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Health SA Gesondheid (Online)

versão On-line ISSN 2071-9736
versão impressa ISSN 1025-9848

Health SA Gesondheid (Online) vol.13 no.1 Cape Town  2008




Outpatients' experiences of quality service delivery at a teaching hospital in Gauteng



Ebin J ArriesI; Odette NewmanII

IM Cur, D Cur, M Phil (Ethics). Senior Lecturer, Department of Nursing Science, University of Johannesburg
IIB Cur student (IV), Department of Nursing Science, University of Johannesburg





Quality service delivery to the consumer of health is a legal reality as it is emphasised in the White Paper on the Transformation of Public Service delivery (South Africa, 1997). The guiding philosophy adopted within this framework is that of Batho Pele, which means placing the consumer at the centre of healthcare service delivery. Increasing attention has been paid to hospital processes from a quality perspective. By analogy, outpatient departments can be viewed as industrial plants where technological know-how is transferred to patients through service delivery, which is a cornerstone of a hospital's business. Outpatients, as consumers of healthcare, draw conclusions about the quality of service delivery based on their experiences of such services. In this vein, an outpatient's experience of a particular service is an indicator of his/her level of satisfaction with the quality of that service. No South African study can be found in the literature on out-patients' experiences of quality service delivery. This study's purpose is to explore and describe outpatients' experiences of the quality of service delivery at a teaching hospital in Gauteng. A qualitative, explorative, descriptive study that was contextual in nature was conducted to achieve this aim. Focus group interviews were conducted with outpatients who met the selection criteria. Open coding was used to analyse the contents from the transcripts and field notes typed verbatim. Strategies for trustworthiness, namely co-coding, prolonged engagement, triangulation and adequate referencing, were employed to ensure the credibility of the study and research findings. The results reflect themes that were reduced into two main categories, namely positive and negative experiences. The positive experiences reflect outpatients' experience of their relationship with medical staff and their satisfaction with the quality of medical care. Negative experiences relate predominantly to a lack of service commitments, unethical context, and inter-personal relationship difficulties that render them powerless and dehumanised. Recommendations are made to improve the quality of service delivery at outpatient departments.

Keywords: experiences; out-patients; quality; service delivery; dehumanisation


Gehalte dienslewering aan die verbruiker van gesondheidsorg is 'n wetlike realiteit wat in die Witskrif op die Transformasie van die Openbare Dienste (South Africa, 1997) beklemtoon word. Die rigtinggewende filosofie wat in hierdie raamwerk aangeneem word is die van Batho Pele, wat beteken dat die verbruiker van gesondheidsorg op die voorgrond geplaas word. Vanuit 'n gehalte perspektief word daar toenemend aandag aan hospitaalprosesse gegee. Analogies, kan 'n buite-pasiëntdepartement gesien word as 'n industriële area waar die tegnologiese kennis aan pasiënte oorgedra word deur dienslewering, wat 'n hoeksteen van die besigheid van 'n hospitaal is. Buitepasiënte as verbruikers van gesondheidsorg maak gevolgtrekkings oor gehaltedienslewering op die basis van hulle belewenisse van sodanige dienste. In dié opsig, is 'n pasiënt se belewenis van 'n bepaalde diens 'n aanwysing van sy/haar vlak van tevredenheid met die gehalte van daardie diens. Geen Suid-Afrikaanse studie oor buite-pasiënte se belewenisse van gehaltedienslewering kon in die literatuur gevind word nie. Die doelstelling van die studie is om buite-pasiënte se belewenisse van die gehalte van dienslewering by 'n opleidingshospitaal te verken en te beskryf. 'n Kwalitatiewe, verkennende, beskrywende studie wat binne 'n spesifieke konteks plaasvind, is uitgevoer. Fokusgroeponderhoude is gevoer met buite-pasiënte wat aan die seleksie-kriteria voldoen het. Oop-kodering is gebruik om die inhoud van die verbatim getranskribeerde transkripsies en veldnotas te analiseer. Strategieë vir vertrouenswaardigheid, naamlik mede-kodering, verlengde betrokkenheid, kruisvalidasie en voldoende verwysing is toegepas om die geloofwaardigheid van die studie en navorsingsbevindinge te verseker. Resultate reflekteer temas wat binne twee hoofkategorieë gereduseer is, naamlik positiewe en negatiewe belewenisse. Positiewe belewenisse reflekteer buite-pasiënte se belewenisse van hulle verhoudings met mediese personeel asook hulle tevredenheid met die gehalte van mediesesorg. Negatiewe belewenisse hou hoofsaaklik verband met 'n gebrek aan diensleweringverbintenisse, 'n onetiese konteks, asook interpersoonlike verhoudingsprobleme wat hulle magteloos en verontmenslik laat voel. Aanbevelings word gemaak om die gehalte van dienslewering binne buite-pasiënte-afdelings te verbeter.



