TOPIC:

EVALUATING THE OPERATION PROCESS IN THE SERVICE INDUSTRY, A STUDY

OF KORLE BU TEACHING HOSPITAL.

BY:

SAMUEL ABOAGYE

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ABSTRACT

The service sector operations has become complex and increasingly characterized by intense

competition. The Korle bu Teaching hospital (KBTH) is Ghana’s foremost referral hospital

with an average attendance of about 1,500 patients at the outpatient department (OPD) and

about 150 admission daily. The hospital has over the years been struggling to adequately care

for its patients.

This study aimed to evaluate the operation process at Korle bu teaching hospital to understand

how these process influence the healthcare delivery outcome and suggest process tools and

techniques to improving the system of healthcare delivery.

This study was conducted among 120 respondents comprising seven 7 selected units of the

hospital. These includes 60 patients and 60 staff who are part of the service delivery process.

Participants were selected using the simple random sampling method to select from the units

being considered for this study. Data was collected using structured questionnaires. In

analyzing the data for this study, SPSS was utilized for that purpose. 120 respondents were

interviewed comprising of 60 patients and 60 staffs of the facility. Respondents generally

expressed worry about the delays in the healthcare delivery process which is affecting the

ability of the system to function effectively.

Majority of the patient’s respondents making 83.3% (50 out of 60) said the delays at the various

stages of the healthcare delivery process is inappropriate, with 80% of staff respondents

indicating they often run out of supplies resulting in the delays. 87.6% also indicated they

encounter system or equipment breakdown thereby affecting the process of healthcare delivery.

The test of association between the various operation process variables and the influence it may

have on the healthcare delivery outcome was however not significant.

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Clinical staff being present regularly made the highest contribution by 0.210 or 21% which

does not even indicate a level of strong relationship. Adequate medicine and medical supplies

contributed -0.217 or 21.7%. Waiting time at each stage of the process being appropriate

contributed 0.107 or 10.7%. Waiting time to see Doctor is appropriate contributed -0.093 or

9.3%. Ease at registration at the OPD contributed -0.023 or 2.3%.

Most of the respondents however indicated that, they will recommend the facility to other

people but stated that, the facility do not give much education on disease prevention. There was

no significant statistical relationship between the operation process constructs and the

healthcare delivery outcomes.

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CHAPTER ONE

INTRODUCTION

1.1 THE RESEARCH BACKGROUND

The service sector operations has become complex and increasingly characterized by intense

competition. The Korle bu Teaching hospital (KBTH) is Ghana’s foremost referral hospital

with an average attendance of about 1,500 patients at the outpatient department (OPD) and

about 150 admission daily. The hospital has over the years been struggling to adequately care

for its patients.

Emerging private healthcare facilities are constantly adopting better means of improving their

healthcare delivery. This is putting pressure on the major institutions like KBTH to adopt ways

of facilitating the process of delivering healthcare to patients.

The current expectations of customers for services has increased, new ideas that amplify the

means of interacting globally and ensure greater productivity are available to many people than

before. Many firms are mandated to move along with the rapid changing business environment

while ensuring that the firm meets stakeholder’s expectations on investment returns and on

working capital. Firms are constantly forced to improve on their operational processes by

constantly revising them in order to survive.

Every single organization provides a set of interconnected procedures in delivering services to

customers. The interconnected services when put together, defines what a total chain of

delivering services by activity which put together ensures that customers obtain the services

needed. One difficult issue to deal with is that, most health facilities ensure that the

responsibility of an efficient processes being individual or a collective action is properly

managed. In considering a health provider for example, a lot of processes by the various units

and individuals involving the hiring of nurses, doctors, pharmacist etc. further systems like the

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procurement and remuneration, equipment for laboratory, printing, filling and maintenance

systems. The underlining point is that, every customer expect the delivery of a quality and

efficient service without being concerned with the procedures it went through before the service

was delivered. In achieving this expectation, it must be stated that each unit or individual

involved in the process must contribute efficiently to the whole delivery process.

It is not bewildering maybe, that customers at times are deprived of a good service of which

they expect due to the complex set of processes a service has to pass through before being

rendered. The key ingredient in the service delivery process is the uniformity of the processes,

if any unit fails to deliver as expected, the customer will not receive the desired service. In the

health sector, the issues is of a uniformed service is troubling since many units and agencies

have to render services before the customer finally received the final output. The NHIS unit,

the external suppliers of pharmaceutical products and other consumables all form part of the

interconnected processes needed to ensure the customer is satisfied.

Established service firms do experience total control on its operational procedures, particularly

the one that are strategically significant to the firm and therefore constitute the foundation of

which a perpetual renewal for survival is based on. Operational procedures in the service sector

is one of the strategically important dimensions of set-ups that aids to the productivity of the

how a firm is strong enough in the competitive world within the sector it operates. The focus

is with making decisions that bothers on what the organization can do to satisfy the market

demand and the appropriate means it will achieve this strategy. (Hagelin & Hagelin, 2008).

For the past thirty years, the service blueprint has be widely used to support firms as a tool for

the design of service processes. A widely accepted model is always paramount in the system

thinking and production management where commonly used systems like flowcharts are

needed to design manufacturing processes.

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This gap is what the researcher seek to fill by exploring and evaluating the operations and

processes in the service industry with Korle Bu Teaching Hospital as a case study. This

perspective will give the researcher the opportunity to contribute to understanding the operation

process of a hospital in delivering healthcare and the means by which appropriate process aids

and techniques can be used to effectively manage the process for greater efficiency. After

evaluating the operations and processes and understanding process tools and how they can be

applied in the service industry and at Korle Bu teaching hospital, the researcher of this study

seeks to propose some process improvement methods by which efficiency will be achieved.

1.2 PROBLEM STATEMENT

Every organization production processes frequently have replication, ineptitudes, and delays

that are manageable and hence can be appropriately corrected so far as every procedure is

perfectly acknowledged and explained to all. The industry players must ensure there is a critical

scrutiny on the basics of operational procedures being used in their firm, and define a clear

means of building on from there.

Often, you will frequently identify a specific or variant procedures likely instigated by different

means spread among various department in the same firm with no specific reason or purpose

for which that same process is applied differently in a different sector. The difficulty is with

how one can identify such an anomaly by just observing during the process. No matter how

keen one observes, it will be very difficult to. (Pojasek & Ph, 2014)

Subsequently, every service method or mode of delivery may generate a result which will put

the customer in a state of being satisfied or dissatisfied with the service encounter. The

important thing here is that, every service firm devote time to ensuring that it’s all systems and

procedures are properly designed to deliver the expected services to the customer. (Brown et

al., 1994).

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The business service sector has become one of the sensitive sectors when it comes to

production, which normally involves the recipient of the service. It is therefore very paramount

to have a more prudent operational process by which a standardized service can be assured.

Over time, it is possible for a lot of the procedures developed to be ad hoc for the moment.

Employees may not even understand and accurately record the said process by which the

service is delivered, and hence they may not be the best people to effectively carry out the

service delivery process of the firm. The key aspect of ensuring performance improvement is

by strategically thinking through a more logical and reasonable means of getting the processes

of the firm efficient.

It is therefore based on this, that thesis therefore sought to evaluate the operations process in

the service sector with Korle Bu Teaching Hospital as the focal point.

1.3 RESEARCH OBJECTIVES

This research has a primary objective of evaluating the operations process in the service sector,

a study of Korle Bu Teaching Hospital. By examining this processes, the delays and time

wasting in the operational processes can be eliminated.

