Improving service delivery at a public health care clinic through a quality management system : the case of Hartebeeskop Clinic in Elukwatini, Mpumalanga

Abstract

Service quality challenges in public healthcare clinics in South Africa are multi-faceted and complex. Resource constraints, staff-related challenges, and patient-related challenges are healthcare providers' primary obstacles in providing high-quality service. These challenges are interrelated and can have a significant impact on the quality of service provided to patients. The implementation of a Quality Management System (QMS) can have significant benefits for public healthcare clinics in South Africa, including improvements in patient satisfaction, quality of care, and staff morale. QMS can also help to address some of the challenges facing public health care clinics in South Africa, including resource constraints, resistance to change, inadequate training and support, cultural and language barriers, and a lack of effective leadership and governance. However, successful QMS implementation requires adequate resources, effective training and support, successful communication and buy-in from all stakeholders, good leadership and governance, and sustained monitoring and evaluation. Therefore, there is a need for a concerted effort to support the implementation of QMS in public health care clinics in South Africa, including policy support, funding, training and support, and ongoing monitoring and evaluation. Numerous studies have been conducted to evaluate the effectiveness of QMS in the public clinics in South Africa. The studies have assessed the impact of QMS on various aspects of healthcare services, such as patient outcomes, healthcare workers' satisfaction, and healthcare system performance. However, in all these studies, a gap still emerges in that in some studies, only patients were participants, while in others, only health care providers were participants. This research project aimed to Improve service delivery at a public health care clinic through a Quality Management System: The case of Hartebeeskop Clinic in Elukwatini, Mpumalanga. By ascertaining the challenges and gaps in service delivery at the Hartebeeskop Clinic and to improve service delivery, by discovering the gaps in service delivery at the clinic through conducting a survey amongst patients and conducting interviews with the health care providers to ascertain the effectiveness of the QMS that is currently in place at the clinic by document analysis. The study also set out to establish how the health sector can realise the provision of quality service delivery to the community, as enshrined in the South African Constitution, Act 108 of 1996. A pragmatist paradigm was deemed to be most suitable for this study because the researcher gathered quantitative data from patients and qualitative data from clinic staff, thus enabling a complete picture of the phenomena under study to emerge. The study employed a mixed methods research design and as a result, the researcher was able to corroborate the findings and better interpret them and give a deeper understanding to the study. The researcher adopted phenomenology as a design in quantitative research because the researcher sought to understand how patients experience the service delivered by the healthcare providers, in addition to exploring the experiences and perspectives of patients and healthcare providers. For the quantitative part of the study, the research had a population of 6000 patients and the sample size of 364 patients. The researcher used Kaur’s (2018) formula to find the sample size for a quantitative study. The participants were selected using systematic probability sampling. The researcher chose every 3rd patient who did not answer previously and agreed to participate in the study; for patients who refused to participate, the researcher asked the next patient. The population for the qualitative study was 18 healthcare givers. Therefore, there was no sampling because the population was small, and all healthcare providers were interviewed. Reliability assumes that data collection instruments and procedures will produce consistent results. The researcher used the software SPSS version 20 for Windows 11 for data analysis. According to Heris (2018), a construct or variable is said to be highly reliable if it provides a Cronbach Alpha value of > 0.7- 0.9. The researcher used Cronbach's Alpha to determine the reliability of the questionnaire. This study recommends that the government ensures that there is improvement in resource allocation to public healthcare institutions, so that public institutions provide quality service delivery and quality healthcare services to customers. The National Health Department must ensure that all public institutions implement the National Core Standards (NCS); Batho Pele principles should be familiar to staff to ensure patients’ rights and to enhance service delivery at the public clinic. Reducing staff attitudes at Hartebeeskop Clinic is an essential endeavour. The challenges faced by healthcare workers in these settings are numerous, but with the right strategies and a commitment to improving the work environment, positive change is possible. By addressing issues such as resource allocation, communication, training, and organisational culture, Hartebeeskop Clinic can create a more positive atmosphere for both staff and patients. Continuous monitoring and adaptation of these strategies are key to long-term success in improving staff attitudes and, consequently, the quality of care provided to the community. The study’s contributions include an identification of key service delivery factors and demonstration of QMS effectiveness, providing valuable insights for healthcare quality improvement in public clinics.