The Importance of Quality Assurance in Rural Public Healthcare Facilities

Abstract

This chapter aims to discuss the importance of quality assurance in public rural healthcare facilities. In developing countries, there is a massive problem regarding poor health services. Inadequate resources, coupled with the waning of the Ubuntu philosophy in public rural healthcare facilities, led to a lot of complaints and litigations. However, improved healthcare quality can lead to fewer errors, shorter waiting times, higher efficiency, increased market share, and cheaper costs. Besides, Ubuntu as a reflection of a person’s willingness to share, to give generously, to care, and to be full of compassion enhances quality assurance. A positive work environment and staff’s positive attitude when providing quality care are effective approaches that augment patient satisfaction. The importance of providing quality patient care is nonnegotiable in all healthcare facilities. Quality assurance and quality control using the fundamental standards in place are the responsibility of leadership management. The art of leadership and the organizational culture determine and strengthen quality in healthcare facilities. Therefore, the chapter covers the significance of compliance in service standards applications to uphold quality assurance. Furthermore, the chapter addresses the assessment of staff capabilities, describes healthcare needs, resources, and maintenance approaches, explores strategies for Ubuntu restoration, identifies challenges, barriers, and poor services, and recommends improvement interventions. A literature review or desktop approach was used.

1. Introduction

This chapter aims to explain the importance of quality assurance in public rural healthcare facilities. By closely observing each step of the delivery or production process, quality assurance (QA) maintains the required standard of quality for a service or product [1]. Hence, in this study, quality assurance means providing quality patient care in a comprehensive manner, using available resources in place, and complying with the nursing norms and standards set. It involves administrative and procedural activities to achieve requirements and goals, ensuring systematic measurement, comparison with standards, and monitoring processes for error prevention. However, healthcare facilities are faced with several quality challenges such as underuse, overuse, preventable mistakes, differences in services, a lack of resources, inadequate diagnosis and treatment, inefficient resource usage, inadequate information, referral systems, disrespect for human dignity, a lack of drugs, poorly maintained records, and poor delivery systems.

All these mentioned challenges lead to various lawsuits that healthcare facilities are faced with. Hence, the author is interested in the importance of QA in public rural healthcare facilities. The objectives of the chapter are outlined below.

2. Objectives of the chapter

This chapter:

• defines key concepts.

• assess the capabilities of staff members who can manage the QA office.

• describes healthcare needs, resources, and assessment approaches for quality maintenance.

• explores strategies for restoring Ubuntu in healthcare facilities.

• Identifies challenges faced by relatives, patients, and quality assurance managers handling complaints.

• explains barriers for maintaining quality care in healthcare facilities.

• describes the effects of poor healthcare services.

• explains the improvement interventions.

3. Background

In many instances, this question is raised. “Why is QA important in healthcare facilities”? A robust healthcare QA program enables immediate identification of patient care and safety issues. Besides, high-quality health services provide appropriate care, timely delivery, and responsiveness to users’ needs, minimizing harm, and resource waste. Two components of quality management are quality assurance (QA) and quality control (QC), with QA activities spanning the full quality system and QC being a subset of QA activities [2]. Seven measurable qualities of these services exist efficacy, safety, people-centeredness, timeliness, equity, integration, and efficiency. Additionally, “Ubuntu” should be accepted as a fundamental attribute in healthcare, representing humanity, hospitality, generosity, and empathy; all of which are necessary for providing patients and others with high-quality care [3]. An African traditional concept known as “Ubuntu” emphasizes the importance of taking patients’ cultural backgrounds into account when practicing ethical medicine [4]. It encourages collective moral principles and unity. According to Oleribe et al. [5], the healthcare system comprises six core components: service delivery, healthcare workforce, information system, medicines and technology, financing, and leadership. All these need to be provided in line with the service standards that promote quality improvement in all healthcare facilities globally. However, due to constraints of poorly resourced public rural healthcare facilities mostly in developing countries, quality care is compromised [6].

Addressing the strain on African hospitals for critically ill patients requires capacity building and early interventions to reduce organ dysfunction progression and reduce strain on poorly resourced hospitals. The poor resources compromise the quality of patient care. Studies have shown that challenges faced by nurses working with constrained resources, erratic staffing schedules, and unpredictably high patient volume and acuity levels are common in rural settings [7, 8]. Similar problems affecting several states have been reported on the quality of care and patient safety at hospitals in under-resourced situations; according to a study conducted in Uganda by Kakyo [9], including issues patient-staff ratio is incredibly low, a lack of necessary medications and equipment, low salaries, and a high level of workload. Besides, the study conducted by Manyisa and van Aswegen [10] revealed that a lack of administrative equipment and well-trained professionals negatively impacts healthcare quality. The definitions of the concepts will be presented below.

