas IQ has a considerable negative impact on MER. Furthermore, cost reduction in patient treatment (CRPT) has a positive significant influence on MER. Patients obtain better medical care when medical professionals have access to complete and accurate information. Medical errors can be reduced or even prevented with the use of EHRs, which can lead to better patient outcomes. The quality of patient care at South African public hospitals and in other developing countries can be enhanced by using this framework as a guide to reduce treatment costs.

Impact of knowledge factors on implementation of smart card technology in public healthcare

Background: Healthcare quality continues to advance with the use of innovative, adaptable technology, which will also reduce costs, increase efficiency, divide the number of errors, boost patient satisfaction, and enhance reimbursement for inpatient and outpatient healthcare professionals.Aim: The study’s aim was to investigate the impact of knowledge factors on the implementation of smart card technology (SCT) in public healthcare. Furthermore, it contributes equally to the understanding of the important determinants that influence the implementation of SCT in these hospitals.Setting: The study examined how knowledge factors affected the use of smart card technology in public healthcare in Southern Africa.Methods: The study used quantitative research approach. There were 489 healthcare professionals who took part in the initial data collection. As a result, 439 questionnaires were sent out and 406 of them were analysed.Results: The outcome of this study revealed that healthcare professionals had an impact on SCT implementation. According to the data, 2.2% and 2.5% of respondents, respectively, had very excellent and decent knowledge of SCT, compared to 33% of respondents who have a good understanding of SCT. A significant correlation between the application of SCT and effort expectancy (EE) may also have an impact on these outcomes. Effort expectancy was found to have a positive, considerable influence on the application of SCT in public healthcare in this study.Conclusion: This study showed that the Department of Health’s ability to properly administer SCT depends on certain factors that affect how it is implemented in South African public hospitals. Given these reasons, the possibility for adopting these e-health programs is of utmost importance.Contribution: The study can assist the Department of Health to understand how different knowledge-related factors impact the implementation of SCT in public healthcare.

An analysis of referral patterns of traumatic brain injury at Groote Schuur Hospital Trauma Centre.

Traumatic brain injury (TBI) can result in significant morbidity and mortality if not diagnosed in a timely manner. Brain computed tomography (CT) is the diagnostic gold standard but is of limited availability in most South African public hospitals, resulting in transfer of TBI patients to tertiary hospitals. To describe the referral patterns and outcomes of patients with TBI referred to Groote Schuur Hospital Trauma Centre. This was a retrospective audit of all patients admitted to the Trauma Centre who had a brain CT scan for suspected TBI between 1 February 2022 and 31 March 2022. Demographic data (age, sex), mechanism of injury and Glasgow Coma Score were recorded. Referral pathways were determined, and final disposition of patients was recorded. A total of 522 patients had a brain CT for TBI. Of these, 314 (60.1%) were referred from other hospitals. CT scan was abnormal in 178 (34.1%) patients. Three hundred and two (58.6%) were discharged home within 24 hours. The mean time between referral and CT scan was 13 hours. More than half of patients referred for a CT scan were discharged from the Trauma Centre within 24 hours of admission, which indicates additional costs and inefficiencies in the health system. These data are useful to guide resource planning and allocation for district hospitals, since less expensive point-of-care modalities now exist to diagnose TBI, and which are useful in indicating the prognosis of patients.

South African public hospital intrapreneurship culture: Unit nurse managers’ governance role

South African public hospital intrapreneurship culture: Unit nurse managers’ governance role

A retrospective cohort analysis of factors associated with the development of refeeding syndrome in children 0–59 months diagnosed with severe acute malnutrition in a South African setting

