ORIGINAL

Niger J Paed 2014; 41 (3):181 –187

Ahmed PA

Sibbel R

Jones C

Level of health care and services in a

tertiary health setting in Nigeria

DOI:http://dx.doi.org/10.4314/njp.v41i3,6

Accepted: 29th January 2014

Abstract: Background: There is a

growing awareness and demand for

quality health care across the

world; hence the need to describe

the level of health care and services

provided to meet the patient cen-

tered care by the frontline stake-

holders.

Aim of study: To determine the

current level of care provided in a

tertiary hospital in a developing

country setting. Study design: pro-

spective, descriptive and question-

naire based survey.

Methods: The study was conducted

at the National Hospital Abuja, a

tertiary care setting in Nigeria. 157

health workers were enrolled, who

responded to questions on the clini-

cal, support and corporate services

of the hospital. Response were

either yes, no or do not know. The

result were analyzed and presented

in tables and charts.

tions well managed to prevent er-

rors and adverse reactions

(75.2%). Infection control and

routine surveillance were low.

Safe blood sample collection

measures (74.5%), measures to

reduce break in skin integrity

(77.7%), and bed sores rare and

effectively managed (38.9%).

Some agreed that patient received

appropriate nutrition (58.0%). In-

formation on patients’ rights and

responsibilities, and continuous

quality control measures rates

were low. Others were adverse

incidences reported and treated

(50.3%), feedbacks mechanism

(66.9%) and complaints manage-

ment rates (54.8%). Hand washing

practice rates were low among

doctors and nurses and patient

relatives. Staff rated that both

workforces planning that

supported needs and recruitment

and appointment systems low.

Records were not updated to meet

with international standards (ICD-

10); (22.9%) and had low rates for

use in future purposes. Also low

were the level of medical and envi-

ronmental research, informal rela-

tionship and security, but the man-

agement had a high level of social

responsibility in form of emer-

gency and disaster management to

the immediate community;

(83.4%).

Ahmed PA⁽

)

Department of Paediatrics,

National Hospital Abuja, Nigeria.

Email: ahmedpatience@yahoo.com

Sibbel R

Frankfurt School of Finance and

Management

Institute of International Health

Management

Frankfurt- Germany

Jones C

National Manager Quality

&Compliance,

Health scope, Australia

Results: Of 157 respondents, 66

males (42.0%) 91 females (58.0%).

Doctors and nurses formed 64.3%

of the study population. 114

(

72.6%) of the health staff agreed

that patients received appropriate

medical needs and treatments, 118

(

75.2%) that care was planned with

patient involvement, 107(68.2%)

that patients were informed of re-

sults and final care processes, 127

(

80.9%) that patient were aware of

consent processes and 112 (71.3%)

that patients at discharge were

aware of their ongoing and subse-

quent care. 90 (57.3%) of the re-

spondents agreed that the patients

records were accurate with pa-

tients’ participation and medica-

Conclusion:

Health workers

agreed that some of the patients’

needs were met.

Key word: Health care, health

workers, services

Introduction

services in a way that is safe, timely, patient centered,

efficient, and equitable . Care delivery involves a com-

1

Health care seeks to diagnose, treat, and improve the

physical and mental well-being of patients across the

lifespan by helping people stay healthy, recover from

illness, live with chronic disease or disability, and cope

plex organizational or structural matrix, by diverse pro-

fessionals. The three basic dimensions of quality in

health care organization include the structure of the

health systems, the processes involved and the eventual

1

2

with death and dying . Quality health care delivers these

outcomes . The structure consists of the care providers

1

82

and whether it’s a hospital, nursing home or clinics set-

ting. The care processes refer to the actual performance

of the activities of care, from identification of patient

need and the patient interaction with the health care sys-

tem; and lastly to eventual outcome as to whether the

person got better or worse or suffered an adverse event

care , and either through the national health insurance or

pay out of pocket.

