ABSTRACT
The general aim and objectives of the study is to establish the influence of staff attitudes and information flow systems in Health Management System in general hospital in Niger State, the gap, staff attitudes has produced, challenges encountered and a way forward in general hospitals in Niger State. Descriptive survey design was used and a self-administered questionnaire for data collection. The population of the study comprised of both the hospital staff and patients which were 1045 and 2209 respectively. Using Kerjgie and Morgan table, 278 and 327 was sufficient for the study. A total of 605 copies of the instrument were distributed, but 383 were retrieved. It is discovered that (45.5%) of the staff agreed to the mode of information transmission is by verbal direction to places of treatment, and (49.7 %) making announcements while in the vicinity. In addition, the level of information flow appears to be very weak in general hospitals in Niger State with (7.9%), Positive staff attitude can enhance services rendered, is revealed with (53.7%), staff preferred profession stimulate high exhibition of behavior which revealed that (55.1%) are practicing by will, while inadequate information to be communicated increase patients’ ill status with (43.7%). The use of radio and television jingles will reduce communication gap to patients, Announcement in each outlet or passage to notify /make awareness to patients of their whereabouts in the hospital will help in sensitizing the patient, The use of electronic computers to receive and send information from any unit of the hospital regarding a patient during visit, help reduce the long stay/ traffic at the various sections in the hospital. The management of the general hospitals in Niger State should provide medical personnel with wide knowledge of ICT, for adequate use and effective service delivery.
CHAPTER ONE
1.0 INTRODUCTION
1.1 Background to the Study
The essential goal of the Nigeria healthcare system is to enhance the provision, efficiency, effectiveness and general quality of healthcare services provided by the healthcare system. The Nigeria healthcare system is established and maintained by the three tiers of government, that is the Federal, State, Local governments, private sector, as well as religious and non-governmental organizations. The Federal government, Federal Universities, teaching hospitals and the Federal Medical Centers (FMCs) provide specialized support for their healthcare system. The State government provides technical support and is responsible for secondary healthcare through the General hospitals and state owned universities and teaching hospitals. (Iroju, 2014). Similarly, the Local government is responsible for primary healthcare, which is organised through the wards, district healthcare centers (Iroju et al., 2013). The primary health centers are usually the first point of contact of patients, but due to the poor funding, sufficient man- power at a time to attend to situations and space for accommodating patients, and they are referred to as secondary healthcare facilities. Furthermore, Iroju (2014) emphasised that the private sector provides a larger percentage of healthcare services due, to poor coordination and funding of the healthcare system by the three tiers of government. Hence, 75% of the 3275 secondary health facilities in Nigeria are privately owned (Annan, 2002).
Healthcare managements in Nigeria is responsible for countless numbers of classified staff and their wellbeing, starting from the minister to the cleaner in the hospital or clinic, each playing a vital role or function to ensure the success of the system or guarantee the framework. The minister is concerned with the execution of the policies that govern the health sector are worried about the execution of these strategies. At the state level, the commissioner is at the helm of affairs in the policy formulation and implementation. However, most of the policies are made to ensure proper and timely access to healthcare in the states, and are executed in the general hospitals, where the beneficiaries who are the patients go for health care services. Nonetheless, a large portion of the arrangements are made to guarantee appropriate and opportune to admittance to medical care in the states and therefore, it is important that the health management services are executed in the state and executed in the clinics where the recipients who are the patients go for medical services administrations. Subsequently, it is significant that the wellbeing of the board’s administration to be efficient at the level.
A general hospital which is a secondary medical service provider in the state, attracts majority of patients, and is headed by a Chief Medical Director with various departments. Each department depends on the other for effective delivery of medical services. Ahmady et al. (2016) stated that, there are four particular department constituted to support each other in running the general hospital effectively, these are; The Administrative and General Services, headed by the Director Administration and General Services with the responsibility of administration, accounting matters, staff welfare, manpower development, recruitment, and promotion as well as treating disciplinary cases. The Hospital Services, headed by the Director Hospital Services and the department is responsible for coordinating and supervising the activities of all zonal/hospital/equipment and structure, it is a liaison office between the Non-
Governmental Organizations (NGOs) and the Health Management Board. The units is in addition concerned with planning research and statistics and ensure that all the resources needed for access to quality health service is in place. The third is the Medical Services, headed by a Director, coordinating and supervising the medical activities in the secondary health care facilities, the laboratory and other related activities. The Pharmacy Department supports the hospital by ensuring accountability and transparency in the operation of Drug Revolving Fund (DRF) scheme, and ensures the usage of good, quality drugs, and pharmaceuticals in the state owned facilities made available all the time and at affordable price to patients. This is headed by the Director Pharmaceuticals.