BackgroundRefeeding syndrome (RFS) is a life-threatening, underdiagnosed, and under-researched complication in treating children with severe acute malnutrition (SAM). This study aimed to determine the incidence and onset of RFS and identify biochemical abnormalities, clinical signs, and complications associated with RFS development in children, 0–59 months, treated with SAM in a South African public hospital setting. MethodsA retrospective cohort study was performed on hospital medical records of children aged 0–59 months, diagnosed with SAM at Rahima Moosa Mother and Child Hospital, Johannesburg, from 1/10/2014 to 31/12/2018. The onset of RFS among children included in the study was diagnosed based on published criteria for RFS. On admission, children who developed RFS and those who did not were compared concerning biochemistry and clinical signs and symptoms. ResultsA total of 148 medical records were retrieved from the hospital archives. The diagnosis of SAM based on the World Health Organization (WHO) definition was confirmed in 126 children who were then included in the study. The median age of the 126 children (63 % male) with confirmed SAM was 11.2 months (P25:7.0 months; P75:17.0 months). The in-hospital mortality rate was 18.2 %, of which 8.7 % were retrospectively diagnosed as having developed RFS during their recorded hospital stay, despite implementing the WHO treatment guidelines for SAM. A significantly higher percentage of the children who developed RFS presented on admission with hypophosphatemia (p = 0.015), hypokalemia (p = 0.001), hyponatremia (p = 0.001), an international normalized ratio (INR) of above 1.7 (p = 0.025), diarrhea (p = 0.042), dehydration (p = 0.029) and urinary tract infection (UTI) (p = 0.041), than those who did not. Children who developed RFS stayed in hospital significantly longer than those who did not (18 vs. 12 days with a p-value of 0.003). ConclusionIn this population of children with SAM treated in a South African public hospital setting, the presence on hospital admission of low levels of electrolytes, elevated INR, dehydration, diarrhea, and UTI was significantly associated with developing RFS. Recognizing these as possible red flags for developing RFS in children admitted with SAM might contribute to improved outcomes and needs further investigation.

The Role of Employee Engagement in the Relationship between Staff Morale and Employee Wellbeing of Nurses in the South African Public Hospitals

Employee engagement is essential for corporate success and is a requirement for gaining and retaining a competitive edge in public hospitals. This study assesses the role of employee engagement on the relationship between staff morale and employee wellbeing of nurses in public hospitals. A quantitative approach using self-administered questionnaires was applied to 461 nurses in the public hospitals of six provinces in South Africa for data collection. Statistical Package for the Social Sciences (SPSS) application was used to analyse the data obtained in the research. Ethical considerations were applied throughout the research process. Employee engagement was significantly and partially related to staff morale and employee wellbeing, and staff morale and employee wellbeing were significantly and related to employee engagement. Furthermore, the study determined that employee engagement has a mediating and moderating role in the relationship between staff morale and employee engagement. The study concluded that is that management needs managers should bring teamwork, motivation, trust, engagement, growth, and development to their employees, to identify their believes, hope, values, interests, and needs and know to what extent it matches with the hospital values, believes and goals.

Managing under austerity: a qualitative study of management–union relations during attempts to cut labour costs in three South African public hospitals

PurposeIn this paper, the authors examine the strategies used to reduce labour costs in three public hospitals in South Africa, which were effective and why. In the democratic era, after the revelations of large-scale corruption, the authors ask whether their case studies provide lessons for how public service institutions might re-make themselves, under circumstances of austerity.Design/methodology/approachA comparative qualitative case study approach, collecting data using a combination of interviews with managers, focus group discussions and interviews with shop stewards and staff was used.FindingsManagement in two hospitals relied on their financial power, divisions between unions and employees' loyalty. They lacked the insight to manage different actors, and their efforts to outsource services and draw on the Extended Public Works Program failed. They failed to support staff when working beyond their scope of practice, reducing employees' willingness to take on extra responsibilities. In the remaining hospital, while previous management had been removed due to protests by the unions, the new CEO provided stability and union–management relations were collaborative. Her legitimate power enabled unions and management to agree on appropriate cost cutting strategies.Originality/valueFinding an appropriate balance between the new reality of reduced financial resources and the needs of staff and patients, requires competent unions and management, transparency and trust to develop legitimate power; managing in an authoritarian manner, without legitimate power, reduces organisational capacity. Ensuring a fair and orderly process to replace ineffective management is key, while South Africa grows cohorts of competent managers and builds managerial experience.

Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa

BackgroundUnderstanding why patients experience loss to follow-up (LTFU) is essential for TB control. This analysis examines the impact of travel distance to RR-TB treatment on LTFU, which has yet to be analyzed within South Africa.MethodsWe retrospectively analyzed 1436 patients treated for RR-TB at ten South African public hospitals. We linked patients to their residential ward using data reported to NHLS and maps available from the Municipal Demarcation Board. Travel distance was calculated from each patient’s ward centroid to their RR-TB treatment site using the georoute command in Stata. The relationship between LTFU and travel distance was modeled using multivariable logistic regression.ResultsAmong 1436 participants, 75.6% successfully completed treatment and 24.4% were LTFU. The median travel distance was 40.96 km (IQR: 17.12, 63.49). A travel distance > 60 km increased odds of LTFU by 91% (p = 0.001) when adjusting for HIV status, age, sex, education level, employment status, residential locale, treatment regimen, and treatment site.ConclusionPeople living in KwaZulu-Natal and Eastern Cape travel long distances to receive RR-TB care, placing them at increased risk for LTFU. Policies that bring RR-TB treatment closer to patients, such as further decentralization to PHCs, are necessary to improve RR-TB outcomes.

Public hospital pharmacists’ knowledge, attitudes, and practices for antibiotic stewardship implementation in Limpopo Province, South Africa

BackgroundHospital pharmacists are important in antibiotic stewardship programs (ASP), a global strategy to combat antibiotic resistance (ABR). South African public hospitals have limited ASP implementation. This study describes Limpopo Provincial Hospital pharmacists’ knowledge, attitudes, and practice toward ASP implementation.MethodA questionnaire to explore pharmacists’ knowledge, attitudes and practices regarding ASP implementation comprised 43 questions hosted online. A link was sent by invitation e-mail to eligible respondents in November 2021. Five questions on respondents’ demographics, 15 questions on ASP knowledge, 10 Likert scale questions on attitude, and 13 on ASP practices were included. Mean (standard deviation (SD)) knowledge and attitude scores and a median (interquartile range (IQR)) practice score was calculated. Associations between categorical variables were assessed using chi-square/Fisher’s exact analysis (p < 0.05), with Cramér’s V as effect size.ResultsThe survey yielded 35 responses (13.1%). Twenty (57.1%) respondents were female. Seventeen (48.6%) respondents were between the ages of 31 and 40 years. The mean knowledge score of respondents was 9.8 (2.6) (N = 34), with knowledge gaps on One Health and socioeconomic determinates of ABR. Ten (29.6%) respondents thought One Health discouraged multi-sector collaboration, and nineteen (55.9%) respondents thought ASP was the only strategic response to ABR. Sixteen (47.1%) respondents did not know that poor access to clean water accelerates ABR and seventeen (50.0%) did not know that poverty could be a determinant for antibiotic use. The mean respondent attitude score was 8.0 (1.7) (N = 28). Twenty-seven (96.4%) respondents agreed that ASP was necessary and agreed to participate in ASP respectively. All 28 (100.0%) respondents agreed to lead an ASP. The median (IQR) respondents’ practice score was − 2.0 (IQR: -6.0–5.8) (N = 16). Respondents were inconsistently (never, sometimes, every time) participating in multi-disciplinary forums (6/16, 37.5%) and expressed a desire for training (11/13, 84.6%) on ASP through in-service (7/27, 25.9%). Respondents thought ASP training should include medical officers (12/29, 41.4%) and nurses (9/29, 31.8%). Knowledge score was associated with gender (p = 0.048; V = 0.416) and attitude score (p = 0.013; V = 0.556).ConclusionOur study found pharmacists had good knowledge and a positive attitude toward ASP implementation but poor ASP practices. A multi-disciplinary in-service training could address identified knowledge and practice gaps.