The study survey was prospective, descriptive and

questionnaire based. The questionnaire was developed

from the EquIP5 standards and criteria document of the

Australian council on healthcare standards (ACHS) -

2

or even died . The poor health care provided to the

American people was highlighted in a committee report

1

2

2010 . The EquiIP5 documents assess levels of clinical,

support and corporate services. The clinical section as-

sesses the care given to the patients in terms of medical

needs, ongoing processes, outcomes and follow up. Oth-

ers include questions on the organization risk identifica-

tion, minimized and managed, patient’s right and re-

sponsibilities, feedbacks. It contained 29 subsections out

of which we generated 20 questions related to this sub-

section for the questionnaire. The support section

(human resource and record information) were based on

the organization workforce and recruitment policies and

medical information system. It contained 20 subsections

out of which four questions were generated. Lastly the

corporate section assessed the organization environ-

mental safety measures and well being of the patients

and staff, emergency responses and security issues. It

has 12 subsections out of which four questions were

generated. A total of 28 questions were included in the

study questionnaire. A pilot survey on 10 participants

was carried out and these were included in the overall

study. They had to be answered as yes, no or do not

know. Only staffs that consented to filling the question-

naire were included. These were randomly selected

among staffs that were on duty in the morning hours

from 8am to 4pm in the various department’s wards and

clinics. Staffs who did not give consent to filling the

questionnaire were excluded.

‘

(

crossing the quality chasm’ of the Institute of Medicine

IOM) in 2001 . That the U.S. health care delivery sys-

1

tem did not provide consistent, high quality medical care

to all people, a care system based on the best scientific

knowledge, which was evidently lacking. Instead it’s

health care harmed patients too frequently and routinely

fails to deliver its potential benefits, with a chasm be-

tween the health care they were receiving and what it

should be. Several factors had combined to create this

chasm, among which were advances in medical sciences

and technology at an unprecedented rate during the past

half-century, the growing complexity of health care,

hence the nation’s health care delivery system failure to

meet the rapid changes to translate knowledge into prac-

tice and to apply new technology safely and appropriate-

1

ly .

Health care services are always associated with some

risks, errors and adverse events, hence the need for

measures that aim at continuous quality assessment and

3

improvements . Medical errors to patients are defined as

a preventable adverse effect of care, whether or not it is

evident or harmful, that includes an inaccurate or incom-

plete diagnosis or treatment of a disease, or care but

executed incorrectly . They may result in little or no

disability, re- admissions, and worse off than no treat-

ment, inconveniences distresses, permanent damage, and

deaths. Medical errors are often described as human

errors in healthcare . Medical errors usually occur in

hospital inpatient settings that may lead to excess length

of stay, extra costs and mortality . Quality health care

may mean different thing to different people , but can be

4

-6

1

3

The sample size was calculated with the formula N=

7

2

z pq/d ; where N was the desired sample size (when

population under study is less than 10,000); z confi-

dence interval at SD=1.96 for 95percent confidence in-

terval; p= prevalence of 10 percent was used (10percent

as estimated rate of adverse events as there was no pre-

vious reports in the environment), q= proportion 1-p; d=

absolute sampling error,₌fixed at 5percent (0.05). N=

8

9

simply defined as getting the right care to the right pa-

1

0

tient at the right time- every time’ . The Institute of

Medicine (IOM) defined it as the ‘the degree to which

health services for individuals and populations increase

the likelihood of desired health outcomes and are consis-

2

3.84*0.10*0.90/ (0.0.05) 138.24; N= 138 plus a 5per-

cent attrition rate = 152.

1

tent with current professional knowledge’ . The aim of

this report is therefore is to describe the current level of

care and services as perceived by the health care profes-

sional and understanding of a patient – centered care as

a measure of quality.

Data was analyzed with student statistical package for

students (SPSS) version 16. Mean, SD, proportion, per-

cent, chi-square x test were calculated and a p value of

<0.05 was considered statistically significant. Ethical

approval was obtained from the hospital Ethical Review/

Institutional Review Board.