The Nursing Department is responsible for nursing service matters, which is usually headed by the Chief Nursing Officer or a Matron. The whole affiliation is proposed to provide and give quality clinical/ healthcare referred to as Health Management System. The beneficial aspect occurs during the process of treatment, it is referred to as process quality. Process quality then refers to the action of health professionals in the process of providing health care. Staff attitude towards patients, holding and waiting period in the hospital, and the way in which treatment is passed and communicated to patients are important examples of process quality of care. Poor staff attitude could intimidate patients and or make them compromise from asking relevant questions that could make treatment beneficial. Long waiting periods for treatment represent opportunity cost to many patients especially those in the informal sector who may have to give up a whole day’s income in order to seek care in the hospital. Besides, long waiting period, delay treatment and hence can deteriorate / crumble health status. Finally, when treatment, such as drug dosage, is not clearly communicated to the patient, this resulting in wrong treatment which increase deterioration in patient’s health. In separate studies,
Bannerman, et.al. (2010) noted that the attitude of health workers has been described by the literature as rude, uncaring, and indifferent. Amporfu, Eugenia, et al. (2013), the GHS commissioned several researches on quality of care, where poor staff attitude and long periods of waiting were the most common complaints made by patients Healthcare facilities are been advised to keep unfriendly workers away from patients (Owusu and Ampratwum, 2013). The poor staff attitude has persisted or keeps occurring despite increase in salaries, this has not swayed the demeanor of staff the right route towards improving appropriate health management system across health care workers in Nigeria.
The Federal and State governments do budget a large percent of annual budgetary allocation to Health sector, yet this has not influenced the attitude of staff in the right direction towards enhancing appropriate Health Management System across health care facilities in Nigeria. Hence, the problem persists. Clarity of treatment communication is very important for treatment because there may be several treatment options and it is important that the patients be well informed about the requirements for adopting the treatment and the possible reactions to treatment. For example, some medications do not work well when taken on empty stomach and can reduce energy level and hence constrain some activities. Such information should be, unquestionably provided to patient to ensure the adoption of the right behaviour.
Given that salary increment has not improved process quality in the Ghanaian health sector, there might be the need to strengthen the accountability relationship between the healthcare managements (policy makers) and healthcare providers as well as between healthcare facility administrators and health workers. The inspiration of this assessment is to find out the poor staff attitudes and information flow systems on Health Management System in General Hospitals in Niger State. Strong accountability relationship is especially important in the public sector because staff attitudes could be
affected by several factors depending on the type of health facility that is providing healthcare. In a public healthcare facility, healthcare is provided as a merit good and so is operated in a non-market setting with the objective of providing healthcare service to the public. The ownership of public health facilities does not belong to those providing the service to the citizenry and funded by taxpayers’ money. The relationship between the operators of the facility and the policy maker is as principal agent relationship. The principal, the policy maker, hires the agent, the workers of the health facility, to provide services in accordance with the objectives of the principal. Since the principal cannot observe all treatment activities of the agent, there exists asymmetric information between the two and hence the need for a principal to adopt some mechanisms to induce the desired response from the agents; i.e., strengthen the accountability relationship between the principal and the agent.
The strength of the accountability relationship between the principal and the agent are affected by institutional factors such as the principal’s effectiveness as well as agent incentives (Kimenyi, et al., 2012). Principal’s effectiveness refers to the type of governance adopted by the principal to induce the desired behaviour from the agent. The agent incentives refer to the reward system that the principal uses to induce the desired behaviour of the provision of high process quality (Kimenyi, et al., 2012). Hence, the principals then uses these institutional factors to induce the desired behaviour from the agent. Since good institutional factors ensure good accountability, process quality is likely to be high when institutional factors favours strong accountability relationship between the principal and the agent. Therefore, it is imperative for policy makers to examine the relationship between patients and healthcare practitioners in order to ensure optimal healthcare delivery.
Staff attitude include; the tone of voice, instructional strategies employed for conveying medical instructions to patients, cumbersome nature of accessing healthcare facilities, delayed treatments, aggressive attitudes by staff during treatment, lateness to work, irregular ward attendance to patients, use of foul language to patients by doctors, nurses and cleaners and host of others. This influences the quality and outcome of care in the hospitals. Health Management System is therefore the overall procedures that ensure proper delivery of health services of the citizens. Many of the procedures involve the transmission of information through files and folders. This ensures paper record keeping of the activities in hospitals as it affects patients and the general management of the hospital. The procedure can be transmitted today in electronic formats. However, irrespective of the mode of storage, and transmission, healthcare information need to be exchanged amongst diverse healthcare providers such as physicians, nurses, pharmacists and laboratory technologists within or across healthcare institutions for effective healthcare delivery. This is because, information created by an healthcare provider could be used by another for decision making irrespective of their geographical locations. For instance, a physician can order for an imaging procedure of a patient in a radiology center. The radiologist takes the picture and sends the image back to the physician who uses the image for decision making (Ojerinde & Iroju, 2015). Therefore, presence of appropriate information flow among the management of the hospital and from management to their patients is needed.