Work ethics climate in relation to nurses’ commitment in a South African hospital

Orientation: Commitment, well-being and employer loyalty affect nurse retention. Literature shows that nurses are leaving the workforce at an alarming rate and that various factors are causing them to leave their employers.Research purpose: The main aim of this study was to investigate the influence of the ethical work climate in the organisation on nurses’ commitment.Motivation for the study: The health sector is essential in promoting mental, physical and emotional health but faces a shortage of skilled workers. The work ethics climate (WEC) can play a crucial role in retaining skills.Research approach/design and method: A quantitative research approach was adopted in a non-probability convenience sample of 208 permanent nurses from a South African public hospital. Participants completed self-assessments on an ethical climate questionnaire and an organisational commitment scale (OCS), and regression analysis was used to analyse the data.Main findings: Work ethics climate correlated with nurses’ affective, continuance and normative commitment. In addition, the results indicated that WEC predicted nurses’ commitment.Practical/managerial implications: Public hospitals in South Africa should create policies, laws and procedures that encourage ethical behaviour characterised by honesty, justice and dignity to boost nurse commitment. Thus, the South African hospital should foster an ethical workplace and implement an ethical code.Contribution/value add: This study contributes to the theory of ethical work climate and ethical behaviour by suggesting that nurses who positively perceive policies, rules and hospitals that have clear regulations are more likely to engage.

Prevalence and factors associated with burnout among junior medical doctors at a South African tertiary public sector hospital.

burnout is a syndrome characterized by emotional exhaustion, depersonalization and emotional exhaustion that occurs due to exposure to stressful conditions over a long period. It can lead to poor job performance, apathy, and lack of productivity. This study looks at the prevalence of burnout in medical interns in a tertiary hospital in South Africa and the factors that may contribute to burnout. an analytical cross-sectional study was conducted. Medical interns working in Chris Hani Baragwanath Hospital in 2019 were invited to participate. The participants filled questionnaire that had demographic information, the Maslach Burnout Inventory Scale, a scale to rate the rotations that they believed contributed towards their burnout and factors they think contributed towards their burnout. Our data was analyzed using Stata. out of a possible 165 potential participants, 101 medical interns enrolled. 95% of the participants reported burnout. Statistically significant factors contributing towards burnout were lack of resources and poor relations with support staff and senior staff. The medical rotation that was reported by the participants to contribute most towards their burnout was internal medicine. burnout in this population of medical interns is alarmingly high. Higher than reported in similar studies in South Africa and internationally.

Implementing artificial intelligence in South African public hospitals: A conceptual framework

Orientation: Artificial intelligence (AI) is stimulating the generation of knowledge and innovations in healthcare by making machines smart through algorithms to nurture learning and improve resilience in global health systems. Despite these potential benefits, operations managers in a South African public hospital continue to favour manual systems over existing AI technologies within their units.Research purpose: The purpose of this study was to develop a conceptual framework to facilitate the implementation of AI in a public hospital in South Africa.Motivation for the study: A gap was identified, highlighting the need for a conceptual framework that facilitates the successful implementation of AI in a public hospital. The aim is to ensure that operational managers fully embrace the benefits of AI, thereby improving the healthcare system.Research design, approach and method: A qualitative, exploratory, descriptive and contextual research design with a phenomenological research approach was adopted. Five phases were followed to develop a conceptual framework. Twelve individual interviews and two focus group interviews were conducted to collect data. Thematic data analysis was applied to extract and identify significant themes.Main findings: Three themes were identified: positive experiences related to AI, management and leadership processes in AI facilitation and challenges related to AI. These themes served as the foundation for the development of a conceptual framework.Practical/managerial implications: There is ambivalence in embracing AI in the units of this public hospital, and it will be addressed by this conceptual framework.Contribution/value-add: The proposed conceptual framework is designed to enable the operational managers in facilitating the implementation of AI in a public hospital setting. It serves as a valuable resource to promote the integration of AI technology in healthcare operations.