2

Methodology

Justification for the study

The study location is the National hospital Abuja, a 350

bedded inpatient tertiary specialist facility that provides

care for the general population. It is staffed with quali-

fied medical consultants and supportive staff, providing

specialist services in the major medical and surgical

fields. Patients are seen in the hospital as either referred

or walk in, in- patients and outpatients (ambulatory)

Providing the right care and services that meets the pa-

tient’s expectations and needs with no harm done should

be the goal of every health care system. Because of the

routine in medical care, most times error occur without

full consideration of a patient's preferences and values,

with health care systems that may be inefficiently and

unevenly distributed across the populations. The report

1

83

of the IOM tagged to “To Err is human” brought to the

fore-light the issues of medical errors and patient mis-

management, and that these errors were system based

because they involved human beings. This led to some

significant reforms in most developed nations that had

high burden of aging population with associated chronic

illnesses, with an increased demand for new technologi-

cal services and drugs, contributing greatly to increasing

cost and wastes. The Nigerian health system still has to

handle a high burden of preventable disease conditions,

with a slowing rising rate of non- communicable dis-

eases, in the presence of poor infrastructure, low fund-

ing, inter-professional disputes, recurrent strikes and a

host of other issues.

measures were taken.

Table 1a: Distribution of the responses of health workers on

patients’ clinical care processes

Parameters

Yes(%)

(CI)

No(%)

(CI)

Do not

know

Total(%)

(%)(CI)

Medical needs/

treatment

114(72.6%)

(0.65, 079)

29(18.5%)

(0.13,0.35)

14(8.9%)

(0.05,0.15)

157(100%)

Identified

Patient involved in

planned care

118(75.2%)

(0.68, 0.81)

27(17.2%)

(0.12,0.24)

12(7.6%)

(0.04, 0.13)

157(100%)

157(100.0)

Patient informed of

result and final care

107(68.2%)

(0.60,0.75)

32(20.4%)

(0.14, 0.28)

18(11.5%)

(0.07,0.18)

Patient informed of

consent process

127(80.9%)

(0.73, 0.87)

14(8.9%)

(0.05, 0.15)

16(10.2%)

(0.06, 0.16)

The ideal situation in care and services should do no

harm, but to provide a level of care that is satisfactory to

the client. Medical science and technology is advancing

rapidly, to which the health care system has to respond.

Patient in the center is demanding his/her rights, and

with globalization, growing medical insurance claims

and litigations, the health care providers must have to

respond appropriately.

Discharged patients

aware of ongoing

and subsequent care

Health records are

Accurate with

112(71.3%)

(0.64, 0.78)

25(15.9%)

(0.11,0.23)

20(12.7%)

(0.08, 0.19)

90(57.3%)

(0.49,0.65)

43(27.4%)

(0.21,0.35)

24(15.3%)

(0.10,0.22)

patients’ participa-

tion

Medications are

managed to prevent

errors/adverse

reactions

118(75.2%)

(0.68, 0.82)

22(14.0%)

(0.09, 0.21)

17(10.8%)

(0.06,0.17)

157(100.0)

Quality in health care is system based and our level of

care must be reviewed frequently to meet up with cur-

rent scientific knowledge and patient satisfaction, hence

in need of urgent redesign. To truly achieve this we

must now focus on the patient as the center in line with

best practices and international standards. With these

global challenges, the aim is to draw attention to the

present level of care and services as viewed by the

health care providers themselves.

Routine surveil-

lance done by

infection control

unit

55(35.0%)

(0.28,0.43)

52(33.1%)

(0.27,0.41)

50(31.8%)

(0.25,0.40)

Safe blood sample

collection

117(74.5%)

(0.67,0.81)

19(12.1%)

(0.07,0.18)

21(13.4%)

(0.08, 0.20)

157(100.0)

One hundred and twenty two (77.7%) agreed that meas-

ures were in place to reduce incidence in skin breaks of

patients, 61(38.9%) that bed sores where rare and effec-

tively managed and 91(58.0%) that patients had appro-

priate nutrition given to them while on admission. Forty

three (27.4%) agreed that patients were informed of their

rights and responsibilities, and 49(31.2%) that continu-

ous quality control measures was in place, 70 (50.3%)

that adverse incidents were reported and treated, 105

Results

1

57 responses were received, males 66 (42.0 %) and

females 91 (58.0%), giving a male: female ratio of 0.73:

. One hundred and one (64.3%) of the respondents

(

66.9) that patients were encouraged to give feed backs

1

and 86(54.8%) that complaints and feedbacks were man-

aged to help improve services as shown in table 1b.

were doctors (50) and nurses (51), 22(14.0%) pharma-

cists and 12(7.6%) laboratory scientists. Others were

physiotherapist (6), records officers (4), nutritionist,

administrators, biologists and statisticians three each.

