Implementation framework of the hospital revitalisation programme in a regional secondary level public hospital in Paarl, South Africa

Abstract

The National Department of Health of South Africa implemented a Hospital Revitalisation Grant to modernize and transform the infrastructure and health technology of hospitals and improve the quality of care and access to health care. Paarl Hospital, a secondary level semi-rural public regional hospital, was entered as a project into the Hospital Revitalisation Programme (HRP) in January 2006 and reached practical completion on 23 March 2012. This study critically evaluated the HRP implementation at Paarl Hospital and developed a framework for implementation which addresses the needs of the clients and staff, and assures technical quality of care. Building healthcare facilities is complex and the incorrect planning and implementation thereof can give rise to expensive mistakes. Research on quality of care in health fulfils a social and practical mandate to create information for use by public managers to improve services or by decision makers to inform policy. A descriptive case study design, with qualitative research methodology was utilized for this study. The case study involved an intensive exploration of the circumstances, dynamics and complexities of this public hospital project. A multi-method approach to data collection was taken which included focus group discussions; individual and pair interviews; as well as photographic and document review. Action research methodology, which is concerned with collaborative knowledge enquiry and sharing, was applied by means of an intervention. The findings which arose during the study were simultaneously used and actions were taken to improve HRP implementation in the Psychiatry planning and decanting stage. The study’s findings indicate that hospital revitalisation holds huge benefits for the community the relevant hospital serves, but that client, staff and technical quality are at risk during implementation. The proposed implementation framework serves to inform of the risk management strategies that can be taken for the infrastructure, health technology, organisational development and quality assurance deliverables of the HRP. Future hospital revitalisation projects stand to benefit from the framework to enhance quality of care during implementation, in the interest of economically effective and efficient allocation of public resources and quality health for all.