Enhancing management’s commitment in maintaining an effective quality assurance system in the health sector : a case study at the Okaikoi sub-metro of the Greater-Accra Region

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It is believed that commitment of management to QA defined as “the understanding of QA Principles and the Application thereof “will enhance firm grasp of management responsibility to ensure the sustenance of the Quality Assurance (QA) system on a continuous basis in a given health facility. The Ministry of Health (MOH) has been engaged in the establishment of QA teams, in Eastern, Upper West, Central, Volta, Ashanti, and not too long ago the Greater Accra Region. The Okaikoi sub-metro is one of thirteen sub-metros of the Ac Metro in the Greater Accra Region, where QA teams have been institutionalized in the Kaneshie Polyclinic and Achimota Hospital since May, 2002. However, the Metro Directorate suggests en ineffective QA System in the sub-metro. The commitment, of management to Quality Assurance appears not forthcoming. Establishing QA teams is not an assurance that functions will be performed. Management has a role to play in the establishment and maintenance of any QA system: through the provision of clearly defined principles, training, timely and adequate allocation of resources, provision of tools for supervision and monitoring systems thinking, team work and shared Vi3ion. In their work Adoghoba et al (March, 2000) suggest a further study into other areas 01 QA operation in respect of management practices. Hence the decision to embark on this project to help define the central role of management in maintaining these QA teams structures on a continuous basis. Practicable policies could be formulated in this regard to help ensure the discharge of management’s duty with respect to QA operation. The project was basically a descriptive and purposive evaluative study of the QA team in the Okaikoi Sub-metro, specifically the Kaneshie Polyclinic and Achimota Hospital. The forty-four (44) management team members of both Kaneshie Polyclinic and Achimota Hospital in the sub-metro were given self-administered questionnaire whilst a client satisfaction evaluation study was conducted at the Kaneshie polyclinic. Focus group was then held which brought together eight staff members to ascertain their perception on QA within the Sub-metro. From the study it was realized that there is no well-established principle for the operation of QA. It was also ascertained that there is no demonstrable commitment on the part of management of the QA system in respect of provision of resources. Besides, training for low level management in QA has not been done to a large extent. Supervisory and monitoring tools for QA structures were lacking. Finally even though a large majority of patients (97.0%) were satisfied with services being rendered at the Kaneshie Polyclinic, majority of clients spent between two and seven hours before seeing the Health provider, an indication those clients are either event oriented or lack knowledge of the Ghana Health services goal of Treatment within thirty minutes and two hours. In addition, clients have not been provided with a human face through which the grievances could be channeled to the notice of management. It was also realized that Team Work, Systems Thinking, Shared Vision, Mental Model and Personal Mastery. (The STAR framework) were very weak. Though these disciplines are not clearly stared as part of the traditional principles and structure of Quality Assurance, these leadership skills has been suggested to be a key to greater effectiveness and efficiency in the performance of management and staffs of many institutions (Mosley, 2004). Clarification of the principles of the QA system, provision of support, provision of a challenging atmosphere for initiative among management is recommended.
A thesis presented to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of MSc.degree in Health Services Planning and Management, 2005