Hand washing practice was reported in 29(18.5%) of the

doctors, 36(22.8%) of the nurses and in 6(3.8%) of the

patient relatives (p value <0.05) as shown in table 1c

Responses of health workers on patients’ clinical care

processes

Responses of health workers on support services

The health workers agreed that patients’ needs for

medical care and treatments were identified (72.6%),

patients were involved in planned care (75.2%), patients

were informed on results and final care (68.2%), were

aware of consent processes (80.9%) and were given in-

formation at discharge of ongoing and subsequent care

Forty nine (31.2%) health workers agreed that work-

force planning supported needs; 69 (43.9%) that the

recruitment and appointment system was good, 36

(

22.9%) that health records were according to ICD10,

and that the records were useful for future purposes by

4 (47.1%).

7

(

71.3%) as shown in table 1a. Ninety (57.3%) of the

respondents agreed that the patients records were accu-

rate with patients’ participation, 118 (75.2%) that pa-

tients medications were managed to prevent errors and

adverse reactions, 55(35.0%) of staffs reported that rou-

tine surveillance was done by the infection control unit,

and 117(74.5%) that safe blood sample collection

Responses of health workers on corporate services

Of the health workers 5 (3.2%) agreed the hospital en-

couraged and conducted medical and environmental

safety research, 129 (82.2%) that the hospital had no

facilities for both indoor and outdoor games activities,

1

84

1

disaster management to the community and 75 (47.9%)

that the hospital security unit was effective.

31 (83.4%) that the hospital provided emergency and

Table 2: Distribution of the responses of health workers on

support services

Parameters

Yes(%)

(CI)

No(%)

(CI)

Do not

know(%)

Total

(%)

(

CI)

Table 1b: Distribution of the responses of health workers on

patients’ clinical care processes

Workforce plan-

ning support

needs

Good recruitment 69(43.9%)

and appointment

system

Health records

according to

international

code(ICD-10)

Health records

useful for future

purpose

49(31.2%)

(0.24,0.39)

70(44.6%)

38(24.2%)

(0.37,0.53) (0.18,0.32)

157

(100.0)

Parameters

Yes(%)

(CI)

No(%)

(CI)

Do not

know(%)

Total

(%)

44(28.9%)

44(28.0%)

(0.21,0.36) (0.21,0.36)

157

(100.0)

(CI)

(0.36,0.52)

Measures to

reduce break in

skin integrity

Bed sores rare/

managed effec-

tively

122(77.7%) 15(9.6%)

20(12.7%)

(0.08,0.19)

157

(100.0)

(0.70,0.84)

(0.05,0.15)

36(22.9%)

(0.17,0.30)

48(30.6%)

73(46.5%)

(0.23,0.38) (0.39,0.55)

157

(100.0)

61(38.9%)

(0.31,0.47)

40(25.5%)

(0.19,0.33)

56(35.7%)

(0.28,0.44)

157

(100.0)

74(47.1%)

(0.39,0.55)

55(35.0%)

28(17.8%)

(0.28,0.43) (0.12,0.25)

157

(100.0)

Patients’ re-

ceive appropri-

ate nutrition

Patients’ in-

formed of

91(58.0%)

(0.50,0.66)

32(20.4%)

(0.14,0.28)

34(21.7%)

(0.15,0.29)

157

(100.0)

43(27.4%)

(0.21,0.35)

82(52.2%)

(0.44,0.60)

32(20.4%)

(0.14,0.28)

157

(100.0)

Table 3: Distribution of the responses of health workers on

corporate services

rights /

responsibilities

Continuous

quality control

measures in

place

Adverse inci-

dence reported

and treated

Parameters

Yes(%)

