An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
- Full Text:
- Date Issued: 2018
An assessment of quality health care in the operating theatres of Frere Hospital in the Eastern Cape
- Authors: Bennett, Fabion Charton
- Date: 2018
- Subjects: Medical care Surgical instruments and apparatus -- Safety measures
- Language: English
- Type: Thesis , Masters , MPH
- Identifier: http://hdl.handle.net/10353/13425 , vital:39660
- Description: BACKGROUND: Operating theatres are one of most expensive resources in a hospital. The management of operating theatres is complex due to the conflicting priorities and preferences of all stakeholders. Operating theatres also pose one of the greatest medico legal risks to any hospital. This study was conducted at Frere Hospital in East London to assess the functioning of the operating theatre system. The focus of this study was on Pre-operative categorisation of emergency cases, the utilisation of the World Health Organisation Safety Checklist, compliance to the National Core Standards for Health, the effectiveness of governance and review processes, theatre staffing as well as theatre efficiency indicators (start time/tardiness, utilisation, turn-around time, re-admission to theatre rate, cancellation on day of procedure, slate under/over runs, Anaesthetic time as a percentage of theatre time). OBJECTIVE: The purpose of this study was to promote the adherence to the various operating theatre universal approaches by operating theatre staff with the goal of reducing costs and errors caused by poor quality in operating theatres and improving the overall health system. METHOD: In this research a convergent parallel mixed method research design was applied. The research was non-experimental and descriptive in approach, using a mixed method questionnaire, a structured open ended interview, a structured infrastructure assessment, a structured observation checklist and an audit of patient files for a review of emergency surgical cases. Data was collected during October 2016 and January 2017.The study population consisted of 13 operating rooms across 6 operating theatre suites, surgical management staff as well as clinical and nursing staff in the operating theatres at Frere Hospital in East London. RESULTS: The study showed opportunities for improvement in the overall management of the operating theatres to ensure efficient quality care; the data from the observations, questionnaires, interviews as well as the analysis of the efficiency indicators consistently showed that an effective process of operating theatre governance and performance is non-existent, the Pre- operative categorisation of emergency cases is inconsistently applied, the compliance to the principles of the World Health Organisation Safety Checklist Is very low, theatre nursing staff levels per case is low, staff are also demotivated and theatre efficiency indicators require improvement. During this study, the Paediatric theatre suite appeared to be well run and compliant with opportunity to increase theatre utilisation, the casualty theatre is underutilised and has potential to be utilised as an enabler to improve the efficiency of other theatres. The main theatre and endoscopy suites have opportunities to improve its compliance to universal operating theatre quality and efficiency standards, the Orthopaedics and Obstetrics theatre suites, however, require urgent improvement focus. DISCUSSION: According to the findings, a structured operating theatre governance and performance review processes should be implemented with the intention of ensuring consistency across the management of the 6 operating theatre suites in the hospital. A review of staffing allocation and relative task allocation should be conducted. Interventions should be implemented to increase utilisation rates, improve the pre-operative categorisation of emergency cases, improve the compliance to the principles of the World Health Organisation Safety Checklist, reduce case start time variance/tardiness, reduce cancellation on day of procedure, increase anaesthetic time as a percentage of theatre time by introducing pre- anaesthetic induction prior to the patient being wheeled into the operating room.
- Full Text:
- Date Issued: 2018
The role of migrants in the Pan Africanist struggle for liberation from 1962 to 1963 : the case of Cofimvaba
- Authors: Mwanda, Sindiswa Christina
- Date: 2018
- Subjects: South Africa -- History -- 1962-1963 South Africa -- Politics and government -- 1962-1963
- Language: English
- Type: Thesis , Masters , History
- Identifier: http://hdl.handle.net/10353/9883 , vital:35107
- Description: The perspective of South African liberation history needs to be balanced by recalling events that might otherwise be overshadowed by the subsequent electoral dominance of the African National Congress since 1994. This study is concerned with one such: the Cofimvaba struggles of 1962-3 which was organised by Cofimvaba migrants under the ideology of the Pan Africanist Congress. Whereas previous historians have based their accounts mainly on trial records, this thesis strives to recover the migrants’ own perspective through intensive and detailed interviews with the surviving veterans. It aims to provide an accurate historical account of the role played by migrant labourers, thereby correcting the historical distortions arising from overreliance on official sources to record the memories and perceptions of the struggle veterans, as exemplified by transcripts of interviews with and thereby provide some balance to the overall perspective of South African liberation history. The thesis opens with a description of the situation on the ground in Cofimvaba and Western Thembuland which gave rise to resistance. It continues with a discussion of the Pan-African Congress, especially in the Western Cape, the labour centre where most Cofimvaba migrants were concentrated. It proceeds to a detailed narrative of the events in Cofimvaba, more especially the battle of Ntlonze. The final chapter concludes with a critical reassessment of previous historical work, showing that the role of the migrants and the non-elite require greater appreciation and respect.
