FACTORS INFLUENCING SCALING UP QUALITY OF REFERRAL PROCESSES IN - - PowerPoint PPT Presentation

FACTORS INFLUENCING SCALING UP QUALITY OF REFERRAL PROCESSES IN KENYA: A STUDY OF KENYATTA NATIONAL HOSPITAL.

AGNES CHIKA MSc -HSM Fellowship in Quality Management in Health Care (Germany) THURSDAY 15 JUNE 2017

Background of the study

• The study investigated factors influencing scaling up quality
• f referral processes in Kenya.
• This study was conducted at Kenyatta National Hospital.
• Referral process is whereby an initiating facility refer patients

to another facility that can better provide the level of care needed (Ramirez B, 2013).

• Quality health care falls under Service delivery, one of the six

health system strengthening building blocks (WHO, 2007).

Background Cont’d..

• Referral process can be streamlined through;
• Appropriate communication,
• Implementation of standardized guidelines and policies.

(Barouch P.G, 2011; Zadry &Yusof, 2009).

• These interventions lead to effective referral systems, and;
• Ensures continuity and promptness of care hence reduces mortality rate

(Bowling A. & Redfern J, 2006).

Objectives of the study

• To determine the factors influencing scaling-up of quality

referral processes at KNH.

• Specifically, the study investigated:
• How the management of referrals can scale up the quality

referral processes at KNH.

• How the pre-referral communication

scale-up the quality referral processes at KNH.

• How referral staff can scale up quality referral process at KNH.

Methodology

Study design: The study adopted a descriptive cross – sectional,

retrospective study design.

• Sampling Technique: The desired sample size was

determined using the Fisher et al. formulae and 384 number of patient health records were entered between June and August 2015.

• The 10% Gay principle was adopted for computation of the

sample size of staffs and 100 staffs were sampled.

Methodology Cont’d..

• Data collection procedures:

Self-administered structured questionnaire and a checklist. .

• Data analysis was done using SPSS Version 21
• Data presentation:

Statistical tables, Bar graphs and Pie Charts

Ethical considerations

• Ethical Considerations
• Approval of the study was obtained from KeMU Ethical Research

committee,

• KNH & UON Ethics and Research Committee.
• A

study registration certificate from KNH research and programmes department.

Findings and Discussions

Gender Of The Respondent

Majority of the referrals were male 246(64.1%). Female referrals comprised 138(35.9%). Disagrees with Ayeni B. et al, (2007) who found out that referral to tertiary hospitals was common amongst females because of the perception of quality maternal and newborn health services offered particularly during delivery.

• Fig. 4.1.

Age Of Referred Patients

• Fig. 4.2
• Agrees with Ayeni B. et al, (2007) who found out that referral to

tertiary hospitals was common on patients above 50 years.

Health Care Providers

Majority of the respondents 28(32.6%), were staff from A&E , Neurosurgeon 13(14%), physician 6(5.8%), ophthalmologist 3(3.5%), 1(1.2%) Anesthetist, 1(1.2%) ENT doctor, 1(1.2%) dentist, and 35(40.7%) indicating others.

• Fig. 4.3

Management of referrals; Staff's Knowledge On Existence Of Policy Objective 1 Tab.4.1 Referral policy Frequency(n) Percent(%) Yes 25 25 No 39 39 I don’t know 36 36 Total 100 100

• Junghans C. et al, (2007); policy increases the effectiveness of changing referral

timeline, continuity of care and pre-referral management.

Staff's Knowledge On Existence Of Guidelines Tab.4.2 Referral guidelines Frequency (n) Percent (%) Yes 28 28 No 43 43 Don’t know 29 29 Total 100 100

• Junghans C. et al, (2007);referral guidelines can be effective in changing referral

behaviors.

Staff's Knowledge On Existence Of Standard Operating Procedure

Tab.4.3

The staff’s knowledge on Existent

• f Standard Operating

Procedure Frequenc y (n) Percent (%) Yes 27 27 No 37 37 Don’t know 36 36 Total 100 100

• The findings are in agreement with Franks. O.S.W, (2009); SOPs establish a systematic

way of doing work and ensure that work is done consistently.

Referral Channels Of Communications Objective 2

• FIG. 4.5
• A study by Speed C.A. (2008) indicated that lack of clear communication channels among

facilities in a referral network increases patients mortality.

