| dc.description.abstract | Background.There is pressure for hospitals to adopt tool that can help them address the
challenges facing the delivery of health care services. Quality management systems (QMS) are
being adopted for this purpose. However, there is limited studies’ on their effect on patient
care.
Objectives.To establish the determinants of quality management system uptake in hospital
setting and effect of implementing QMS on patient care at MTRH, Eldoret.
Methods. This was a cross sectional research which utilized quantitative and qualitative
research methods. A sample of 96 nurses chosen by simple random and purposeful sampling
and working in a surgical unit were involved. Data was collected using 5 point Likert scale
questionnaires, key informants guide and documentary reviews.
Results. The aim for ISO certification was to standardize (mean 4.47, p=0.000) and to improve
the quality of care (4.25, p=0.000). Critical factors to consider were staff commitment (4.16, p
= 0.000) and understanding of ISO standard (4.00, p=0.000). The main challenge faced was
increased amount of documentation (4.11, p=0.000).
Efficiency in provision of care had improved (mean 3.88, CI 3.75-4.02) especially retrieval of
records (mean 4.26, p=0.00), clear work instruction (mean 4.24 p=0.000) and improved
documentation (mean 4.13, p=0.00). Patient centered care improved through provision of
feedback to clients (3.89, p=0.000) and responding to clients (3.73, p=0.000). Patient safety
improved (3.77, CI 3.63-3.90), while there was reduction in medication errors (4.06, p=000)
and surgical site infections (4.04, p=0.000). Accessibility (mean 3.27, CI 3.10-3.43) and equity
(3.6, CI 3.47-3.75) in provision of care also increased. Documentary review indicated a
consistentcustomer satisfaction of 75%, an increase in bed occupancy of 10% but no change in
length of stay.
Conclusion and recommendations Quality Management system was implemented in a public
hospital with the aim of improving service delivery. Understanding requirements of QMS are
critical in its implementation, though one need to overcome increased documentation which is
seen as a major challenge. Implementation of QMS improved aspects of care but others had not
improved significantly. Use of performance indicators may provide reliable measure of the
effect of QMS on quality of care.
Key words.Quality management systems, ISO 9001; 2008, quality of care | en |
| dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