4. Definition of concepts

4.1 Health facilities

Health facilities encompass various healthcare establishments such as hospitals, clinics, outpatient care centers, and specialized hospitals [11]. In this chapter, health facilities refer to all healthcare facilities that provide healthcare services.

4.2 Public health

All organized efforts, whether governmental or private, to prevent illness, enhance health, and increase lifespan are referred to as public health [12]. In this chapter, public health refers to measures used to promote quality of care.

4.3 Rural health

Rural health refers to the health of individuals living in rural areas, which are typically further from medical facilities and amenities compared to urban areas [13]. In this chapter, rural health refers to the health of individuals residing in rural areas, often located further from healthcare facilities.

4.4 Quality

According to Ref. [14], quality is described as measurable, effective, efficient, accessible, acceptable, equitable, and safe services. In this chapter, quality refers to achieving goals with available resources.

4.5 Quality of care

Quality of care refers to the effectiveness of health services in achieving desired health outcomes and aligning with current professional knowledge [15]. In this chapter, quality of care refers to achieving clients’ needs with available resources. This includes equity, accessibility, comprehensiveness, continuity, privacy, and confidentiality when providing quality patient care.

4.6 Quality assurance

Quality assurance is any systematic process of determining whether a product or service meets specified requirements [16]. In this chapter, QA in healthcare encompasses the activities and series of measures that are designed to ensure continuous improvement in the quality of patient care.

4.7 Quality control

Quality control is the process that ensures that the stipulated standards are adhered to always [17]. In this chapter, QC means monitoring healthcare provided, healthcare providers, and resources to improve or maintain quality standards.

The author used desk research methodology technique for compiling and analyzing data from secondary sources that are easily accessible such as books, articles, reports, academic publications, and other materials that were obtained online [18]. The author employed a desk study as an initial appraisal process that gathers and reviews existing site information to guide the subsequent site search to discuss the importance of quality assurance in rural public healthcare facilities.

5. Content of the chapter

5.1 The assessment of the capabilities of staff members who can manage the quality assurance office

The assessment of the staff members who can manage the QA office depends on the culture and the goals or objectives of the organization. Being appointed as AQ manager is very important because this is attached to greater responsibility and accountability regarding the reputation of the organization.

Therefore, the person should have experience in clinical practice and quality assurance and be passionate about working with all stakeholders both internal and external. Furthermore, the manager should embrace Ubuntu’s philosophy to work with all stakeholders with Ubuntu as a global concept derived from a South African Zulu word, promoting love, caring, sharing, respect, kindness, compassion, and cooperation. It encourages equal interaction without feeling less human.

Managers are crucial in maintaining control and strategic decisions in the quality assurance department. They ensure that the department operates at high standards, complies with corporate rules, and meets quality requirements. Their primary tasks include client satisfaction, collaboration with subsidiary companies, and maintaining project quality standards [19].

Quality assurance manager ensures successful implementation in:

• Coordinating meetings and interviews with employees.

• Analyzing project standards and ensuring technical solutions of the departments are aligned with QA standards.

• Communicating effectively with employees and technical implementers.

• Resolving issues.

• Addressing project and design issues.

• Allocating test budgets and preventing losses.

• Establishing quality standards.

• Monitoring operations.

• Assessing customer expectations.

• Conducting inspections and collecting data for proactive solutions.

5.2 Healthcare needs, resources, and assessment approaches for quality maintenance

Despite the importance of quality, managers must be active in patient care delivery. Managers must prioritize numerous quality aspects, take into account the demands of providers and patients, and manage resources given to them by the government, commercial entities, and the community. It is critical to address resource distribution, fee schedules, personnel patterns, and management procedures.

Quality, as a multidimensional notion, is especially useful for managers who prioritize access, effectiveness, technical competence, and efficiency. The QA, on the other hand, involves monitoring healthcare professionals’ provision of patient care using cost-effective resources and motivating nurses to deliver excellence. It involves nurses taking accountability for their care and ensuring services are regulated by professional members.

Quality assurance aims to create an environment that produces consistent, reliable, and high-level products, detects challenges, and corrects problems that may affect quality. It is a proactive process that prevents quality failures by setting core standards and ensuring compliance. Procedure and policy manuals, healthcare standards, and the South African Nursing Council’s scope of practice guide healthcare staff in providing quality patient care. However, the strategies were put in place with limited positive results. Patient satisfaction is not met. There are a lot of complaints in most rural public healthcare facilities that lead to various litigations. The study by Madaka [20] reveals that despite numerous quality improvement initiatives, South Africa’s healthcare facilities have not achieved high-quality service delivery, posing a challenge for the government to ensure long-lasting improvement. Below are the challenges faced by relatives, patients, and quality assurance managers handling complaints.

