Applying human factors and ergonomics to a healthcare clinic record-keeping process using a community-based participatory research approach in Makhanda

Kingwill, Kirsten Rosemary

Title: Applying human factors and ergonomics to a healthcare clinic record-keeping process using a community-based participatory research approach in Makhanda
Creator: Kingwill, Kirsten Rosemary
Subject: Human engineering
Subject: Clinics Records and correspondence
Subject: Community-engaged research
Subject: Community-based research
Subject: Records management
Date Issued: 2025-04-02
Date: 2025-04-02
Type: Academic theses
Type: Master's theses
Type: text
Identifier: http://hdl.handle.net/10962/479152
Identifier: vital:78265
Description: Background: Healthcare record-keeping is an important process. However, several challenges associated with taking, storing and maintaining accurate records have been identified as a barrier to the quality and safety of care globally and locally in primary healthcare clinics in Makhanda, Eastern Cape, South Africa. In this context, local healthcare providers argue that this stems from the hybrid nature of the system (paper and electronic) and the impact of several systemic challenges. Poor records can result in negative outcomes for patients, healthcare workers and the greater public healthcare system. For example, if patient files are not adequately completed, poor patient care and medico-legal litigation costs may emerge. Furthermore, given that HFE promotes the participation of stakeholders in identifying and resolving workplace challenges, this study adopted a participatory research approach, more specifically a Community-Based Participatory Research (CBPR) approach. This research project, therefore, aimed to explore the barriers and facilitators to record-keeping in a primary healthcare clinic in Makhanda, the adequacy of patient file completeness and reasons as to why files may or may not have been adequately completed, following a CBPR approach. Methods: Following a period of pre-data collection embedding in the clinic to become familiar with the system and the staff and to form a relationship with a community collaborator from the clinic, this study was completed in two broad phases. During Phase 1, observations, informal discussions and semi-structured interviews were conducted with 11 clinic staff members to understand the clinic and record-keeping systems through the work system components and barriers of both systems. Phase 1 data was analysed through thematic analysis and presented by work system components, selected SEIPS 101 tools and a Hierarchical Task Analysis to detail the tasks involved in the record-keeping process. During Phase 2, a comparative assessment of a sample of patient files (n=55) was conducted against a local standard checklist, detailing what was to be completed in patient files. This was done to assess the completeness of different file sections which were analysed through a frequency count. This was followed by three interviews with clinicians, which explored their perceptions on why sections of the records may have been better completed than others. The interviews were then thematically analysed. Results: Administrative staff shortages, a lack of file storage space, limited access to technology such as computers, lost files, and the amount of information to complete in files were identified as the major challenges associated with the record-keeping system and influencing the completion of patient files. Through the analysis of patient files, it was found that some patient file sections were completed more adequately than others. For example, administrative details were the most well-completed section, and the Anti-Retroviral Therapy (ART) initiation section was the most poorly completed. The findings also revealed reasons as to why these sections may or may not have been adequately completed. These included the need for the duplication of information, particularly for antenatal care clinicians. Time pressure for clinicians to see and complete patient records and work ethic and accountability were additional emergent themes. Lastly, clinicians argued that having a lack of access to, a shortage of or broken medical and record-keeping equipment that inhibited clinicians from obtaining and recording patient information, were additional reasons for poorly taken records. Conclusions: As the findings revealed, the primary healthcare clinic and its hybrid record-keeping system and process were influenced by a variety of clinic and record-keeping challenges that interacted and ultimately influenced the record-keeping process and completeness of patient files. The system constraints are important considerations as understanding how the clinic functions under them is a starting point for future system improvement. Furthermore, barriers impacting the record-keeping system influence several key steps in the record-keeping process, including the completion of details within patient files. Here it was found that some sections and information details were more adequately completed than others, which impacted the continuity, quality and safety of patient care. Additionally, the discrepancies found between the standard checklist and patient files were highlighted as a point of concern for the Department of Health (DoH) as clinics were being assessed based on a checklist that did not match the patient files, incorrectly representing the completeness of files to the DoH. Throughout the research project, the application and implementation of HFE and CBPR have been shown to be important in the local healthcare record-keeping system in that real-world challenges were identified through the perspective of community members facing the challenges. Therefore, HFE researchers should adopt a CBPR approach and apply these complementary domains in other complex systems and varying contexts to comprehensively understand the barriers, facilitators and opportunities for human-system interaction improvements.
Description: Thesis (MSc) -- Faculty of Science, Human Kinetics and Ergonomics, 2025
Format: computer
Format: online resource
Format: application/pdf
Format: 1 online resource (169 pages)
Format: pdf
Publisher: Rhodes University
Publisher: Faculty of Science, Human Kinetics and Ergonomics
Language: English
Rights: Kingwill, Kirsten Rosemary
Rights: Use of this resource is governed by the terms and conditions of the Creative Commons "Attribution-NonCommercial-ShareAlike" License (http://creativecommons.org/licenses/by-nc-sa/2.0/)

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