Information flow means the standard procedure of communication in a formal setting. In the Nigeria healthcare system, the standard procedure of communication between patients and medical healthcare practitioners is through verbal and written communication. Upon arriving at the hospital, the patient retrieves or obtains cumulative medical record folder carrying a unique identification number from the
Medical Record Department. The Medical Records Department transfers the patient’s folder to the medical doctor for Physical Examination and diagnoses. The doctor may request the patient to run a number of tests at the laboratory department the outcome of which is communicated to him in written form for onward treatment and prescription. In some cases, patients are admitted for intensive care; therefore, such in-patients are expected to come along with a caregiver and a sponsor. While the caregiver stays and attends to inpatients in terms of sanitary and feeding obligations, the sponsor or financier is required to procure doctor’s prescription from the Pharmacy for onward administration by the nurse at the ward. The sponsor also provides basic needs to the patient in terms of feeding arrangement and provision of toiletries throughout their stay at the hospital. Patients on admission could eventually be discharged if well while those that require further attention are referred to the next level of care. All the above processes are discharged by the various set of practitioners to the receiver, and this can only be achieved when it is rightly communicated to the receiver through appropriate channels. Hence, the flow of information amongst diverse healthcare practitioners is either, in non-electronic format or electronic format.
The flow of information in non-electronic formats involve the exchange of information amongst healthcare practitioners in paper based forms while the flow of information in electronic formats involves the use of Information and Communication Technology (ICT) tools to exchange information. Nevertheless, the flow or exchange of information within a Health Management System is plagued with several challenges especially in developing countries such as Nigeria. This is because data collection is majorly manual. Furthermore, there is significant fragmentation and duplication in data collection and storage. Hence, healthcare organizations find it difficult to manage information effectively as it flows within healthcare (Ojerinde & Iroju, 2015).
Information exchange is usually untimely, sometimes due to the attitude of staff and information systems. Consequently, this result in inappropriate decision making and healthcare management, inapt research, inappropriate quality assessment, ineffective planning, increase in medical errors and cost as well as a decline in the quality of patients’ care. Hence, there is an information gap created. This could be, attributed to the poor staff attitude, which make patients suffer from inadequate in treatment and information. There is also irregularity in medical compliant because, patients practically notice inadequacy in information flow between the hospital staff and himself, as such, may find it difficult to let out all the complains he/she has to the doctor. This is an information gap. Medically, information gap is understood as, population-specific differences in the presence of disease, health outcomes or access to healthcare. (Riley,
2012). Information gap exist in forms of undetailed information, impolite and unfriendly means of response, lack of structured communication system, etcetera. Due to the negligent in the part of the management in checking and balancing the communication system and attitude of the staff, the situation keeps repeating itself and it is almost becoming a tradition. Some are so use to it to the extent they are displayed openly, especially the nurses at the delivery section. In view of this, this research would examine the influence of staff attitudes and information flow systems on the Health Management System in general hospital in Niger State.
1.2 Statement of the Research Problem
There has been an increasing challenge in accessing medical healthcare in Nigeria due to poor staff attitudes and lack of well-structured information flow systems in hospitals. Vecchio, et.al. (2018), mentioned that, many hospitals in developed countries are experiencing increasing pressure due to rising numbers of patients presentation and emergency Room (ER) admission. Although, the statistics show that many ER
presentation are non-urgent and often do not require specific hospital treatment, but it is, due to lack of detailed information concealed by the patients, which causes death if it actually was major case. The medical staff are saddled with the responsibilities in providing care and appropriate/ well-structured information flow systems in the Healthcare Management System that cannot be over emphasised. Kneck, et.al. (2019), aimed at exploring information pathways within an integrated healthcare. It revealed that, patients were excluded from information flow, but services are better-delivered and productive interaction between informed patients and experienced and accountable clinicians etcetera. Hence, there has been a clarion call on the need for positive staff attitudes and well-structured information flow systems to reduce communication gaps as well as bottlenecks hindering effective communication between patients and healthcare centre and between healthcare institutions and relevant stakeholders. Poor staff attitudes and lack of well-structured information flow systems has been blamed for non-compliance to the smooth implementation of the Health Management System in Nigeria. It is believed that staff attitudes and structured information flow systems has accounted for slow pace in attending to emergency cases of patients as well as slow rate of reporting and handling disease outbreaks in recent times resulting in chronic health concerns and sometimes death. Most of these deaths could be effectively and efficiently avoided, if healthcare centre incorporate positive staff attitudes and structured information flow systems for easy access within and across healthcare institutions, stakeholders, medical researchers, policy makers and other relevant agencies that may need public health indexes for prompt intervention. This situation has informed this research endeavor to investigate the influence of staff attitudes and information flow systems on Health Management System in General Hospitals in Niger State.