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ABBOTT, P & LEWRY, S 1999: Front office: Procedures, social skills, yield and management. Oxford: Butterworth & Heinemann.         [ Links ]

ACCREDITATION MANUAL FOR HOSPITALS, 1990: Chicago: Joint Commission on Accreditation of Healthcare Organizations.         [ Links ]

AGULAIR, L & STOKES, L 1996: Multicultural customer service. Illinois: Malloy Lithographing.         [ Links ]

BATE, P 1994: Strategies for cultural change. Oxford: Butterworth Heinemann.         [ Links ]

BECKER, P 2006: Assessing the quality of service provision for people with challenging needs placed out of borough. Learning Disability Review, 11(4):12-18.         [ Links ]

BELL, R; KRIVICH, M & BOYD, M 1997: Charting patient satisfaction. Marketing Health Service, 17(2):22-29.         [ Links ]

BROWN, ER 1991: Community action for health promotion: A strategy to empower individuals and communities. International Journal of Health Services, 21(3):441-456.         [ Links ]

CACERES, RC & PAPAROIDAMIS, NG 2007: Service quality, relationship satisfaction, trust, commitment and business-to-business loyalty. European Journal of Marketing, 41(7/8):836-866.         [ Links ]

CAREY, RG 2000: Measuring healthcare quality: How do you know your care has improved? Evaluation and the Health Professions, 23(1):43-57.         [ Links ]

CRESWELL, JW 1994: Research design: Qualitative and quantitative approaches. London: Sage.         [ Links ]

DEMING WE 1991: Out of crisis. Cambridge: Cambridge University Press.         [ Links ]

DONABEDIAN, A 1988: The quality of care: How can it be assessed? Journal of the American Medical Association, 260:1743-1748.         [ Links ]

DRENNAN, D 1992: Transforming company culture. London: McGrawHill.         [ Links ]

DUNN, JD 1998: Powerlessness regarding health-service barriers: Construction of an instrument. Nursing Diagnosis, 9(4):136-142.         [ Links ]

FERNS, T 2006: Violence, aggression and physical assault in healthcare settings. Nursing Standard, 21(13):42-46.         [ Links ]

FETZER, SJ 2003: Professionalism of associate degree nurses: The role of self-actualization. Nursing Education Perspectives, 21(3):139-143.         [ Links ]

GILMORE, J 2006: Violence in the workplace. Nephrology Nursing Journal, 33(3):254.         [ Links ]

HARTRICK, G 1998: Developing health promotion practices: A transformative process. Nursing Outlook, 46(5),September/October:219-225.         [ Links ]

HIIDENHOVI, H; NOJONEN, K & LAIPPALA, P 2002: Measurement of outpatients' views of service quality in a Finnish university hospital. Journal of Advanced Nursing, 38(1):59-67.         [ Links ]

JAMES, C 2005: Manufacturing's prescription for improving healthcare quality. Hospital Topics, 83(1):2-8.         [ Links ]

KALISCH, BJ & AERBERSOLD, M 2006: Overcoming barriers to patient safety. Nurse Economics, 24(3):143-155.         [ Links ]

KAPLAN, H & SADOCK, B 1998: Synopsis of Psychiatry; 8th edition. Philadelphia: Lippincott Williams & Wilkens.         [ Links ]

KATZ, A 1993:"Measuring technology's business value". Information Systems Management, 10(1):33-39.         [ Links ]

KATZ, JM & GREEN, 1992: Managing quality: A guide to system-wide performance management in healthcare; 2nd edition: St Louis: Mosby-Year Book.         [ Links ]

KATZ, JP & SEIFER, DM 1996: "It's a different world out there". Human Resource Planning, 19(2):32-47.         [ Links ]

KENNEDY, I 2001: Learning from Bristol: The report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary, 1984-1995. CM 5207(1). London: The Stationery Office.         [ Links ]

KERSBERGEN, AL 1996: Case management: A rich history of coordinating case to controls. Nursing Outlook, 44(4):169-172.         [ Links ]