More explicitly, this research had the following objectives:

1. To evaluate the operation process at Korle Bu Teaching Hospital.

2. To assess how the operation processes influence the healthcare delivery at KBTH

3. To evaluate the process techniques available in the hospital.

1.4 RESEARCH QUESTION

Most research conducted on operation process have proved to be very useful in the

manufacturing sector and how it has helped in the improvement of the processes. Therefore

this research sought to address these questions:

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 1. What are the operation process at KBTH

2. How does operation processes influence healthcare delivery at KBTH

3. What are the process techniques available for the operations in the service industry.

1.5 SIGNIFICANCE OF THE STUDY.

This research is significant based on the following points:

 The modern day growing significance of services in every economy which is requiring

operators in the industry to be more efficient, hence the need to evaluate the operational

processes for efficiency.

 To help improve the service operation process by eliminating waste and streamlining

processes to improve financial position of the health sector.

 To enhance the adoption of appropriate process, applicable to hospitals in the delivery

of healthcare.

The research outcomes will provide policy makers with important information that can be

adopted in ensuring efficient process of service delivery and profitability. The findings of this

research has the potential to contribute to making people acquire knowledge on how to evaluate

operational process of service organizations. The study is also a requirement for the award of

a postgraduate degree at Kwame Nkrumah University of Science and technology.

1.6 SCOPE OF THE RESEARCH

The study was be based on empirical records from KBTH of the operations and processes in

healthcare delivery and other secondary sources of information pertaining to the process of

service delivery elsewhere. Therefore the study will only cover KBTH and no other hospitals

in or outside Accra.

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The research was also limited to available resources at the time of the research. This research

was be based on theoretical framework and data gathered from questionnaires and semi-

structured interviews with employees and patients of KBTH.

1.7 METHODOLOGY AND ESTIMATION STRATEGY

The researcher developed a conceptual framework to approach the analysis in a structured

manner. To understand the operational processes in service sector, more primary data was used

to evaluate the processes.

Considering the nature of this research, the focal source of information was the primary means

of getting information which was generated from questionnaires and personal interviews that

was given to staff at the different departments at the hospital and patients. The researcher also

used observation and further experience the process of service delivery to understand the total

process of operation. The various staff of the hospital and patients will constitute the research

population. This will be then narrowed to 120 sample respondents.

Questionnaires was administered both in person with face to face interviews as well. The

researcher used SPSS and Google analytics to generate tables and graphs for interpretation.

1.8 THE STRUCTURE OF THE STUDY.

This very research is offered in five headed chapters. The opening chapter will center on the

introduction which looks at exploring and analyzing the foundation of this research work, the

statement of the problem, the study objectives, questions, importance of the study and the

limitations identified thereof.

The chapter two demonstrates how various literature concerning the study was reviewed. This

will includes the review of headings such as the background and importance of operation

process and business process re-engineering, the importance of these concept in the service

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sector, how the concept can be integrated into the process of Hospital in achieving the needed

results by looking at the various tools. Finally, a summary of the various literature and a

proposal of a solid framework was developed to help improve the operation processes at

KBTH.

The third chapter explains the methodology used for this research which involves the research

design, the population of the study, sample size and sampling techniques. The various sources

of data is explained there and the various methods of collecting and analyzing data.

The fourth chapter explains how data collected from the study was analyzed, discussed and

presented.

The fifth chapter concludes the study by summarizing the various findings, recommendation

and conclusion of the study.

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CHAPTER TWO

REVIEW OF LITERATURE

2.1 Operations Process concepts

2.1.1 Process Defined

The definition of any process can be looked at as a connected set of similar responsibilities

assigned a resources tasked to generates productivity. Organizations put processes in place to

ensure customers get value, whereas stakeholders and society benefit as well. Process design

defines what tasks need to be done and how they are to be coordinated among functions, people,

and organizations. Planning, analyzing, and improving processes is the essence of operations

management. Processes are planned, analyzed, and redesigned as required by changes in

strategy and emerging technology. (Slack, Chambers, Johnston, Betts, & Hall, n.d.)

A process involves a set of foundations and settings which are often put together in a repeated

manner to effectively transform inputs into outputs. It may be continuous or in a consistent

form of which the encounter becomes very effective for the end user.

In explaining a process, it must be noted that it should be unceasing and a consistent continuous

set of actions which is done in a more concise and identified way, and can finally arrive at

accomplishing the main aim of rendering a service to a client.

When one talks about a Process, it is now seen as an important conception which has

acknowledged greater recognition and has many explanations from different perspective

(Adesola & Baines 2005). According to Adesola & Baines (2005) a common definition of a

process is “The transformation of inputs into outputs, the inputs can be resources or

requirements, whilst the outputs can be products or results. The outputs may or may not add

value and could be an input to another process”. The output of a process can be a service,

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product or information to a customer; customers are the one that receives that process output

(Anjard 1998).

Many factors have impact and effect of the above given approach, but the key one is the ability

to represent and model the process. One could say that a process can be viewed from different

perspectives, depending on what kind of information required. Usually this is of the type what

is going to be, when it will be done, who will take the decision. Hence a process has functional,

behavioral, organizational, and decisional and resources based content (Bal 1998).

According to Bal (1998), an operation process can be viewed from four fundamental

perspectives. The functional view represents what activity or element of the process is being

performed. It represents the act or activity that is being done by the actors or the employees.

The behavioral view relates to when the process is being performed, and how it is being done.

The activity or process as a whole could be going through a feedback loop or an interactive

process. The organizational view represents who is performing the process. The mechanism

through which there is interaction or transfer of content. The informational view represents the

information details or entails what are being manipulated by the process; these can be data or

product entity details. The informational view considers both the data involved and their

relationship.

2.1.2 Business Processes

Processes are considered as one of the primary ingredient in every organization. The way

businesses get things done is what business processes are about. (Armistead et al, 1999). Most

businesses view processes as a strategic asset by which a business process orientation approach

must be taken. (McCormack and Johnson, 2001). Understanding a business process must not

be beyond just an approach or act of controlling what is termed redesigning, instead a but a

full prevalent matter which demands serious thinking through and attention. It is a mainstream

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means of innovation. Business process management in this scenario looks at the procedures

and process as a very critical way of ensuring there is a clear view on the activities of the

business. (Habib & Shah, 2013)

Organizations produce for its clients in order to meet their expectation. In meeting such

expectations, the firm must ensure the processes are very efficient and effective. It is the sole

responsibility of the operational process to ensure a transformation of resources into outputs

that are beneficial to the customer. With time, business operations are assessed to ensure a

greater efficiency and this often give birth to the modelling of current business processes to

arrive at an improvements in the key aspect relating to cost, quality, speed and efficiency.

In every organization, one of the key areas of concern is the operations function, which helps

the evolution of strategy by creating a more better and new way of offering services. The first

thing to do is to make sure the firm has the ability to manage all the important variables that

are set as important, and competitively use them to their advantage. To achieve this, a lot more

connected decisions are made concerning product and services, facilities and capacity,

technology and processes, quality, sourcing and operating procedures. At the operational level

hundreds of decisions are made in order to achieve local outcomes that contribute to the

achievement of a company’s overall strategic goal. These local outcomes are usually not

measured directly in terms of profit, but instead are measured in terms of quality, cost-

effectiveness, efficiency, productivity, and so forth. Achieving good results for local outcomes

is an important objective for individual operational units and individual operations managers.