Documents Submitted

Tab.4.4 Documents submitted Frequency (n) Percent (%) Referral letter 65 65 Lab results 23 23 X-ray results 12 12 Total 100 100

• Agrees with Bodek S. et al, (2006); absence of key information can prevent

reliable decisions with regard to triage.

Previous Treatment / Investigations Before Referral

• Fig. 4.6

Findings agree with Williams PT, (2009); information gaps including; poor explanation of why the patient is being referred and missing clinical information, provisional diagnosis affects the management of referral patients. .

Knowledge Of Health Care Provider On Referral Procedures Objective 3 Tab.4.5

Knowledge of Health care providers on referral procedures

Frequency (n) Percent (%) Yes 13 13 No 80 80 Don’t know 7 7 Total 100 100

• Sibbald B, et al, (2007); inappropriate referrals usually result from lack of knowledge,

skills, insufficient tools and supplies required to treat.

Availability Of Staffs: Person Escorting Patient

• FIG. 4.7
• The referral guidelines MOH (2014); all emergency referrals shall be accompanied

by a trained staff and also the referred clients to receive priority attention at the receiving health facility.

Quality Of Delivery Pre Referral Communication

Referring health worker should communicate directly to the receiving health worker to ensure advance notice of the impending referral to allow adequate preparation and continuity of care for quality of patient care (MOH,2014);

• Fig. 4.8

.

Timeliness Of Care Time Taken Before Seeing A Doctor

Fig 4.9

• Findings disagrees with Levine D. I. (2010); organizational outcomes like promptness of

treatment translates into reduced mortality and increase customer satisfaction.

Referring Institutions

Hospitals near KNH prefer to refer their patients there probably as a result of the affordability, accessibility and quality of services. Tab.4.6

Name of referring Institution Frequency (n) Percent (%) Machakos 51 18.0 Kiambu 36 12.7 Mama Lucy 26 9.2 Muranga D H 22 7.7 Mbagathi 21 7.4 Kikuyu PCEA 14 4.9 Garissa 11 3.9 Embu County 10 3.5 Maragua 9 3.2

Conclusion

• There is inadequate knowledgeable by the staff on the

existence of referral policy and guidelines.

• Referring institution to call before transferring a

patient; avoid investigations duplications, reducing delays, cost to patients and reducing mortality rate.

• Timeliness to see a doctor can be reduced with previous

communication and availing the complete referral documents

Recommendations

• KNH management to disseminate and do awareness of

the referral policy, guidelines and SOPs for the staffs.

• MOH management should ensure Referral tools and

forms are distributed at all levels of the health system.

• The staff allocated at the referral office to ensure

prioritization and prompt treatment of the referred patients.

Recommendations For Further Research

• Future studies is required to examine whether

scaling up referral processes can improve customer satisfaction.

Acknowledgement

• Supervisors: Musa Olouch and Susan Njuguna.
• Mr. Douglass Owino QA Manager and Dr. Mark

Mudenyo, Assistant Director Health information for their guidance and support during the study.

• Research Assistance; Mr. Ali Wagara, Ms Rael Maina

and Mr. Vincent Chagara.

• Kenyatta National Hospital Staff.

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Key References

• Ayeni B, Rushton G. McNulty LM. (2007). improving the geographical accessibility of health care

in rural areas: a Nigerian case study. Social Science and Medicine, 25(10), 1083 – 94.

• Bowling A. Redfern J. (2006.). The process of outpatient referral and care: the experiences and views of

patients, their general practitioners, and specialists. British Journal of General Practice, 50(451), 116–20.

• Franks. O.S.W. (2009). A Theoretical Model for Implementing Quality Management in an Automated
• Environment. International Journal of Control and Automation, 2(2).
• Junghans C, Feder G, Timmis AD, Eldridge S, Sekhri N, Black N, & Shekelle P, Hemingway H. (2007).

Effect of patient-specific ratings vs conventional guidelines on investigation decisions in angina: Appropriateness of Referral and Investigation in Angina (ARIA) Trial. Archives of Internal Medicine, 167(2), 195–202.

• Ministry of Health. (2014). Kenya Health Sector Referral Implementation Guidelines.
• WHO. (2007). everybody’s Business: Strengthening Health Systems to Improve Health Outcomes. WHO’s

Framework for Action, Geneva.

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