KILIAN, JG 1995: Critical care costs: Our challenge for the future. South African Medical Journal of Critical Care, 85(5):419-420.         [ Links ]

KITSON, A; HARVEY, G & HYNDMAN, S 1998: Approaches to implementing research in practice. Quality Healthcare, 7(3):149-159.         [ Links ]

KRUG, EG; MERCY, JA; DAHLBERG, LL & ZWI, AB 2002: The world report on violence and health. Lancet, 360(9339):1083-1088.         [ Links ]

KRUEGER, RA 1994: Focus groups: A practical guide for applied research; 2nd edition. London: Sage.         [ Links ]

LASALA, KB & NELSON, J 2005: What contributes to professionalism. Medsurg Nursing, 14(1):63-67.         [ Links ]

LAZARUS, IR & BUTLER, K 2001: The promise of six sigma (Part 1). Managed Healthcare Executive, 13(1):22-26        [ Links ]

LEDGER, S & SHUFFLEBOTHAM, L 2006: Assessing the quality of service provision for people with challenging needs placed out of borough. Learning Disability Review, 11(4):19-27.         [ Links ]

LIN, L & LIANG, BA 2007: Addressing the nursing work environment to promote patient safety. Nursing Forum, 42(1):20-30.         [ Links ]

LINCOLN, YS & GUBA, EG 1985: Naturalistic inquiry. New York: Sage.         [ Links ]

MCCORMACK, B; KITSON, A; HARVEY, G; RYCROFT-MALONE, J & SEERS, K 2002: Getting evidence into practice: The meaning of "context". Journal of Advanced Nursing, 38(1):94-104.         [ Links ]

MITRA, I & ALEXANDER, R 2003: Out-of-the-area placements: Implications of psychiatric services in learning disability. Psychiatric Bulletin, 27(6):382-385.         [ Links ]

MOKWENA, K 1997: Empowerment as a tool for community health development. CHASA, Journal of Comprehensive Health, 8(2):66-70.         [ Links ]

MULLER, M 1996: Nursing dynamics. Johannesburg: Heinemann.         [ Links ]

PERA, SA & VAN TONDER, S Eds 2005: Ethics in healthcare; 2nd edition. Landsdowne: Juta.         [ Links ]

ROBERTS, SL 1986: Behavioural concepts and the critically ill patient; 2nd edition. East Norwalk, CT: Appleton & Lange.         [ Links ]

SECREST, JA; NORWOOD, BR & KEATLEY, VM 2003: "I was actually a nurse": The meaning of professionalism for baccalaureate nursing students. Journal of Nursing Education, 42(2):77-82.         [ Links ]

SEARLE, C & PERA, SA 1998: Professional practice: A Southern African nursing perspective. Durban: Butterworths.         [ Links ]

SMITH-PITTMAN, MH & MCKOY, YD 1999: Workplace violence in healthcare environments. Nursing Forum, 34(3):5-13.         [ Links ]

SOUTH AFRICAN NURSING COUNCIL 1984: Regulation relating to the Scope of Practice of persons who are registered or enrolled under the Nursing Act, 1978. Regulation 2598. Pretoria: South African Nursing Council.         [ Links ]

SOUTH AFRICA, 1997: White Paper on the transformation of Public Service delivery (Batho Pele). Notice 1459 of 1997. Pretoria: Government Press.         [ Links ]

TESCH, R 1990: Qualitative research: Analysis types and software tools. New York: The Falmer Press.         [ Links ]

VAN VUUREN, L Undated: Institutionalising business ethic: A multi-level ethics strategy (In: Rossouw, D & Van Vuuren, L 2004: Business Ethics. M. Phil (Ethics). Reader for FIL 1308, Module 2. Auckland Park: University of Johannesburg).         [ Links ]

WEBSTER'S THIRD NEW INTERNATIONAL DICTIONARY 1986: Springfield, MA: Merriam-Webster.         [ Links ]

WILLIAMS, RP 1998: Nurse leaders' perceptions of quality nursing: An analysis from academe. Nursing Outlook, 46(6):262-267.         [ Links ]

WIMBUSH, JC; SHEPHARD, JM & MARKHAM, SE 1997: An empirical examination of the relationship between ethical climate and ethical behaviour from multiple levels of analysis. Journal of Business Ethics, 16(16):1705-1716.         [ Links ]

WORLD HEALTH ORGANIZATION 1986: Ottawa Charter for health promotion. Ottawa: Health and Welfare Canada.         [ Links ]



Ebin J Arries

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