However, all these decisions are interrelated and must be coordinated for the purpose of

attaining the overall company goals. (Russell & Taylor, 2011)

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The manner in which our daily life activities come in conflict with each other depicts the

seeming problems related to the challenges organizations face. For instance, a lot of people

daily board vehicles to work in order to begin a process usually called work. The most basic

aim for many in this example is to get to work early and it will mean they have completed a

process. In the event that any of such individuals identify the objective or aim of arriving at

work early cannot be achieved, the possibility of applying speed is then required or applied.

The probability of such individual running into confusion with other objectives is high since

the primary aim may come into conflict with other aims. Such personality will either run red

light, or overlook speed rumps etc. which may results in flouting rules and regulations.

A business entity also encounter same or similar scenario in its daily transactions. In order to

arrive at a set objective, the firm must ensure there is a balance between making employees

comfortable and cost reduction. For customers, they expect a good satisfaction while

shareholders also maybe expecting returns on investment.

To ensure all these objectives are achieved, there must be a business process which is

effectively active and desirable to produce returns. The essence of an efficient operation

process is to produce results for all stakeholders.

2.1.3 Service processes

In determining how well a service will be provided, there is the need to evaluate the processes

needed to execute such a service delivery. This particularly determines which elements is

needed to be outsourced, bought or made in-house, the processes to be selected and

documented, with specifications the manufacturing and delivery.

Service Processes depends on:

- Customization (management consulting; high variety – low volume)

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 - Consistency (call centers; low variety – high volume)

- Skill and knowledge of individual employees (medical doctors)

- Technology

A typical Service procedure process:

- Customers

- Materials

- Information

- Staff

The service process is only one part of the service business operation, but it is the glue that

holds it all together. The interconnection between ever materials, customers and information

and how they are put together to create a wonderful experience for the customer is what service

process does. There are several instances where the activities takes place either in the presence

of the customer (Front office), or at the remote side of the customer (back office).

Front office:

1. Interact directly with customers.

2. The client/customer engages with either technology or staff.

3. The customer is regarded as an operational resource because he/she plays an important

role in the service delivery.

4. The unpredictability of the customer becomes a problem

Back office

1. The customer is distant from the operation

2. Becomes more efficient because of lack of customer involvement.

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Service organizations must ensure they are able to effectively manage the total connection of

processes, that binds the back- and front office together and finally the end user. It will be a

result of poor reliability, lack of consistency and increased cost if a firm fails manage the

processes that link the output to the customer.

A service organization has the responsibility not to transaction only with the individual issues

regarding front- and back offices, but also deal with integrating these two. There should be a

design of the journey of the customer from view of the service being rendered. (Christian

Hellstrom, 2008).

2.2 Operations Process Management

People and procedures uses a unified method to complement the interactions between

maintenance and operations to drive reliability and capacity improvements across the

organization. Operational processes are the foundation for every organization in achieving

efficiency.

In defining operations, it is most times associated with a process of transformation whereby

the resources of every firm whether being capital, labour, machines, management or materials

is better changed to the state of which customers will appreciate its use. The customer plays a

key role in ensuring the process of transformation is complete in that their feedback helps firms

to efficiently transform the inputs into outputs. Every operations manager will have a sole aim,

to ensure that the process is efficiently managed such that the value of the final products will

be more than what was invested at the onset. In all, the operations process primary aim is to

create value, making sure the end product is beneficial for the user.

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Russell & Taylor (2011) further indicated that the input–transformation–output process is

characteristic of a wide variety of operating systems. In an automobile factory, sheet steel is

formed into different shapes, painted and finished, and then assembled with thousands of

component parts to produce a working automobile. In an aluminium factory, various grades of

bauxite are mixed, heated, and cast into ingots of different sizes. In a hospital, patients are

helped to become healthier individuals through special care, meals, medication, lab work, and

surgical procedures. Obviously, “operations” can take many different forms. The

transformation process can be:

 As a results of a physical encounter in a manufacturing setting,

 Storing of items or providing transport,

 Creating an exchange environment like a retail transaction,

 Providing a physiological help as in healthcare

 Offering entertainment which will be psychological,

 Or giving information as in communication.

Establishing a procedure of organizing resources with the mindset of meeting the set objectives

of the firm, various set of work must be shared among different departments or units within the

organization. The bright side is that it must be done efficiently among every unit in order to

ensure efficiency.

2.3 Business Process Reengineering (BPR)

BPR most times has been associated with being a new concept. There are a number of the

principles and concepts underpinning BPR have their antecedents in other disciplines. For

example, Strassman (1993) identifies the contribution of the industrial engineering discipline

in which methods such as process analysis, activity costing and value-added measurement have

been around for about 50 years. Earl (1994) also discusses the contribution of a number of

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fields, including the operations management domain (e.g. Juran, 1964), sociotechnical systems

thinking (Leavitt, 1964) and systems analysis. However, BPR is now coming to the fore in a

different business environment. Certainly, the technological infrastructure is now very

different, offering capabilities that were not feasible in the past. Also, BPR attempts to reorient

the axis of the organization away from the traditional vertical management control of employee

up to management, and towards a horizontal value orientation of vendor to customer (Orr,

1993). The latter orientation is one where real value may be added for the enterprise. (Fitzgerald

& Murphy, 1996)

In BPR, the process to be reengineered is the so-called business process. Davenport describes

a business process as “simply a structured, measured set of activities designed to produce a

specified output for a particular customer or market”. Riemer (1998) describes business

processes in an object-oriented style: “business processes are series of steps that change states

of business objects (that is, customers, orders and inventory), thereby causing business events”.

However we should note that BPR is concerned with customer-orientation. Thus the outputs

of business processes should not only achieve the company’s objectives, but also need to satisfy

customers’ requirements. From these definitions we can conclude that business processes start

and end with customers, and the value of business processes is dependent upon customers.

(Reengineering, n.d.)

By means of comparing, business process reengineering is mostly seen as a process by which

a firm tries to resolve the associated problems with the hierarchical organizational structure. In

essence, BPR is taunted as a process oriented means by which the relationship between

management and employees of a firm are bridged to ensure a smooth interaction. BPR creates

an enviable co existing environment of innovation which encourages process flow and defect

minimization.(Kumar & Ozdamar, 2004)

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2.3.1 Distribution Process/Channel Reengineering (DPR)

To succeed in the modern global economy, it is critical to build a logistic network that is

information-rich, highly flexible, cost effective, and defined by both customer needs and

internal corporate strategy. Organizations must constantly reinvent their logistic networks to

allow for growth and change. The nature of the distribution process is changing from simply

holding physical inventory towards a business model that relies on information and inventory

linkages with customers and suppliers. Customer expectations now include both traditional

activities associated with warehousing and distribution and new activities like technical

support, electronic order processing, and customized financial services, to name a few (more

added value activity). Structural changes in distribution channels are currently taking place

which are accelerating deliveries to customers. These new distribution channel structures, in

which logistics management is typically centralized, have proven to be both extremely cost

efficient and effective in improving customer services. The value of centralized logistics

activities within logistic channels is analyzed. Modern information technology (IT) has been a

necessary enabler of the move to more centralized distribution structures. High operational

efficiency is dependent on quick, accurate and continuous exchange of information between

organizations and also between and within different functions within organizations. Rapid

developments in IT have increased the availability of information and also the opportunities to

transfer information between different inter and intra-organizational units. (Sciences, Logistics,

& Communication, 2011)

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2.4 BPR in Healthcare

The concept of reengineering has changed in the past decade from the supposed slow ideology

to a more radical approach of managing systems. Various sectors have developed and

implemented BPR and the results has been tremendous. However, the health sector continue to

experience various downtown because of the difficulty in implementing such efficient systems.

