1. 1 Project Khaedu SMS Action Learning Programme Port Shepstone Hospital - preliminary findings 19 May 2006

2. 2 Contents Executive summary Situation Some suggestions

3. 3 Executive summary and key message Port Shepstone hospital is a well-managed and resourced hospital with relatively high levels of customer satisfaction and staff morale. Further improvement is constrained by the organisation structure, delegations of authority and physical space. The patient administration process could be further enhanced with some relatively small changes.

4. 4 Due to time constraints a limited sample was used to perform the following: Interviews Observations Data analysis Methodology

5. 5 Areas of focus during situational analysis Patient Administration and OPD Clinics Information Systems Human Resources Finance / Systems

6. 6 Current situation High patient volumes exacerbated by no district hospital close by Bottlenecks in patient administration and OPD leading to long wait times Process Finance/ Procurement/ Systems OrganisationPhysical Major space constraints in just about all areas of the hospital, but particularly severe in –Pharmacy –OPD –Medical Wards Hospital maintenance department a constraint to service delivery (pharmacy, toilets, filing) Sub-optimal organisation structure in some areas, with a significant impact on service delivery Delegation of authority Inefficient Performance Management and Development System Very slow procurement when provincial head office involved in the process (e.g. IT over 8 months) Sub-optimal use of IT in some areas, e.g. –Manual recording of file retrieval –Manual registration at OPD –Lack of an integrated HIS

7. 7 PS hospital is swamped with high numbers of outpatients per day…. Patients start arriving at 5h00 in the morning and by 7h00 the entire area is overflowing with patients. Patient screening starts between 6h45 and 7h15. Patients are channeled to different counters (clinics, OPD) The duplication of registration at Admissions and OPD result in bottlenecks

8. 8 …which impacts on service delivery

9. 9 PS hospital is swamped with high numbers of outpatients… Average annual growth rate = 4.4% 20022003200420052006 Average per day = 662 (Some are repeat patients and do not get seen by a Dr)

10. 10 In general, patients are satisfied with the services, except for waiting time.

11. 11 IT equipment IT support Shortage of staff nurses and nursing assistants Delays due to shortage of key resources:

12. 12 Staff is generally satisfied

13. 13 Training Career progression Quality of facilities Performance management Awareness and Training down to the lowest level Budget for performance bonuses However, the following areas need attention:

14. 14 What are staff saying? “ We are not happy with the performance management system…our KPA’s are handed down to us and we do not have a say in the matter” “Batho Pele is just on paper…it is not practised enough” “There is no shelter outside and we get wet transferring patients in the rain” “We are happy with the new management” “We work under very cramped conditions…space is a problem for everybody…we do not have a tea room or a canteen” “There is a severe shortage of nursing staff but we are doing our best”

15. 15 Many areas are very cramped; lack of space is a pervasive problem

16. 16 Decentralising admin support in the early morning by: »Moving files to separate clinics the day before »Deploy patient admin. staff to clinic to handle cash collection at separate points. Suggest later appointment times to local / urban patients Ensure availability and function of printers Consider one combined registration point Suggestions for Improvements Options for decongesting the patient admin and OPD

17. 17 At present the Procurement process goes through three levels resulting in delays Eliminate the District IT Committee level because it does not add value Budget centralised at Head Office level – applications must be considered at that level Fast track the implementation of a Provincial integrated hospital IT system Suggestions to improve procurement of IT

18. 18 Human Resources Organisational structure e.g. nursing Span of control 1:1 Span of control 1.4:1 Span of control 1:1 Very low span of control and we can’t attract more CPN’s “We could get through much more work if we had more NA’s and staff nurses…we just need more hands”

19. 19 Improve delegations with regard to the ODE function E.G the ability to create and abolish posts, within available funds, should be delegated to the institution. Convert professional nurses posts to staff nurse posts as they are easier to recruit and will relieve professionals from performing lower level work, e.g bathing patients Human Resources Organisational structure e.g. nursing

20. 20 Fast track minor alteration requests (e.g pharmacy, archives) Interim arrangements must be made in Casualty for patients waiting for beds (portable screens) Shelter needed across casualty and OPD Improvement of signage Finance and Sytems

21. 21