- Full Text:
- Date Issued: 2018
- Authors: Mwanda, Sindiswa Christina
- Date: 2018
- Subjects: South Africa -- History -- 1962-1963 South Africa -- Politics and government -- 1962-1963
- Language: English
- Type: Thesis , Masters , History
- Identifier: http://hdl.handle.net/10353/9883 , vital:35107
- Description: The perspective of South African liberation history needs to be balanced by recalling events that might otherwise be overshadowed by the subsequent electoral dominance of the African National Congress since 1994. This study is concerned with one such: the Cofimvaba struggles of 1962-3 which was organised by Cofimvaba migrants under the ideology of the Pan Africanist Congress. Whereas previous historians have based their accounts mainly on trial records, this thesis strives to recover the migrants’ own perspective through intensive and detailed interviews with the surviving veterans. It aims to provide an accurate historical account of the role played by migrant labourers, thereby correcting the historical distortions arising from overreliance on official sources to record the memories and perceptions of the struggle veterans, as exemplified by transcripts of interviews with and thereby provide some balance to the overall perspective of South African liberation history. The thesis opens with a description of the situation on the ground in Cofimvaba and Western Thembuland which gave rise to resistance. It continues with a discussion of the Pan-African Congress, especially in the Western Cape, the labour centre where most Cofimvaba migrants were concentrated. It proceeds to a detailed narrative of the events in Cofimvaba, more especially the battle of Ntlonze. The final chapter concludes with a critical reassessment of previous historical work, showing that the role of the migrants and the non-elite require greater appreciation and respect.
- Full Text:
- Date Issued: 2018
Understanding the role of the media in Zimbabwe African Union-Patriotic Front (ZANU-PF) factional fights and the representations of the Lacoste faction in Zimbabwe public discourses
- Mauswa, Desmond Tagara Tavengwa
- Authors: Mauswa, Desmond Tagara Tavengwa
- Date: 2018
- Subjects: ZANU-PF (Organization : Zimbabwe) Political parties Mass media
- Language: English
- Type: Thesis , Masters , MSoc
- Identifier: http://hdl.handle.net/10353/12582 , vital:39290
- Description: This thesis sought to critically examine the origins, nature and impact of ZANU PF factionalist tendencies and how a particular faction headed by former Vice President Emmerson Dambudzo Mnangagwa was represented in Zimbabwean public discourses. Drawing from comparative politics, history, media studies and Zimbabwean current affairs, this interdisciplinary narrative detailed how the new media played a central role in precipitating factional implosion in the liberation war based political party (ZANU PF). Clearly, ZANU PF internecine conflicts in and outside the state controlled and new media had far-reaching socio-economic and political ramifications as rival ZANU PF factions resorted to dirty strategies and tactics to try and weaken and outwit each other. These political machinations took the form of slandering, use of hate speech, dissemination of fake news, assassinations and poisoning among others. As the battle for factional supremacy raged on, the Zimbabwean economy continued on a downward spiral due to inter alia policy contradictions and uncertainty but at the end, November 2017 saw Mugabe being unexpectedly deposed in a coup after 37 years in power. This study went on to identify a number of factors that were working against Mugabe’s patient and heir apparent – Mnangagwa, as he sought to take over the reins of power. These included inter alia the presence and close proximity of the G40 faction linked to the first family but opposing the former vice president, his tainted political record as a result of his involvement in the Matabeleland massacre of the Ndebele ethnic group in the 1980s, allegedly masterminding and engineering electoral fraud in 2008 and having been Mugabe's right hand man for almost four decades. On the other hand, findings from this study suggest that Mnangagwa’s liberation war credentials and his close association with the military and the war veterans played a pivotal role in assisting him to land the presidency following Mugabe’s forced resignation or what was defined by many as a coup. While the Lacoste faction eventually prevailed over their G40 rivals, the study concluded that ZANU PF factionalism negatively impacted on governmental decisions, policies and systems and the aftermath of the military coup continues to pose serious challenges to Zimbabwe’s political future however defined.
- Full Text:
- Date Issued: 2018
- Authors: Mauswa, Desmond Tagara Tavengwa
- Date: 2018
- Subjects: ZANU-PF (Organization : Zimbabwe) Political parties Mass media
- Language: English
- Type: Thesis , Masters , MSoc
- Identifier: http://hdl.handle.net/10353/12582 , vital:39290
- Description: This thesis sought to critically examine the origins, nature and impact of ZANU PF factionalist tendencies and how a particular faction headed by former Vice President Emmerson Dambudzo Mnangagwa was represented in Zimbabwean public discourses. Drawing from comparative politics, history, media studies and Zimbabwean current affairs, this interdisciplinary narrative detailed how the new media played a central role in precipitating factional implosion in the liberation war based political party (ZANU PF). Clearly, ZANU PF internecine conflicts in and outside the state controlled and new media had far-reaching socio-economic and political ramifications as rival ZANU PF factions resorted to dirty strategies and tactics to try and weaken and outwit each other. These political machinations took the form of slandering, use of hate speech, dissemination of fake news, assassinations and poisoning among others. As the battle for factional supremacy raged on, the Zimbabwean economy continued on a downward spiral due to inter alia policy contradictions and uncertainty but at the end, November 2017 saw Mugabe being unexpectedly deposed in a coup after 37 years in power. This study went on to identify a number of factors that were working against Mugabe’s patient and heir apparent – Mnangagwa, as he sought to take over the reins of power. These included inter alia the presence and close proximity of the G40 faction linked to the first family but opposing the former vice president, his tainted political record as a result of his involvement in the Matabeleland massacre of the Ndebele ethnic group in the 1980s, allegedly masterminding and engineering electoral fraud in 2008 and having been Mugabe's right hand man for almost four decades. On the other hand, findings from this study suggest that Mnangagwa’s liberation war credentials and his close association with the military and the war veterans played a pivotal role in assisting him to land the presidency following Mugabe’s forced resignation or what was defined by many as a coup. While the Lacoste faction eventually prevailed over their G40 rivals, the study concluded that ZANU PF factionalism negatively impacted on governmental decisions, policies and systems and the aftermath of the military coup continues to pose serious challenges to Zimbabwe’s political future however defined.
- Full Text:
- Date Issued: 2018
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