BPR is increasingly recognized as a form of organizational change characterized by strategic

transformation of interrelated organizational subsystems producing varied levels of impact.

This organizational change perspective recognizes that business process reengineering is not a

monolithic concept but rather a continuum of approaches to process change (Kettinger et al.

1997). The faster the speed of change the more difficult and stressful it is to manage (Edwards

and Walton 1996).

With 80 percent of the expenses tied to patient care activities, hospitals and healthcare systems

can garner substantial savings and improve clinical practices by better managing their labor,

supplies, equipment, and facilities. The benefits of reinventing hospitals hold the tangible and

realistic promise of radically reducing cost while dramatically increasing the quality of care

provided (Harmon 1996).

A case study at Karolinska Hospital in Sweden by Jacob (1995), and Hout and Stalk (1993)

reveals that rising costs and a weakened economy in 1990s were forcing the government to

reassess and reduce health care expenditures. Karolinska followed Boston Consulting Group’s

(BCG) Time-Based Management methods to reengineer the way work was done. BCG

reorganized work at the hospital around patient flow by creating a new position of "nurse

coordinator" in most departments. By redesigning operating procedures and staffing patterns,

Karolinska was able to cut the time required for preoperative testing from months to days, close

2 of 15 operating rooms and still increase the number of operations per day by 30 percent.

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Operating theatre management often involves human resources, information systems, finance,

physical plant design and utilization, capital equipment, clinical quality and efficiency and

regulatory (Merriam-Webster 2002). Furthermore, surgical cases are conventionally classified

into elective and emergency. An elective case is one whereby the patient can wait at least three

days without sustaining morbidity or mortality. A surgical group comprises of several surgeons

who share allocated operating theatre time. The term block time is the time allocated to each

surgical group into which only the surgeons belonging to that surgical group can schedule their

patients.

2.5 Process Classification Framework in Service Industry

2.5.1 Hospitality Sector

Several authors have developed framework for different sectors in the service industry for

shaping their operational process in achieving efficiency. This has greatly impacted on the

performance of such industries in relation to resource use and delivery of good services.

Borjan Kristic, Ernad Kahrović, & Tanja Stanišić stated that the familiar key challenges facing

the hospitality industry and its structures are the globalization of the business environment,

persistent technological advancement and the regular demand for interested parties. The first

challenge is the increasingly competitive environment of the hotel and lodging enterprises in

all geographic regions. While some temporary aberration may result in less opposition, the

forces that are shaping the hotel industry dictate that intense competition in all business sectors

will be the rule and not the exception. The second challenge is the tremendous increase in the

sophistication of information technology and social network of hotels. And third, always

promising, challenge are requests of hotel guests. In response to the mentioned challenges,

hotel enterprises are forced to innovate faster their business models and must focus on

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customers, competition and processes. These new business models have been described as

‘’business process management system’’ (BPMS).

This system means that a focus is placed on the business process (Krstić, Jovanović, Kahrović,

2012). The functional structure of hotel organization will not be sufficient for a long run answer

to aforementioned challenges. Classic structural model of hotel organization must be upgraded

through developed, documented and implemented business process. In order to run hotel

successfully, numerous interrelated activities must be defined and managed. The

implementation of business process management systems in the hotel enterprise, their

definition and interaction, together with the management, can be defined as a business process

approach of management. Business processes are one of the important elements of hotel

management system. If they are not developed, documented and implemented, we can fairly

ask whether the hotel management system is capable of meeting requests of interested parties,

primarily hotel guests. (Borjan Kristic, Ernad Kahrović, 2015).

They argued that, business processes can be classified in several ways. Keen (1997) suggests

that relevant processes are those that create value, processes that provide options and processes

that sustain the value. According to Harrington (1997) the following activities within a business

process are considered important: a) high-value adding activities, b) value adding activities and

c) low-value adding activities. Following Harmon (2005), the crucial business processes are

the following: core processes, enabling processes, and managerial processes. Despite numerous

possible types of business processes, and numerous diversities of process structures, all

business processes in a hotel can be divided into three types: operating processes (processes

that create, produce and deliver products and services that hotel guests want), supporting

processes (processes that do not produce output for hotel guests, but which are necessary to

start up a business) and managerial processes (Cerović, 2010, pp. 415-416).

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Their framework hinged on these cardinal statements: the total changes in the hotel settings to

attaining an effective process management system either horizontally or by means of process

management points out to the essence of letting go the functional organization system in the

firm. rather, attention must be directed at leadership of all levels to improve their processes

either being operational, supporting or managerial.

2.5.2 Telecommunication Sector

Chang, (2011) also developed a framework for the use in the telecommunication industry. He

came out with eTOM which clearly identifies all the key business lines in the

telecommunication service providers firm and also help to improve on innovation and

continuous improvement.

He further stated that in order to assess and improve the performance of a business process, we

must measure it in quantifiable terms. Generally to measure a business process, financial,

external, internal measures are used. Financial measures track the difference between the value

provided to customers and the cost of producing and delivering the product. External measures

track customer expectation in terms of product cost, response time, variety, and quality as well

as, customer satisfaction with product performance along these dimensions. Internal measures

track the performance of the process in terms of cost, low time, flexibility and quality. Internal

performance measures can thus be a predictor of customer satisfaction and thus financial

performance if customer expectations have been identified accurately. It can be seen that

several methods to evaluate and improve the performance of a business process are available.

In telecommunication industry many telecom companies are now trying to adopt eTOM

business framework for the business process management. If telecom companies want to have

a standard way to describe their company’s processes and identify processes that require

changes when new strategies and goals are announced, they need a telecom process architecture

23
like eTOM. eTOM is a business process framework that defines all major business processes

in telecom service providers. Actually, it is one of Next Generation Operations Systems and

Software frameworks. It has almost four levels in details from 0 to 3 level in which 0 level

shows the highest conceptual level of the eTOM and level 1 shows how the major process areas

Strategy, infrastructure & Product and Operations – are decomposed and levels 2 and 3 are

further decomposition of the previous processes’ view.

These framework has given a more elaborate concept for the researcher to look into developing

a suitable framework for use in the healthcare industry.

2.6 Process Framework in Health Care Industry

One of the most urgent challenge facing Hospitals and health service providers includes the

ability to develop a proactive operational framework that is dedicated to an improved patient

flow, greater efficiency and a more competitive advantage. (Kumar & Ozdamar, 2004)

Many of the health service providers involving clinics, CHP compounds and Hospitals do have

similar practices for many years in the same manner of healthcare delivery. Hospitals today are

experiencing serious pressure from all stakeholders to provide excellent services meanwhile

the resources available are making it difficult in meeting such expectations.

In view of the several operation process framework in the service industry, nearly every

operation process framework for a Hospital has three main thematic areas (figure 1): operating

process (activities that generate, produces, offer services that patients need), Supporting

process (activities that do not produce output for hospital patients, but which are important to

services given at the operating stage) and Managerial process (Key in directing, coordinating,

integrating and controlling operating and supporting activities to create value for clients and

shareholders).

24
These processes contribute to the delivery of healthcare, in other words, the effective

management of these processes, will contribute to a system of healthcare delivery that is

beneficial to the stakeholders.