5.3 Challenges faced by relatives, patients, and quality assurance managers handling complaints

The two components of quality management are quality assurance and quality control, with QA activities encompassing the full quality system and QC being a subset of QA activities [21]. The evaluation of healthcare quality is becoming more and more important in developing nations, with outcomes serving as a major indicator. Some African nations are creating national quality programs and policies, such as South Africa’s National Policy on quality in Healthcare and Zambia’s National Quality Assurance program [22, 23]. Ghana is putting into practice a national health quality program, and it is anticipated that quality assurance systems will become essential to the regular provision of health services. Through the implementation of quality assurance systems, Nigeria’s health sector reform seeks to increase access to high-quality healthcare. All reform plans and programs must include quality improvement measures according to the Federal Ministry of Health. To establish a quality culture in healthcare systems, health professionals must participate in the quality program and be aware of the required behaviors. An example was the study conducted by Romdhane et al. [24], which showed three key problems in Africa’s healthcare system:

• Insufficient human resources.

• Insufficient financial allocations.

• Poor management and leadership.

More than two-thirds of the perceived problems are attributed to these obstacles, which focus on leadership and governance, the healthcare workforce, the provision of health services, and financing [5]. Furthermore Broadhurst et al. [22], revealed that inadequate training facilities, brain drain, and adverse governmental policies are overt problems. Another significant issue is inadequate funding with low budgetary allocation and poverty being the two main financial obstacles that African healthcare systems must overcome. The approaches for restoring Ubuntu in healthcare facilities are described below.

5.4 Restoring Ubuntu in healthcare facilities

Ubuntu relates to humanity. It is a worldwide concept derived from a South African Zulu word. The concept is based on a saying in Zulu, which states that “umuntu ngomuntu Ngabantu” which means I am because you are Um and Lau [25]. In this chapter, “Ubuntu” refers to embracing love, caring, sharing, respect, kindness, compassion, and cooperation in promoting quality assurance. It is very difficult to ensure that QA is maintained in rural health facilities without embracing the Ubuntu philosophy. Therefore, incorporating Ubuntu in daily activities by health workers is very important.

Caring in nursing and Ubuntu have many parallels because both emphasize caring and other caring ideals, such as respect and dignity. The notion that “a person is a person through other people,” which is a direct translation of practically all African languages, is at the center of Ubuntu moral theory, and is known in Tshivenda as “Muthu ndi Muthu Nga Munwe.” Ubuntu ethics encourage people to share their belongings for the benefit of all and to care for all people.

The study conducted by Maphumulo and Bhengu [18] mentions Ubuntu as what is ethically decent for individuals and communities, and it is assessed by dignity, respect, and contentment to promote the well-being of others, all of which are frequently shared fairness ideas. Hence, the following Ubuntu principles need to be of value. Ubuntu principles can help clinicians gain a deeper understanding of patients and others in their daily lives. These include humaneness, empathy, compromise, learning, change, renewal, restorative justice, love, spirituality, and hope. By incorporating these concepts, clinicians can develop relationships with patients, and harnessing their energy to be the healers, they are meant to be. By embracing these principles, clinicians can create a more compassionate healthcare system.

On the other hand, QA integrated with Ubuntu is a crucial aspect of quality management, ensuring the fulfillment of quality requirements for both management and external stakeholders. It involves systematic activities within the quality system to demonstrate confidence in a healthcare service. For instance, [19] found that Ubuntu can affect how nurses provide care. It involves nurses taking accountability for their care and ensuring services are regulated by professional members. Furthermore, QA involves monitoring healthcare professionals’ provision of patient care using cost-effective resources and motivating nurses to deliver excellence showing Ubuntu throughout the caring practices.

Quality assurance aims to create an environment that produces consistent, reliable, and high levels of quality patient care, detects challenges, and corrects problems that may affect quality. It is a proactive process that prevents quality failures by setting standards and ensuring compliance providing quality patient care using autonomy in whatever decision is taken.

5.5 Barriers to maintaining quality care in healthcare facilities

Financial obstacles to healthcare services with high rates of out-of-pocket spending are further issues with the continent’s healthcare system that are common [20]. These issues are caused by an ineffective national health insurance system and insufficient service integration. According to some research, nurses working in rural locations frequently deal with few resources, erratic staffing schedules, and unpredictably high patient census and acuity levels [5, 8].

Inadequate resources: A particular level of output is unachievable with inadequate infrastructure, tools, funding for ongoing costs, and employees.

Personnel issue: The standard of treatment is impacted by a lack of properly trained, skilled, and motivated staff members.

Patients and staff who are unreasonable: Illness, anxiety, delayed response to therapy, unreasonable, and uncooperative behavior, which, in turn, impacts the quality of care.

Poor maintenance: To be used effectively, buildings and equipment need to be properly maintained.

Lack of an informed public: In order to increase the quality of nursing care, it is important for individuals to become informed and assert their legal and ethical obligations to receive high-quality care.