Using Swanson’s theory to improve quality of work life to strengthen the healthcare sector in Ukraine and South Africa

South Africa and Ukraine share similar challenges for staff in the healthcare sector. Health care workers in South Africa have borne the brunt of the COVID-19 pandemic whereas in Ukraine health care workers, amidst the war have had to show valour and a tough spirit in caring for their patients under very trying circumstances. Arising from the above tragedies, health care workers have shown incredible bravery both in Ukraine and in South Africa, however they display extreme burn out. In Ukraine, nurses are working in the conflict zone and have to manage complex patient mental and physical health issues. Some have even been subjected to violence from traumatized patients. This article assesses the healthcare situation both in Ukraine and South Africa and provides a descriptive report utilizing The Swanson's theory of caring. The elements of Swanson’s theory consisting of maintaining belief, knowing, being with, doing for, and enabling can be linked to characteristics such as supporting patients and colleagues, being sensitive, affectionate and empathetic while feeling a sense of responsibility towards the department and patients. The study, based at selected South African public central hospitals in two provinces, adopted a descriptive exploratory paradigm. Qualitative techniques were used to administer an interview schedule to 322 frontline participants. The results revealed that despite high commitment levels, the participants still faced challenges that impact their daily work life. The study conducted in South Africa on Quality of Work life (QWL) experiences of frontline healthcare workers leaves recommendations for the Ukrainian health care sector.

Models using private general practitioners to provide caesarean deliveries at five South African district public hospitals: insights for public-private contracting for obstetric care in rural areas

ABSTRACT Background Harnessing of private sector resources could play an important role in efforts to promote universal access to safe obstetric care including caesarean delivery in low- and middle-income countries especially in rural contexts but any such attempt would need to ensure that the care provided is appropriate and patterns of inappropriate care, such as high caesarean delivery rates, are not reproduced for the entire population. Objective To examine the contracting arrangements for using private general practitioners to provide caesarean delivery services in rural district hospitals in South Africa. Method We utilised a mixed-method study design to examine the contracting models adopted by five rural district hospitals in the Western Cape, South Africa. Between April 2021 and March 2022, we collected routine data from delivery and theatre registers to capture the profile of deliveries and utilisation of contracted private GPs. We also conducted 23 semi-structured qualitative interviews with key stakeholders to explore perceptions of the contracting arrangements. Results All five hospitals varied in the level of use of private general practitioners and the contracting models (three private in-sourcing models – via locum agencies, sessional contracts, and tender contracts) used to engage them. Qualitative interviews revealed insights related to the need for flexibility in the use of contractual models to meet local contextual needs, cost implications and administrative burden. Conclusion Structured appropriately, private public partnerships can fill important gaps in human resources in rural district hospitals. Policy makers should look to developing a ‘contracting framework’ which requires compliance with a set of underlying principles but allows for flexibility in developing context specific contracting arrangements. These underlying principles should include a ‘risk’ based delivery model, adherence to public sector- evidence-based protocols, time-based rather than per delivery/type of delivery remuneration models, group liability arrangements, and processes to monitor outcomes.

Cost-effectiveness of adjuvant chemotherapy for high-risk stage II and stage III colon cancer in South Africa.

Colon cancer incidence is rising in low- and middle-income countries (LMICs), where resource limitations and cost often dictate treatment decisions. In this study, we evaluate the cost-effectiveness of adjuvant chemotherapy for high-risk stage II and stage III colon cancer treatment in South Africa (ZA) and illustrate how such analyses can inform cancer treatment recommendations in a LMIC. We created a decision-analytic Markov model to compare lifetime costs and outcomes for patients with high-risk stage II and stage III colon cancer treated with three adjuvant chemotherapy regimens in a public hospital in ZA: capecitabine and oxaliplatin (CAPOX) for 3 and 6 months, and capecitabine for 6 months, compared to no adjuvant treatment. The primary outcome was the incremental cost-effectiveness ratio (ICER) in international dollars (I$) per disability-adjusted life-year (DALY) averted, at a willingness-to-pay (WTP) threshold equal to the 2021 ZA gross domestic product per capita (I$13,764/DALY averted). CAPOX for 3 months was cost-effective for both patients with high-risk stage II and patients with stage III colon cancer (ICER = I$250/DALY averted and I$1042/DALY averted, respectively), compared to no adjuvant chemotherapy. In subgroup analyses of patients by tumor stage and number of positive lymph nodes, for patients with high-risk stage II colon cancer and T4 tumors, and patients with stage III colon cancer with T4 or N2 disease. CAPOX for 6 months was cost-effective and the optimal strategy. The optimal strategy in other settings will vary by local WTP thresholds. Decision analytic tools can be used to identify cost-effective cancer treatment strategies in resource-constrained settings. Colon cancer incidence is increasing in low- and middle-income countries, including South Africa, where resource constraints can impact treatment decisions. This cost-effectiveness study evaluates three systemic adjuvant chemotherapy options, compared to surgery alone, for patients in South African public hospitals after surgical resection for high-risk stage II and stage III colon cancer. Doublet adjuvant chemotherapy (capecitabine and oxaliplatin) for 3 months is the cost-effective strategy and should be recommended in South Africa.