CI)

No(%)

(CI)

Do not

know(%)

Total

(%)

49(31.2%)

(0.24,0.39)

58(36.9%)

(0.29,0.450

50(31.8%)

(0.25,0.40)

157

(100.0)

(

(CI)

Hospital encour-

age and conduct

research

5(3.2%)

(0.01,0.07) (0.75, 0.88)

129(82.2%) 23(14.6%)

157

(0.09,0.21) (100.0)

79(50.3%)

(0.42,0.58)

40(25.5%)

(0.15, 0.33)

38(24.2%)

(0.18,0.32)

157

(100.0)

(medical and

environmental

safety)

Patients en-

couraged to

give feed backs

105(66.9%) 35(22.3%)

(0.59,0.74)

17(10.8%)

(0.06,0.18)

157

(100.0)

(0.16,0.30)

Hospital has

facilities for

indoor and out-

door games

Hospital pro-

vides emer-

gency/disaster

management

Effective secu-

rity unit

5(3.2%)

(0.01,0.07) (0.75,0.88)

129(82.2%) 23(14.6%)

157

(0.10,0.21) (100.0)

Complaints and 86(54.8%)

31(19.7%)

(0.14,0.27)

40(25.5%)

(0.19,0.33)

157

(100.0)

feedbacks

managed to

improve

(0.47,0.63)

131

(83.4%)

(0.77,0.89)

11(7.0%)

(0.04,0.12)

15(9.6%)

(0.05,0.15) (100.0)

157

services

Table1c: Distribution of the responses of health workers to

clinical care- hand washing practice

75(47.9%)

(0.40,0.56) (0.27,0.41)

52(33.1%)

30(19.1%)

(0.13,0.26) (100.0)

157

Parameters

Yes(%)

(CI)

No(%)

Do not

know(%)

(CI)

Total(%)

(CI)

Hand washing 29(18.5%)

86(54.8%)

(0.47,0.63)

42(26.8%)

(0.20,0.34)

157

(100.0)

by doctors

before seeing

patients

(0.13,0.25)

Discussion

Hand washing 36(22.9%)

73(46.5%)

(0.39,0.55)

48(30.6%)

(0.23,0.28)

157

(100.0)

This report is on the level of care and services provided

in a tertiary health center, with facilities for both in and

out- patient care. Doctors and nurses accounted for 64.3

by nurses

before seeing

patients

(0.17,0.30)

Hand washing 6(3.8%)

103(65.6%) 48(30.6%)

(0.58,0.73)

157

(100.0)

%

of the care processes. The patient values and prefer-

by relatives

before seeing

patients

(0.01,0.08)

(0.23,0.38)

ences are the pivot in any ‘patient- centered care’ ori-

1

,7

ented process . The health workers’ agreed that most of

the time, the patient’s medical treatment needs are iden-

tified and managed. This would mean that patients had

their conditions properly diagnosed, had appropriate

treatment and expected outcome resulted in recovery

and discharge. This may be a response to justify their

professional competence and skills in the care of pa-

tients, however patient’s n₄eeds are varied, including

2

x

342.83

P<0.05

94.6

235.44

p-value

1

psychological and financial .

Patients to some extent were reported to have been in-

volved in their planned care by the heath workers. Pa-

tient’s involvement should include obtaining informa-

tion from them, access to vital signs and documenta-

tions, involvement in follow up laboratory results, and

seeing that their records match the medical documenta-

tion and information. The report shows that some

1

85

full reporting and₃c_,₇o_,₈n_,₁t₈i_-n₂₂uous medical audit and research

measures in place . The use of patient safety prac-

tices, such as electronic medication errors monitor, bar

coding scanning alert, computerized physician order

entry, use of simulators are current measures to mini-

mize drug errors. These systems are necessary for any

organization that is committed to continuous quality

improvement.