Figure 1. Framework of operation processes in Healthcare delivery

OPERATING PROCESS

 Administrative
Services
 Information Services
 Therapeutic Services HEALTHCARE
 Diagnostics DELIVERY

 Reduction in
mortality rate
SUPPORTING PROCESS  Disease prevention
 Satisfied Patients
 Bio-medical  Healthy
 Maintenance community
 Central Supply
 Transportation
 Dietary

MANAGERIAL PROCESS

 M. O. H
 General
Administration

Source: Adopted From (Borjan Kristic, Ernad Kahrović, 2015)

25
2.6.1 Operating Processes

Complete operating processes of a hospital is the core engine of the whole system. This process

contribute in providing the core services of the facility in order to ensure healthcare service is

delivered. These comprise of the following:

Administrative: the administrative unit are the core sector for the smooth running of the

facility.

They are the administrators of the health facility and they manage the operations of the various

units, overseeing finances, estimating budgets, establishing the health facility policy and

maintain a favorable public image with the society etc.

OPD/Information services: this process is the foremost contact point of the hospital and they

are to ensure documentation and processing information of patients are done timely and

accurately. Their services includes:

1. Checks patients into hospital.

2. Gather vital information of patients - name, address, phone number, doctor, date of

birth, all insurance information, and whether out-patient of in-patient.

3. Assign hospital room if in-patient, taking their records and or retrieving their records.

4. Ensure appropriate billing is made and paid for by patients on all services rendered.

5. Maintain copies of all medical records of patients.

6. Maintain a well-coordinated education system for patients on disease prevention, and

other related health issues.

Therapeutics/Medical Services:

1. Providing general and specialized treatment to patients.

2. Diagnosing patients and referring them to appropriate units.

26
 3. Write prescriptions, diagnostics or referrals for patients.

4. Advice patients on health related issues in preventive medicines.

5. Ensure a well-stocked pharmacy is available to offer patients medicine, explain their

use and also educate on the adverse effect of self-medication.

6. Provide nursing services by ensuring patients are catered for as directed by

Doctors/physicians.

Diagnostics:

This department is responsible for identifying the causes of illness through investigation.

Among the various service are as follows:

1. Provide laboratory services by studying tissue samples and blood to determine any

abnormalities.

2. Produce imaging service by means of scan, MRI, CT and Ultra sound scan to explain

the abnormalities in the parts of the human body.

3. The emergency section also provide medical emergency service on diagnostics.

4. Operation of an in-house blood bank to support blood supply.

2.6.2 Supporting Processes

Supporting process are most time linked to operating processes because of the interconnectivity

of the two levels of delivering services. Both of the two levels have a start and end point and

often share boundaries. A complete supporting process in a typical healthcare delivery system

(Hospital) involves:

Biomedical Technology:

a. Effectively design and build equipment needed for biomedical services

b. Ensure effective diagnostic repairs and maintenance of equipment

27
 c. Maintaining a preventive system of maintenance to all hospital equipment

d. Carry out pilot use of biomedical equipment in other hospitals

Maintenance

1. They provide maintenance service to all equipment used in the delivery of healthcare.

2. Ensure up to date software for equipment and the availability of all system needed for

information sharing.

3. Ensure a more accurate and safer environment through regular maintenance of

equipment.

4. Manage cleaners, electricians, carpenters, gardeners.

Central Supply

1. They are responsible for purchases, ordering, receiving, stocking and distributing

various items and supplies needed for daily operations.

2. Ensure a well-coordinated stock management system is run to avoid stock out

3. Responsible for the management of laundry services for supplies

Transportation: involves the management of ambulance services, in-house trolley and

transport of patients within the facility.

Dietary involves the management of good kitchen services for both staffs and patients on

admission. This provides support in ensuring patients are catered for well during treatment as

well as staffs.

28
2.6.3 Management Process

Besides these two categories, the final set of processes includes managerial processes. These

processes are a set of activities to direct, coordinate, integrate and control operating and

supporting business processes that create value for the service clients and shareholders.

Management processes or managerial processes include mainly decision making activities.

They are not tied to just one segment of an organization, but permeate the entire institution and

in the aspect of healthcare delivery, external organizations are involved. Management

processes include: develop and manage human resources, manage inventory, manage financial

and physical resources and manage reputation, quality and change. For managerial processes

it can be said that they constitute a separate and essential subset of the supporting processes.

They are not essential to consumers of the service, but they are essential for management of an

institution to provide survival, competitiveness and development of an efficient service. The

difference between managerial processes is determined by the specificity of management

objects.

These set of processes may have impact on the kind of health service being delivered either

positively or negatively. There is definitely a flow from one stage to the other, and at any point

in time if any of the procedures stalls, it may affect the level of satisfaction attached to the

service being delivered.

2.7 Healthcare Delivery

Healthcare involves the provision a set of various health related services in order to ensure the

patient either receives rehabilitation, disease prevention, identification of diagnosis, relaxing

care, and therapeutic of diseases.

29
Health care delivery outcome may be measure based on the patients status after visiting the

facility, changes in health status over a period of time, the mortality rate of the patients who

access the health services of the hospital, the complications as being experienced by patients

after service delivery and the positive perception of patients about the facility.

In as much as several actors need to work together to ensure an effective healthcare delivery,

the process of delivering the service may or may not influence the outcome of such service.

However, the need to understand the importance of Doctors, nurses and other health workers

are very critical because they directly influence the service delivery outcomes. The back office

also plays a critical role as they either influence the process through the provision of the needed

tools and information needed to effectively deliver such services..

Invariably, these construct in the right hand of the framework is a clear indication of an

effective healthcare delivery, the ideal will ensure low mortality rate, disease prevention

through continuous education on health issues, satisfied patients who have had a good

encounter with the facility and a healthy community for all.

30
CHAPTER 3

METHODOLOGY OF THE STUDY

3.1 Introduction

The focus of this chapter is on explaining the method used for collecting data for the necessary

analysis. In view of this, the following subheadings are discussed below; research design, data

collection source, sampling technique and frame, data collection tools and the means of

presenting the data collected for this research.

Korle Bu teaching hospital is the biggest national hospital which is autonomous as well. The

primary intent for this research is evaluating the operation process of KBTH.

3.2 Study design

The research design portrays the strategy, the needed steps or procedures and means the

researcher applied to acquiring data for the study.

By careful study of the related variable, the researcher considered the key objective of this

research: to evaluate the operation process at Korle Bu Teaching Hospital, the case study

approach was used for the study. This informed the researcher in choosing Korle bu Teaching

hospital as the institution of study.

3.2.1 Study population

The study is being conducted at Korle Bu Teaching Hospital comprising all the 3184 clinical

and 1235 non clinical staffs involved in healthcare delivery at the Hospital. It also includes the

over 1500 and 250 average daily patients visits and admissions respectively.

The sampling frame for this study is the department/units of the hospital which has various

personnel involved in the delivery of healthcare.

31
3.2.1a Inclusion Criteria

 The patients who are willing to give consent

 Child health Unit

 Obstetrics and Gynaecology

 Laboratory

 Medicine

 Pharmacy

 Administration

 Surgery

3.2.1b Exclusion Criteria

 All other departments/units not inclusive.

 Patients who had mental problems

3.2.2 Sampling Technique

Sample size estimation

The statistical formula used for estimating the sample size is shown below:

n= z2 pq

d2

n= Minimum sample size.

z= SD deviate corresponding to a confidence level of 95% (from the normal

distribution table =1.96).

32
 p= Prevalence obtained from previous study unknown so we use p= 0.50 which

assumes maximum heterogeneity (i.e. a 50/50 split)

q = Complementary probability = 1 – p

d = Margin of error, which is 5% and equivalent to (0.05)

n = 1.96² x [0.50x0.50] = 384

0.05²

By expecting 50% response rate from respondents at 95% confidence level, there will be 384

respondents sampled for this research. However, the sample size will be decreased to 120 for

the purpose of this study due to time and financial constraints.