Between suffering and coping: burnout in female medical doctors in South Africa.

Burnout is described as emotional and physical exhaustion, reduced accomplishment, together with an outlook of inadequacy and cynicism related to job stress. It has a harmful impact globally, especially in developing countries, such as South Africa. This study is a phenomenological collective case study focusing on burnout experience in a sample of female medical doctors working in a South African public hospital. Based on ongoing explorations of burnout themes, empirically based intervention strategies are needed to be developed and presented for the South African public health sector to prevent stress-related burnout. The findings support the trend in literature that burnout is an overwhelming experience for female medical doctors in South Africa. The study presents voices of female medical doctors, their concerns, the causes for burnout and their coping mechanisms. It provides a strong contribution to exploring and presenting women's experiences in working in the medical field in South Africa from a positive psychology perspective. The findings indicate the struggles and the coping mechanisms of female medical doctors working in the field.

A Reflection on the Skills Shortage in Intensive Care Units in South African Public Hospitals

Intensive care units (ICUs) are specialist units where critically ill patients are cared for, staffed by a specialist health workforce. With the nursing profession currently undergoing major changes, both in practice and nursing education, there are several factors that are affecting the nursing workforce globally. As a result of natural attrition, nurses are leaving the profession which has resulted in an absolute critical skills scarcity. This article highlights some issues related to the nursing workforce in ICUs. The ICU nurses may be dealing with too much work, while experiencing low recognition of the value of their work. This may happen as nurses are all on the same level of training and they do a similar type of work. However, when the pressures of the ICU environment surpass their ability to cope, the individual nurses end up showing signs of burnout. The question is whether those working in ICUs will remain there forever, and for those nurses who hear the adverse stories about ICUs, whether they will be interested in working in ICUs.

Intersubjectivity in Premature Infant-Mother Dyads: Maternal States of Mind and Premature Infant Responsivity

Premature birth is implicated in the potential derailment of parent-infant relationships. Using a comparative case study methodology, this paper offers an exploration of developing and disrupted intersubjectivity in two mother-premature infant dyads in the context of a neonatal high care ward in a South African public hospital. Maternal narratives from interviews as well as observational material are used to understand infant responsivity and communication in relation to maternal states of mind. The potential for reciprocity is explored, along with the factors that disrupt this potential.

Critical success factors of smart card technology in South African public hospitals

Background: Even though the government has set several admirable targets for raising the standard of healthcare, as highlighted by communities and media reports, public health institutions’ services continue to fall short of patients’ expectations and basic standards of care. For this reason, the general public has lost faith in the healthcare system. The public healthcare system in South Africa is completely dysfunctional and urgently needs to be transformed to serve the majority of those who use public hospitals.Objectives: The study aimed to improve healthcare for the majority of South Africans by investigating the critical success factors (CSFs) that influence the adoption of smart card technology (SCT) in South African public hospitals.Methods: A thorough review of peer-reviewed literature was conducted to determine potential barriers to adopting SCT. Furthermore, a hybrid model that combines the Health Unified Technology of Acceptance Theory (HUTAUT) model, DeLone and McLean IS success model (DM) and the diffusion of innovation (DOI) theory will be developed, validated and tested to identify the CSFs adoption of SCT in public hospitals in South Africa.Results: The validated research model has been developed to be adopted by nurses at public hospitals.Conclusion: This research will contribute to the development of a new framework that identifies the CSFs for SCT adoption in South African public hospitals.Contribution: The study’s results will make a special contribution to the body of knowledge in the fields of health informatics, particularly e-health.