patient were informed of results and final cares; which

may be a reflection of the level of communication be-

tween health workers and patients. When patients are

not fully informed of the results and their final care, the

result in poor coordination and integration of care espe-

cially after discharge and follow up. Health workers

admitted that some discharged patients were aware of

their ongoing and subsequent care. This is particularly

important when patients have chronic conditions and

need long term care, either as outpatients or home ser-

vices. Patients’ were reported to be aware of the consent

processes by 80.0percent respondents. Patient consent

must be sort especially in emergency surgeries as this is

a common point of medical errors. This most times is

achieved through involvement of patient’s relatives for

proper integration of care. Health records were reported

to be accurate and had patients’ participation in 57.3 per

cent. These records were obtained mostly by the attend-

ing physicians and nurses with the record staff from the

patients and relatives. Patient involvement at every level

Complaints and feedback from patients were reported on

the average. Probably these complaints were mostly

against services levels that would include attitude of

health workers, the environment, costs of services and

food. Some feedbacks could also be complementary, in

appreciation of services. Audits and feedback mecha-

nism help bridge the gap of patients’ expectation. Pa-

tients should be encouraged to ask questions and should

be provided with information materials that encouraged

2

3

shared decision making .

1, 3, 9,15,16

of care is the very key to patient- centered care

.

This report showed that the culture of hand washing

was low among health workers and patients’ relatives;

This low level of hand washing among health profes-

sionals₂₄_-a₂n₇d the public has been highlighted by various

Routine surveillance and infection control were rated

low in the responses, which is vital to identify disease

trends as the responsibility under coordination of a multi

reports

Nurses and doctors fail to wash their hands

-

disciplinary team. Some measures to ensure safe blood

the recommend times, between patient contacts and

procedures. The reasons for this low level of hand hy-

giene can be due to the busy hospital and clinics, lack of

soap/ detergent and alcoholic solutions, and running tap

water. Also, the poor attitude of the health workers to

wash t₆h_,₂e₇ir hands has been found to be a contributing

collection and reduce inconveniences to patients and

staff from needle prick injuries and bed sores were ob-

served to be in place as universal prevention. The ability

to effectively manage bed sores is mainly in the domain

of nursing care and is related to the effective use of ap-

propriate bedding materials that prevent bed sores, ap-

propriate nursing care, whether it’s an acute care center

or rehabilitation center. Prolonged hospital stay as seen

in newborns, orthopedic patients with fractures and/ or

neurologic disorder present risk factors, for bed sores

due to long confinement to bed over one week, fecal

incontinence, prolonged d₇ iarrhea, dementia, and other

2

factor . A study report showed that physicians hand

washing rate was 42 percent if the first person failed to

performs hand hygiene,₂b₇ ut the compliance rate rose to

66 percent (p < 0.001),

when the first person leading

the team of physicians in the patient encounter practiced

hand hygiene enforcing the role of peer effect. In what-

ever settings, effective hand washing helps in the pre-

vention and control of infections especially antibiotic

1

hypoalbuminaemia states .

2

8

resistant organisms (AROs) . Relatives were also re-

ported to have very low rate of hand washing, (3.8%)

before attending to the sick patients. This may be a re-

flection of poor hand washing rates outside the hospital

setting. A randomized study report among squatter set-

tlements in Pakistan household showed that hand wash-

ing promotion had a 50% reduction in incidence of

pneumonia, a 53% lower incidence of diarrhea and a

34% lower incidence of impetigo . Patients should be

told and taught the benefits of hand washing to them and

their sick relative because the human hands carry infec-

tions.

This report showed that patients averagely received

appropriate nutrition (58.0 percent). An adequate nutri-

tion and special diet for sick patients promotes healing

especially in some disease conditions and groups. The

respondents agreed that only 27.4percent patients’ had

knowledge of their own rights and responsibilities. Pos-

sible reasons may include low health seeking attitude,

language barrier and ignorance. It then becomes the re-

sponsibility of the care giver to educate and inform his

client, as it is a legal requirement. In this report staff

agreed that medication were managed to prevent errors

and adverse incidence (75.2 percent). The reporting and

adequate treatments of adverse events and errors would

ensure improvements to health systems. The admini-

stration of drugs and medications mainly fall in the do-

main of doctors, nurses and pharmacist; done manually.