To get a significant representative of the whole research population of the units, random

sampling will be used to select the 120 respondents. Every staff and patients at the hospital

belongs to one of the inclusive 7 departments/units and at the time of this study has equal

chance of being selected as a respondent for this study.

The units forms the stratum of which respondents will then be selected by random out of every

stratum. This technique is chosen because of its advantages. It provides a greater precision and

also saves money.

3.3 Data Collection methods

In collecting primary data, the main instrument used was as follows:

 Questionnaires: questionnaire constituted the main source of primary data for this

study. Questionnaires were used to collect data for this research after being designed

by the researcher and approved by the supervisor.

33
 The researcher embarked on a personal distribution of the materials the one hundred

and twenty (120) respondents from the 7 selected departments/units.

The questionnaires will include both open ended and closed questions.

. The secondary sources were from annual reports, library search, internet publications

among others.

3.4 Instruments for data collection

The researcher used among the following tools in collecting data:

A set of Questionnaires made up of structured and unstructured questionnaires with both open

and closed-ended format which may be guided by face to face interviews with staff and patients

of the hospital. This will be made of two sets, one for the patients and another for the staffs.

3.6 Analysis of Data

The data obtained from this research was analyzed thereby being put into the form of

summaries, tables and charts and making statistical inferences. In other to be able to do all

these, a thorough edit and corrections were made to the raw data to remove any conceivable

blunders and oversights that are possible to occur and safeguarding uniformity among all

participants.

The Statistical package for service solution (SPSS) was used to code the respondents into

groups and categories. The data was then analyzed and presented in tabular form, graphical

and narrative form.

34
CHAPTER FOUR

DATA ANALYSIS AND DISCUSSION OF RESULTS

4.2 Introduction

The core of this chapter is to examine the data gathered from the field in order to evaluate the

operation process at Korle Bu Teaching Hospital. This fourth chapter provides information on

how data collected was analyzed and presented. The data gathered are analyzed using

Statistical Package for Social Services (SPSS) software.

The researcher distributed one forty (140) copies of questionnaires in an attempt to gain

important data for the study.

Nevertheless, it must be stated that only one twenty (120) copies of the questionnaire were

completely filled and returned.

Therefore, the analysis made in this study, is based on the 120 respondents who filled and

returned their questionnaires.

4.2 Respondents Demographic characteristics

The demographic features identified for this study were: age, sex, educational level, years of

work experience at the hospital (staff) and number of times patients have visited the facility.

The table below represents the age dispersal of the 120 respondents who answered

questionnaires and guided interviews. The age data obtained involves both staff and patients

who visits the hospital, who constitute the main respondents selected for the study

35
Table 1 A table showing age distribution of respondents

Age No. of Respondent Percentage (%)

18-30 27 22.50

31-40 37 30.83

41-50 26 21.67

51-60 14 11.67

>60 16 13.33

Total 120 100

Source: Field Survey, July 2016

The table above (table 1) clearly shows that majority of respondents fall between the age group

of 31-40 with 37 respondents, followed by the 18-30 age group with 27 respondents. The year

group of 51-60 constituted the least with 14 respondents amounting to only 11.67% of the total

respondents.

36
Figure 2: Bar graph of age distribution of respondents

Age of respondents

30.83%

22.50% 21.67%

13.33%
11.67%

18-30 31-40 41-50 51-60 >60

Source: Researcher’s field survey, July, 2016

The answer saw a total of 57 respondents amounting to 47.5% as males, whiles 63 respondents

representing 52.5% were females. The researcher places must importance to this demographic

characteristic (age and gender) because it has a key influence on the operations process of

healthcare delivery.

4.2a Respondents Level of Education (Patients)

Fig 3 below indicates the educational levels of the patient respondents. Though this do not have

any strong correlation with the evaluation of the operation process, it is beneficial in

understanding how well people with different educational background think the process can be

improved.

37
Fig 3 A bar chart showing educational background of respondents

Education background (Patients)

25 24

20

15
12 12 12

10

0
NONE PRIMARY SECONDARY TERTIARY

Source: Researcher’s field survey, July, 2016

Respondents with tertiary education background were the dominant respondents with 40% and

20% for all the three other options. The likelihood is that because majority of respondents are

with some level of formal education, they are very concerned about the process efficiency of

healthcare delivery.

4.2b Number of times visited hospital (Patients)

With the response on the number of times patients have visited the healthcare facility, 43.3%

of respondents indicated they had visited the hospital more than 4 times with 35% also stating

they have visited the hospital 2-4times, only 21.7% said it is their first time of visiting.

38
Fig 4 A bar chart showing the number of times respondents has visited the hospital

(Patients).

No. of times Visited hospital (patients)

30

25

20

15 43.3%
35%
10
21.7%
5

0
First time 2-4 time More than 4 times

Source: Researcher’s field survey, July, 2016

From the fig 4 above, it clearly indicates that about 78.3% of respondents of patients

interviewed had visited the facility more than twice which is very important for this study

because it gives a more credible outlook to the evaluation of the process.

4.2c Job description of respondents (Hospital staff)

Table 2 shows a greater number of respondents are doctors constituting 12 (20%) out of sixty

respondents making up with nurses following with 16.7%. Administrative staff which includes

OPD staff made up 8.3% with pharmacist making 10% of the respondents of staffs.

39
Table 2 A table of job description of respondents (staff)

Job Description Respondents Percentage %

Doctor 12 20

Nurse 10 16.7

Pharmacist 5 8.3

Admin Staff 6 10

Lab tech 4 6.7

Bio med tech 3 5

Dispensary tech 3 5

Store keeper 3 5

Purchasing officer 2 3.3

Specialist 3 5

Consultant 3 5

Canteen staff 2 3.3

Anaesthetist 4 6.7

Total 60 100

Source: Researcher’s field survey, July, 2016

The study expected that, by the nature of the work at healthcare facilities, the majority of

respondents will have a fair view of the operation processes of delivering healthcare.

40
4.2d Working experience of respondents (staff)

The working years of respondents (staff) was taken into consideration since it was very

important for the study because, it forms the basis for an in-depth analysis of the response on

any operations process information pertaining to the facility.

Fig 5 A pie graph showing the number of years worked by respondents (staff)

NO OF YEARS WORKED (STAFF

RESPONDENTS)
13 AND ABOVE
8% 1-3YEARS
10-12YEARS 20%
12%

7-9YEARS 4-6YEARS
28% 32%

Source: Researcher’s field survey, July, 2016

From Fig 5 above, 19 of the respondents of 60 representing 32% had worked at the hospital for

4-6 years, 17 respondents has also worked 7-9 years representing 28% with 20% having worked

for 1-3 years. Only 11.7% and 8.3% had worked for 10-12 years and above 13 years

respectively. This clearly indicates that majority of respondents have worked at the hospital

long enough to respond on the various issues.

41
4.3 The healthcare delivery process.

For the purpose of this study, variables that were studied under the process of healthcare

delivery from both staff and patients point of view are:

i. Work load for staff

ii. Attitudes of health officers

iii. Delays in the process

iv. Mode of healthcare delivery

v. Interference by management in service delivery

From responses received from staff of the hospital on the workload and whether they think it

is too much for them, 50% of the respondents said it is less demanding with 5% saying it is not

demanding. However, 36.7% said it is demanding and 8.3% also indicated that their work

schedule is very demanding. When asked whether they will require additional hands to ease

the pressure, 48.3% said yes whiles 51.7% also indicated they need no additional hands. The

majority of staff who indicated additional hands is needed falls within the category of Nurses,

Doctors and administrative staff (OPD/Information).

