Patient flow management in a South African academic hospital: the Groote Schuur Hospital (GSH) case

Thesis (MPA)--Stellenbosch University, 2017.ENGLISH SUMMARY : It is known that the South African healthcare system is overwhelmed by a relentless burden of infectious and non-communicable diseases, social inequalities, and insufficient human resources to provide healthcare to the growing population. Therefore, patient flow management has become the cornerstone of patient processing and throughput in hospitals in order to alleviate the disproportionately high burden of disease. To compound the issues of patient flow inefficiencies and unexplored South African patient flow practices, healthcare services are continually attempting to improve their systems in order to adequately address the challenges they face. However, the reality of patient flow management in hospitals is heterogeneous and methods to improve patient flow do not result in similar outcomes, but enough evidence exists that patient flow-related methods and techniques can assist hospitals to improve patient flow. Therefore, it is believed that healthcare professionals’ perception of patient flow is mainly influenced by their background or work environment. The goal of this study is to explore the patient flow system of GSH. The researcher describes the current patient flow system of GSH by using information from hospital statistics, reports and project information. A questionnaire and interviews were used to collect empirical data of how nurses, doctors and managers perceive the patient flow system of GSH. The preliminary results of the research show operational employees find it extremely difficult to ensure efficient patient movement without proper patient flow guidelines. It is also revealed that access block is one of the biggest contributors of increased waiting times. Although GSH managers promote innovation and improvements to the patient flow system, operational staff argues that additional tasks hampers their ability to perform their normal duties optimally, which proves that managers and operational staff does not share the same vision. Another interesting result is that patient flow is not being measured at GSH, which makes it difficult to monitor improvement strategies and the impact new innovations have on the patient flow system. Following an in-depth multi-dimensional analysis and discussion of the preliminary research results, suitable recommendations are presented, which could be used to improve the patient flow management system of GSH.AFRIKAANSE OPSOMMING : Dit is bekend dat die Suid-Afrikaanse gesondheidsdiensstelsel oorweldig is deur ’n meedoenlose las van aansteeklike en nie-aansteeklike siektes, sosiale ongelykhede, en onvoldoende menslike hulpbronne om gesondheidsdienste aan die groeiende bevolking te voorsien. Daarom het pasientvloeibestuur die hoeksteen van pasient-prosessering and -deurvloei in hospitale geword om die oneweredige hoe las van siekte te verlig. Om die kwessies rakende ondoeltreffendhede in pasientvloei en onondersoekte Suid-Afrikaanse pasientvloeipraktyke saam te vat, poog gesondheidsdienste deurgaans om hul stelsels te verbeter om sodoende die uitdagings wat hul in die gesig staar, aan te spreek. Die realiteit aangaande pasientvloeibestuur in hospitale is heterogeen en metodes om pasientvloei te verbeter, lei nie tot soortgelyke uitkomste nie, maar genoeg bewyse bestaan wat toon dat pasientvloei-verwante metodes en -tegnieke hospitale kan help. Om hierdie rede word daar geglo dat mense se siening van pasientvloei hoofsaaklik deur hul agtergrond en werksomgewing beinvloed word. Hierdie studie het ten doel om die pasientvloeistelsel van GSH te ondersoek. Die navorser beskryf die huidige pasientvloeistelsel van GSH deur middel van inligting verkry uit hospitaalstatistieke, verslae en projekinligting. ’n Vraelys en onderhoude is gebruik om empiriese data in te samel oor hoe verpleegsters, dokters en bestuurders die pasientvloeistelsel beskou. Die voorlopige resultate van die navorsing toon dat operasionele werknemers dit baie moeilik vind om doeltreffende pasientbeweging te versker sonder voldoende vloeiriglyne. Dit word ook getoon dat toegangblok een van die grootste bydraende faktore van verlengde wagtye is. Alhoewel GSH-bestuurders innovasie en verbeterings rakende die pasientvloeistelsel ondersteun, redeneer operasionele werknemers dat addisionele take hul vermoe om hul normale pligte na te kom, bemoeilik wat gevolglik bewys dat bestuurders en operasionele werknemers nie dieselfde visie deel nie. Nóg ’n interessante resultaat is dat pasientvloei nie by GSH gemeet word nie wat dit moeilik maak om verbeteringstrategiee en die impak van nuwe innovasies op pasientvloei te monitor. Na afloop van ’n in-diepte multi-dimensionele analise en bespreking van die voorlopige navorsingresultate word geskikte aanbevelings aangebied wat die pasientvloeibestuurstelsel van GSH kan verbeter