Every drug administration should ensure the right pa-

tient; drug, dose, route and time (5Rights) are ensured to

minimize hazards. Errors in clinical practice are com-

mon and these should be reported for effective manage-

2

4

A low level of work force planning that supports needs,

recruitment and appointment system was reported by the

staff. The health care workforce is the backbone of the

health system in terms of infrastructure, as a sufficient

number of providers is important for care delivery sys-

tem and can be an indicator of the quality of care. A

shortage of professionals exists all over the world at

varying degree, especially among several specialties,

18,19

29

ment and preventive measures

.

Because medical

example; nurses and physicians .

errors can have lifelong consequences there is need for

1

86

The health records standards based on international clas-

sification of diseases (ICD 10) was very low, 22.9 per-

cent. The ICD 10 standard provides data for best prac-

tices and proper international disease classification. The

use of updated information technology and electronic

health records is vital for accurate data storage and re-

trieval for epidemiological use and quality. The useful-

ness of the health records for future use was reported to

be available from 47.1 percent respondents. This may

be related to the lack of electronic medical records

which would have provided a standard structured and

coded accurate, clinical diagnosis that makes patient

data potentially computable. However, a third agreed the

available health records were not useful for future plan-

ning. An ideal electronic health records (EHR) when

generated along with the Personal Health Record (PHR),

help with interactive with patients. Physician can track

the patient adherence through electronic communication

with the pharmacy to determine compliance through

refill frequency. Medical records data is the source for

all statistics and planning for development and are legal

documents.

the morale, especially when it provides compensation

for injuries.

Conclusions and Limitations

This report describes and provides information on the

level of care and services process as a measure of qual-

ity, with a focus on the health care workers response to

patient – care. The health workers agreed that his/ her

patients’ medical needs for care, which included identi-

fication and treatment, were mostly met. Core clinical

staff may not have enough knowledge of the workings

in the administrative section and verse visa, because our

hospital operates the traditional departmental lines of

care, organized into skill areas and professional scopes

of practice. Non- clinical staffs have limited contacts

with patients, however with improved communication

and information flow across departments, this creates

better decision making, and helps moves an organization

3

0

from a silos type to a processes based trend . Another

limitation of this report is that only the health workers

own perspective is provided.

Research on medical safety and environmental safety

were low along with facilities for games. Informal inter-

action helps build confidence and create satisfaction for

workers and their employees and patients. The health of

the population is greatly enhanced with physical exer-

cises. There was significant involvement of the hospital

in emergency services and disaster management within

the community, as part of its corporate social responsi-

bility to the local community. Security reported by the

health workers was low which could contribute to low

staff morals and insecurity at workplace. Staff wants to

be protected from physical harm while at workplace,

such as assaults from angry patients and relatives, hence

adequate measures that protect staffs on duty helps boost

Conflict of interest: None

Funding: None

Acknowledgement

I wish to appreciate my work colleagues for their assis-

tance during the time of data collection and advice dur-

ing the write up of the manuscript.

References

1

.

Institute of Medicine. Crossing the

Quality Chasm: A New Health

System for the 21st Century.

Washington, DC: National Acad-

emies Press. 2001.

Pirkis J, Burgess P, Dunt D and

Henry L . Measuring quality in

Australian mental health services:

Defining quality: Structure, proc-

ess and outcome. Australian Gov-

ernment department of Health.

5. Timothy P. Hofer, MD. What Is an

10. Clancy C. Agency for Healthcare

Research and Quality. What is

Health Care Quality and Who De-

cides? 2009. www.hhs.gov. ac-

cessed 16/1/2012

11. Lohr KN. Committee to Design a

Strategy for Quality Review and

Assurance. In: Medicare, editor.

Medicare: a strategy for quality

assurance. Vol. 1. Washington,

DC: National Academy Press;

1990.

12. EquIP5 Standards and criteria

document of the Australian council

on healthcare standards (ACHS) -

2010.

13. World Health Organization. Plan-

ning a health survey. In: Lwanga

SK, Cho-Yook. Ayeni O (2 eds).

Teaching health statistics WHO

1999; 69- 76

Error? Effective Clinical Practice

(American College of Physicians).