4.3 (a) Attitudes of healthcare officers

Patients responded to questions on the attitudes and behavior of staff as it has influence on how

smooth the healthcare delivery process will be since both sides participate in the service

delivery.

The response is shown in figure 6 below:

42
Figure 6 A bar chart showing patients response to punctuality of OPD staff and

introduction of their names.

Punctuality and staff introducing their

names
45 43
40
35 33
30
25
20 15
12 12
15
10 5
5
0
PUNCTUALITY INTRODUCE NAMES

SA A D SD

Source: Researcher’s field survey, July, 2016

From the figure above (fig 6), 75% of respondents indicated that staff were punctual with 25%

disagreeing. This is significant because the process of healthcare delivery needs various actors

to be present at various units as need be.

Most importantly, the respondents seems to disagree on the fact that healthcare officers

introduced their names. 91.7% indicated that staff do not introduce their names to them.

4.3(b) Delays in the process.

From both staff and patients point of view, different information was sought on whether there

are delays in the operation process, and the likely causes for such delays. The fig below (fig 7)

shows the responses gathered from the various respondents on where the delays occur and the

likelihood for it to affect the operation process of healthcare delivery.

43
Fig 7: A bar chart showing patients response to time spent at various units.

Time spent at stages of the healthcare delivery

process

41
39
36

30
28 27
23
19

13 14

8 8 7
2 4 1

OPD DOCTOR/PHYSICIAN PHARMACY LAB DOCUMENTATION

SA A D SD

Source: Researcher’s field survey, July, 2016

From the chart above, majority of patients were of the view that they encountered some delays

in the various stages of the healthcare delivery process. A total of 78.3% of respondents said

the time spent at the OPD was not appropriate, with 73.3% and 68.3% sharing the same view

on the delays before seeing a Doctor/physician and documentation at each stage respectively.

On the time for receiving medicine at the pharmacy, 61.7% of the respondents said it was not

appropriate.

As many as 53.4% of the respondents said the waiting time at Laboratory services was

appropriate which was an indication of an improved system of service delivery at that unit.

44
Figure 8: A bar chart showing staff response to operation process delays.

60

52
50 50
48

40

30

20
12
10
8
10

0
RUN OUT OF SUPPLIES SYSTEM/EQUIPMENT MANAGEMENT INTERFERENCE
BREAKDOWN

YES NO

Source: Researcher’s field survey, July, 2016

On the part of staffs, fig 8 above shows that 80% of respondents said they often run out of

supplies during their daily operational activities. This they say causes some delays as they have

to endure running without supplies. The notable units were pharmacy, Laboratory, OPD and

Canteen.

The respondents further stated that, they often time encounter system/equipment breakdowns

which affect the process flow. 86.7% said these system/equipment breakdowns occur often

thereby affecting the smooth running of the facility.

On the issue of interference by management in the process, 50 out of the 60 employees

representing 83.3% indicated yes there are management interference with 25% saying no to

45
management interference in the process. A question posed to staff respondent on the mode of

healthcare delivery, 63.3% said they perform their activities manually, and 33.3% being

computer aided. Only 3.3% responded they use both manual and computer aided.

With respect to whether the manual method of work activities is likely to cause delay, 65%

responded that it is the likely to cause delays, whereas 35% said it is not likely to cause delays.

The researcher was very particular about the stages where manual dominates the computer

aided process, and their relation to the likelihood to cause delay.

4.4 Process support and tools available to aid in the healthcare delivery process.

In relation to the process support and tools available to aid in the healthcare delivery process,

the following factors were considered for the study:

i. Training opportunities

ii. Staff support for patients

iii. Language used

iv. Adequate information on condition and medication

On the issue of training, 32 respondents said they receive training opportunities for upgrading

their knowledge and better the system of delivering the service, whereas 28 respondents said

they receive no training opportunities.

46
Fig 9 A bar chart showing patient’s response on the supports available during healthcare

delivery.

Operation process support

50

41
39

19
17

10
4

CLINICAL STAFF PRESENT LANGUAGE WAS APPROPRIATE ADEQUATE MEDICINE

SA A D SD

Source: Researcher’s field survey, July, 2016

A series of parameters was posed as questions to patients in the quest to find out if there were

enough support aids available to patients in the process of healthcare delivery.

Respondents who shared the same opinion that the facility is properly labelled which made it

easy for them to move to every unit that they need their services. 51 out of 60 respondent were

said they agree with the labelling of departments of the hospital, 39 out of 60 said clinical staff

were regularly present, 50 out of 60 respondent agrees with the language used to communicate

as it made it easy for the patients to express themselves well to the staff.

The respondents were also satisfied with how diagnosis are explained to them with 43 out of

60 confirming their diagnoses were explained to them. They gave high ratings on the aspect of

drugs being explained to them as well as their condition being made known to them.

47
However, 41 out of the 60 respondents disagrees when asked whether there were adequacy of

drugs and medical supplies at the facility. They expressed worry with the unavailability of

drugs especially during emergency situation.

4.5 Response of Patients on Health Delivery outcomes

A total number of 60 patients interviewed on the health delivery outcomes after visiting the

hospital provided the following response in table 8 below. They were asked questions on the

following parameters:

i. Improved condition after healthcare delivery

ii. Complications after service delivery

iii. Enough education on prevention

iv. Recommend the hospital for healthcare delivery

Fig 10 A bar chart showing the healthcare delivery outcomes expressed by patients.

Healthcare delivery outcomes

40
40 37
35 34

30 26 27
25
19
20 16
15
15
10 7 7
4 5
5 1 2

0
HEALTH HAVE HAD ENOUGH EDUCATION WILL RECOMMEND
IMPROVEMENT COMPLICATIONS ON PREVENTION TO OTHERS

SA A D SD

Source: Researcher’s field survey, July, 2016

48
From figure 10 above, 88.3% expressed the view that there has been improvement in their

health situation after visiting the hospital with. 85% of respondents disagree that their condition

has worsened after visiting the facility. The critical worry here was that, 70% of the respondents

agree that there is not enough education on prevention of diseases.

4.6 The influence of the operation processes on the healthcare delivery outcomes at

KBTH.

The analysis here, depicts the influence of the operation processes on the healthcare delivery

outcome at KBTH.

From the summary generated by the model, the value for R = 0.359 implying that a very weak

correlation exist between health improvement after treatment (dependent variable) and the

operation processes (independent variables). This infers that the independent variables do not

have any sensitive influence on the health improvement after treatment.

The value of R² (R square) from the table determines the relationship and the related level by

which extent to which the autonomous (independent variables) are able to justify the action of

the reliant (dependent) variable. With an R square of 0.129 it clearly signifies that only 12.9%

of the deviations in the operating process variables possibly are able to explain the Healthcare

delivery outcome of Health improvement after treatment. Therefore when there is a change

in the operation processes, it is likely not to result to any change in the health delivery outcome

by patients of KBTH (Health improvement after treatment).

Table 3. Regression summary

Model R R Square Adjusted R Std. Error of the Estimate

Square

1 .359a .129 .048 .660

49
a. Predictors: (Constant), Ease at registration (OPD), Adequate medicine and medical supplies,

Waiting time to see doctor is appropriate, Clinical Staff were present regularly, Waiting time at

each stage is appropriate.

The ANOVA table gives the combined or complete significant relationship of how the left hand

variables (independent) influence the right hand variables (dependent). In table 4 (ANOVA), the

significance assessment generated 0.177 which is greater than the dominant (alpha) level of 0.05, it

can therefore be concluded that, the operations processes do not have a significant influence on the

health improvement being experienced by patients after treatment at KBTH.