1.3 Aim and Objectives of the study
The general aim and objectives of the study is to establish the influence of staff attitudes and information flow systems on the Health Management System in General Hospital in Niger State. Thus, the specific objectives of the study include:
1. Identifying the prevailing information flow systems in General Hospitals in Niger
State
2. Determining the influence of information flow on Health Management System in
General Hospitals in Niger State.
3. Determining the influence of staff attitudes on Health Management System in
General Hospitals in Niger State.
4. Determining the information gap, staff attitudes has produced in Health
Management System in General Hospitals in Niger State.
5. Determining the level of literacy of staff and patients in the use of ICT communication system in Health Management System in General Hospitals in Niger State.
1.4 Research Questions
The following questions were raised to guide the study:
1. What is the prevailing system of communication with Patients, in the Health
Management System in General Hospitals in Niger State?
2. What is the influence of information flow channels on Health Management System in General Hospitals Niger State?
3. What is the influence of staff attitudes on Health Management System in General
Hospitals in Niger State?
4. What extent of the information gap; staff attitude has produced in Health
Management System in General Hospitals in Niger State?
5. What literacy level is expected by staff and patients to have access to the use of ICT and electronic system in the Health Management System in General Hospital in Niger State?
1.5 Research Hypotheses
The following null hypotheses was be tested at, 0.05 level of significance to guide the study.
1. There is no significant relationship between staff attitudes and the Health
Management System in General Hospitals in Niger State.
2. There is no significant relationship between appropriate information flow and
Health Management System in General Hospitals in Niger State.
3. There is no significant relationship between patients’ information and Health
Management System in General Hospitals in Niger state.
4. There is no significant relationship between patients and Health Management
System in General Hospitals in Niger state.
1.6 Significance of the Study
The outcome of this study will be beneficial to the following categories;
Healthcare Centre: – the study will provide a blueprint on how to improve information flow in the hospitals.
Information managers/scientists:- the will allow the information managers/scientists to realise the importance of health management information system.
Researchers:- the health sector will be able to appreciate the importance of information flow in the research cycle of health related issues.
Government: – the government through the ministry of health will be able to chart the right course of action and make good policies that will enhance better healthcare delivery.
The study used the established and available pattern of information flow within and across healthcare centre in Niger State and made relevant recommendation on how to improve it to attain efficient and effective health management system in Niger State with a view to achieving their statutory functions.
In addition, this study provides a basis for well-structured / convenient information flow systems that will enhance the Health Management System in healthcare centre in Niger State.
1.7 Scope of the study
This research work focuses on investigating the influence of staff attitudes and information flow systems on the Health Management System in general hospitals in Niger State. The sample comprised of 278 and 327 selected healthcare personnel and patients respectively spread across selected secondary healthcare facilities (general hospital Bida, general hospital Minna, and general hospital Kwantagora) in Niger State, Nigeria.
1.8 Operational Definition of Terms
These terms are the key to the study and mostly frequented in the body of the work.
Appropriate information: Information could be considered appropriate when there is satisfaction from data received from the staff. This is; Provision of
accurate healthcare information or data for timely and effective decision making, among healthcare personnel.
Health Management System: this is a ministry established to check balance services to be given or rendered to patients accurately and effectively. The system also advance in a medium of recording all medical records on services rendered by the staff on various patients’ data, diagnosis and reports in the management system.
ICT: this means “Information and Communication Technology”. These are electronic gadgets that are used as an enhancement and support for the treatments of patents.
Information flow: this is an acceptable format of passing information within and across healthcare institutions and other relevant stakeholders in the healthcare sector. This medium is used to communicate and enlighten the patients on the health status.
Staff attitudes: this is a behaviour exhibited by the staff to the patient. This encompasses the manner of approach, the tone of voice, time accuracy to work, and use of foul languages by staff to patients seeking treatment in hospitals.
Information gap: information gap is a difference created or in existence within a circle or system which hinders the productivity, success and or satisfaction in the service delivery of that circle or system.
This material content is developed to serve as a GUIDE for students to conduct academic research
INFLUENCE OF STAFF ATTITUDE AND INFORMATION FLOW SYSTEMS ON HEALTH MANAGEMENT SYSTEM IN GENERAL HOSPITALS IN NIGER STATE
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