Lack of accreditation regulations: Hospitals are not adequately inspected to make sure that the minimum requirements are met: Investigate significant instances of neglect and punish the negligent health providers.

Lack of incident review procedures: Several occurrences that may occur, while a patient is hospitalized and have an impact on their care and eventual recovery, include wrong medicine, burns caused by substandard practices, or equipment.

Delayed attendance by doctor or nurse: A patient dies in a hallway without a doctor or nurse present.

Not enough effective healthcare information systems: An effective management information system is crucial for evaluating the quality of care.

Patient satisfaction surveys not conducted: surveys that will be conducted by social workers, hospital management students, and consultant groups using questionnaires, interviews, etc.

Lack of nursing care records: Nurses should consistently record the care they provide using the nursing process or a problem-oriented record system.

Lack of oversight: Absence of supervision, ignorance of the philosophy of nursing care, absence of a policy and administrative manual, absence of a process manual, inadequate quality and quantity of professionals, and subpar education and training.

Poor management: Lack of evaluation methods, ineffective departmental and cross-departmental collaboration, absence of formal job descriptions, and job specifications.

Inadequate programs for nurse education: Lack of continuous education and in-service training opportunities.

5.6 The effects of poor healthcare services

Poor healthcare services are increasing illness burdens and health costs globally, hindering progress in all income levels [12]. Besides, the study conducted by Mosadeghrad [26] showed that poor healthcare services failure endangers patients’ health and safety. Therefore, QA is crucial to measure quality patient care and put quality control in place to mitigate deviations. For example, inadequate resource distribution, particularly inadequate medication supply, increases the risk of malaria, tuberculosis, and HIV/AIDS, which leads to more complications in patients.

The main causes of poor healthcare, which may be prolonged waiting times for treatment and surgery, negative outcomes, poor cleanliness, inadequate infection control procedures, limited resources, and poor record-keeping if well addressed can ensure quality care. In addition, inadequate training of staff members leads to inadequate knowledge and a lack of competency. As a result, it is critical to explain the interventions for the purpose of raising the standard of quality of patient care, see below.

5.7 The improvement interventions

Quality is every health worker’s responsibility and accountability. This means that in every healthcare facility, the developed policies and procedures in place should be defined to reinforce compliance to the standard of service. Therefore, remedial actions should be suggested in case of deviations between the performance and the standards for QC. QA strategy integrates organizational approach, management, staff, and quantitative techniques to meet client needs and expectations. It is an orderly managerial improvement strategy aimed at addressing the demands and prospects of all organizations as they attempt to deal with rising change, complexity, and pressure within their organizations. Hence, the following interventions are implemented to improve the quality. Healthcare managers should contact non-returning patients for information and implement generic measures to improve service quality and patient well-being. Furthermore, suggestion boxes for survey questionnaires are used to determine patient satisfaction with services rendered.

Healthcare managers need to understand the importance of service quality dimensions in patient satisfaction and how dissatisfied patients react to service failures in order to intervene further to improve the quality of care. Ref. [27] affirmed that healthcare is dependent on patient-provider collaboration and supportive surroundings. Furthermore, [28] demonstrated that change can result from visionary leadership, sound planning, education, training, resource availability, proficient management, and provider collaboration. For example, peer reviews and audits must be completed within the agreed-upon time frame, and sometimes unannounced audits are required to improve the quality of care. Furthermore, the buildings must be evaluated in order to increase the security and safety of both clients and health personnel. To avoid unintended consequences, risk officers and occupational health safety personnel should conduct risk assessments in collaboration with quality and infection control practitioners.

The study conducted by Polizzi et al. [28] showed that quality improvement must be a long-term, ongoing activity aimed at reducing errors and creating a trusting atmosphere for both health workers and patients. The healthcare nursing service manager is not solely responsible for quality assurance. All staff members are responsible for assessing and controlling all accidents or hazards. In addition, stated that QA and improvement program is an ongoing assessment of internal audit and consulting work, aiming to enhance the quality and commitment of auditors. As a result, the purpose of the chapter was to explain the significance of quality assurance in public rural healthcare facilities.

6. Conclusion

Quality assurance (QA) is crucial in public rural healthcare facilities to ensure patient care quality and compliance with nursing norms and standards. QA involves administrative activities, measurement, comparison, and error prevention. Healthcare facilities face challenges such as under-use, overuse, errors, service variation, resource scarcity, inadequate diagnosis, treatment, and poor information. Poorly resourced facilities, especially in developing countries, compromise quality care. Capacity building and early interventions are needed to address these issues and improve quality of patient care.

Acknowledgments

The author of this paper sincerely acknowledges the support of my colleagues to encourage me to write the chapter. No funding.

Conflict of interest

The author declares no conflict of interest.

Notes/thanks/other declarations

Nothing to declare.