Table 4: ANOVA

Model Sum df Mean F Sig.

of Squares Square

Regression 3.474 5 .695 1.596 .177b

1 Residual 23.510 54 .435

Total 26.983 59

a. Dependent Variable: Health improvement after treatment.

b. Predictors: (Constant), Ease at registration (OPD), Adequate medicine and medical

supplies, Waiting time to see Doctor is appropriate, Clinical staff were present regularly,

Waiting time at each stage is appropriate.

50
Definition of Variables

Y = Health improvement after treatment – dependent variable

X = ß0+ß1+ß2+ ß3+ ß4+ ß5+ų – Independent Variables

ß0 = intercept

β1 = Ease at registration (OPD)

β2 = Adequate medicine and medical supplies.

β3 = Waiting time to see Doctor is appropriate.

β4 = Clinical staff were present regularly.

β5 = Waiting time at each stage is appropriate.

Therefore the regression equation will be:

Ÿ = ß0+ß1+ß2+ ß3+ ß4+ ß5+ų

Therefore the equation for the model is stated as: Health improvement after treatment = 1.875

- 0.090WTSD + 0.154WTAS – 0.313AMMS + 0.256CSPR - 0.032EAR + μ

Where

WTSD = Waiting time to see Doctor is appropriate

WTAS = Waiting time at each stage is appropriate.

AMMS = Adequate medicine and medical supplies.

CSPR= Clinical staff were present regularly.

EAR = Ease at registration (OPD)

51
Since the beta value of the coefficients table shows the degree of measurement of the impact

of the different variables to the behavior or conduct of the dependent variable, it can be

perceived that Clinical staff being present regularly made the highest contribution by 0.210 or

21% which does not even indicate a level of strong relationship. Adequate medicine and

medical supplies contributed -0.217 or 21.7%. Waiting time at each stage of the process being

appropriate contributed 0.107 or 10.7%. Waiting time to see Doctor is appropriate contributed

-0.093 or 9.3%. Ease at registration at the OPD contributed -0.023 or 2.3%.

The model strength is determined by looking at the values of importance (sig) in the

coefficients table. Per the table presented (Table 5), it can be said that none of the variables

observed are significant. The values are greater than the alpha value of 0.05, this shows clearly

that the variables used have no weighty influence on Health improvement after treatment. This

means that the exclusion of these variables out of the model being has no possible means to

affect the probability of the model.

With this understanding, the researcher therefore concludes that Ease at registration (OPD) of

the process, Adequate medicine and medical supplies, Waiting time to see Doctor being

appropriate or not, Clinical staff were present regularly, Waiting time at each stage is

appropriate have no significant effect on the health improvement after treatment being

experienced by patients.

52
Table 5: Coefficients of the regression model

Model Unstandardized Standardized t Sig.

Coefficients Coefficients

B Std. Error Beta

(Constant) 1.875 .820 2.286 .026

Waiting time to see Doctor is

.090 .141 -.093 -.642 .523
appropriate.

Waiting time at each stage is

.154 .218 .107 .707 .482
appropriate.
1
Adequate medicine and medical
-.313 .194 -.217 -1.617 .112
supplies.

Clinical staff were present regularly. .256 .163 .210 1.567 .123

Ease at registration (OPD) -.032 .186 -.023 -.174 .863

a. Dependent Variable: Health improvement after treatment

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CHAPTER FIVE

FINDINGS SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Introduction

The final chapter of this study demonstrates the research findings, to help arrive at a

conclusions. All the findings of this research are facts based on the research objectives and

questions. In addition, this chapter offers direction for any future related research and

recommendations and suggestion for management of any healthcare delivery facility to ensure

an efficient operation process.

5.2 Findings

A summary of the findings helped to reveal certain key issues from both the primary and

secondary data. Every respondents in the study was a good representation of the entire

population and the researcher is confident of the findings that this research has revealed.

The study was taken from two sides (staff and patients) to evaluate the operations process at

Korle Bu Hospital. The study revealed that even though the facility is supposed to see only

referral and specialized cases, most patients’ walks in to the hospital without being referred or

coming for specialized treatment, and the management are also not much concerned with this

current situation which is having a big toll on the systems and facilities available.

On the issue of the operation process, the study revealed that the facility has all departments

properly labelled which makes it easy for patients to get to their needed unit for services. It was

also revealed that, the facility has a conducive environment for patients while clinical staff

were regularly present to attend to patients. There were issues of delays due to equipment and

system breakdowns and also patients encountered some inconveniencies as a result of the

inappropriate waiting time at OPD, Pharmacy, Laboratory and seeing a doctor/physician. The

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overall observable cause for the delays was that, documentation at each stage takes a longer

time than it’s supposed to be.

Through the study, it was also found out that there were inadequate resources for most

departments/units which caused delays, management interference was also noticed as part of

the causes for disrupting the operation process. The inadequacy of medicine at the pharmacy

often cause patients much inconvenience and most times doctors have to go and chase for blood

for their patients because there are no system to effectively deliver on time.

Management has been doing the best to ensure the process is effectively managed to ensure a

proper healthcare delivery. Most departments/units are being given the capacity to operate their

own pharmacy, laboratory and information unit in order to smoothly relieve the pressure on

the central laboratory and pharmacy. There are plans to also regulate the patient flow by

ensuring that appointments are arranged and scheduled before patients comes to the facility

unless it is an emergency, this will resolve the delays often encountered.

5.3 Conclusion

The conclusion being drawn from the analysis of the research data is that, KBTH remains the

top most health facility in the country in capacity and resource availability, and this means the

facility has the capacity to innovate and re-engineer its operations to ensure improved

healthcare delivery.

Even though there seems to be few administrative challenges, with effective process tools and

techniques, the various delays and operational inefficiencies can be resolved to ensure that

patients are given the best of service within an appropriate time frame.

It was realized that, staff of the hospital are often not happy with the inadequacy of resources

and the lack of opportunities to further innovate and bring out new process for service delivery.

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During the study it was revealed that, staff finds it not easy to suggest new ideas for improving

the process and this is affecting the operation process.

Finally, even though there seems to be challenges with the operation process, patients

expressed appropriate response to the health delivery outcome and this is seen in the outpatient

attendance increase over the period.

5.4 Study Recommendations

The study of evaluating the operation process of KBTH propose the following which could be

considered for implementation in order to improve the operation process of providing

healthcare at KBTH.

 The management should increase the number of staff especially Doctors, Nurses and

information staff since they form the operating process execution of the facility.

Because it is a tertiary facility, adequacy of such personnel will always ensure greater

efficiency.

 Arrangement should be made to implement the service by appointment method for

patients unless it is an emergency or a referral case. This will help alleviate the delays

in the stages of the healthcare delivery process.

 A process management tool like the fishbone (ishikawa) can be used to deal with the

system and equipment breakdown. This tool can help identify the root cause of every

unit delay and breakdown, and ensure adequate provision is made to forestall them.

 The facility should intensify their health sensitization policy for the prevention of

diseases. Most respondents were not satisfied with the health education being done and

for a healthy society to thrive, it must have a solid prevention of diseases rather than

cure.

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 Periodic training for staff on their related fields should also be considered. These

training opportunity should be made easily accessible for all staff at their respective

departments/units.

 There should be a separate unit created to oversee the smooth running of every units,

by ensuring that adequate resources are available daily for use, responding quickly to

any operation process complains and making sure there is a free flow of the patient

journey.

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