November 2000.

6. Rodney AH. "Estimating Hospital

Deaths Due to Medical Errors:

Preventability Is in the Eye of the

Reviewer". JAMA 2001; 286

(4):415-420.

7. Aspden P, Corrigan J, Wolcott J,

et al. Patient safety: achieving a

new standard for care. Washing-

ton, DC: National Academies

Press. 2004.

8. Classen DC, Stanley L, Pestonik

R, et al. Adverse Drug Events in

Hospitalized Patients. JAMA 1997;

277(4):301-306.

2

.

1

999; 17- 36,

3

.

Institute of Medicine. Kohn L,

Corrigan J, Donaldson M, eds. "To

Err Is Human: Building a Safer

Health System;” Washington, DC.

The National Academies Press.

2

000.

Zhang J, Patel VL, Johnson TR

Medical error: Is the solution

4

9. Introduction to clinical govern-

ance. What is quality in health-

care?www.clinicalgovernance.

scot. nhs.uk/.../qualityinhealthcare.

accessed 7/2/2012

"

medical or cognitive?" J Am Med

Informatics Ass. 2008; 6 (Supp1):

14. Health Care Quality.

www.scribd.com/doc/52475068/

Health-Care-Quality. accessed

7

5–77.

7

/2/2012

1

87

1

5. Gerteis M. Through the patients’

eye. San Francisco 1993.

22. Shojania KG, Duncan BW,

McDonald KM, et al. Making

health care safer: a critical analysis

of patient safety practices. Evi-

dence Report/Technology Assess-

ment.(summ) 2001; no 43: i-x, 1-

668. Prepared by AHRQ,

www.ahrq. accessed 12/1/2012

23. Open Disclosure. Health care pro-

fessionals’ handbook. A hand

book for health care professional

to assist with the implementation

of the open disclosure standard.

Australia 2003

24. Luby SP, Agboatwalla M, Painter

J. Effect of intensive hand wash-

ing promotion on childhood diar-

rhea in high-risk communities in

Pakistan: a randomized controlled

trial. JAMA. 2004; 291(21):2547-

54.

25. WHO. Guidelines on hand hy-

giene in health care improving

adherence to hand hygiene prac-

tice: A multidisciplinary approach.

WHO Press. 2006.

27. Ward DJ. Attitude towards infec-

tion prevention and control: an

interview study with nursing

students and nurse mentors. BMJ

Quality Safety 2012. 21(4):301-

306

28. Infection control today. Preventing

infection through hand washing.

2000. http://

www.infectoncontroltoday.com/

articles/2000/07/ Accessed

6/2/2012

29. Physician distribution and access:

Workforce priorities. www.graham

-center.org/.../op53-physician-

distribution.html. Accessed

13/2/2012

6. Potter PA, Perry AG. Fundamental

th

of Nursing 5 Ed. St Louis:

Mosby; 2001

1

7. Richard M, Allman MD, Carol A,

et al. Pressure Sores Among Hos-

pitalized Patients. 1986; 105 (3)

3

37-342 (Abstract).

8. Leape LL, Brennan TA, Laird N,

Lawthers AG, Localio R, Barnes

BA, et al. The nature of adverse

events in hospitalized pa-

tients.Results of the Harvard

Medical Practice Study II. NEJM

1

991;324(6):377–84.

1

9. Phillips DP, Christenfeld N, Glynn

LM. Increase in U S Medication-

Error Deaths between 1983 and

30. Merrill J Caldwell M, Rockoff

ML, et al. Findings from an Or-

ganizational Network Analysis to

Support Local Public Health Man-

agement. J Urban Health. 2008;

85(4): 572–584.

1

993. Lancet 1998; 35(9103):643-

6

44.

2

0. Lohr KN. Outcome measurements:

concepts and questions. Inquiry

1

988; 25(1):37–50. (PubMed)

1. Clancy CM, Farquhar MB, Sharp

BA. Patient safety in nursing prac-

tice. J Nurs Care Qual. 2005; 20

26. Selling soap. Stephen JD, Steven

DL. New York Times Sept 24

(3):193–7.

2

006