Experiences in quality assurance at Bawku Hospital Eye Department, Ghana

Isaac Baba
Eye Co-ordinator, Bawku Presby Hospital, Ghana

Bawku Hospital Eye Department is a 46-bed unit within a general hospital in the north east of Ghana. Following a workshop on quality assurance, run by the Upper East Region Health Administration, we decided to find out what patients think so that we could improve the quality of eye care offered in the Out-patients Department (OPD).

In 2002, we conducted a survey of patients as they were leaving the hospital. One hundred patients were interviewed with a questionnaire. To avoid interviewer bias, a member of the Civic Education Department administered the questionnaire rather than a member of the hospital staff. The 15 questions covered the following areas:

Time taken to be seen, including patient's perceptions about unnecessary delay. (We scored 'time taken to be seen' as unacceptable if the wait was more that 2 hours)
Communication by medical staff about the condition, instructions for care, and return visit
Privacy
Prescription of medicines and pharmacy instructions
Attitude of staff
Cleanliness of the clinic
Promptness of emergency treatment
Overall satisfaction.

The results showed patients to be very satisfied with the attitude of staff, the cleanliness of the clinic, the speed of treatment during an emergency and the overall satisfaction scores were over 90%. We considered all scores below 90% needed improvement. These were:

70% of patients felt that there was no unnecessary delay
83% said they had been told the diagnosis
82 % said they had been told about the illness
76% said they received an explanation about a return visit
60 % were satisfied by the amount of privacy offered during consultations
89% said that they had received the drugs prescribed (some patients were obliged to buy drugs in private pharmacy shops because the hospital did not stock them)
87% said they had fully understood the pharmacy instructions.

Staff discussed how to improve on these scores and a number of measures were put in place. The most notable was a change in the layout and organisation of the OPD. To reduce delays, patient registration is now done by a non-medical member of staff; to improve privacy, partitions were constructed; to improve access to prescribed eye medicines, we increased the stock to include all drugs we usually prescribe. Medical staff became more aware of patients rights and their responsibilities towards them, and undertook to provide clear explanations to patients about their illness, treatment and follow-up.

One year later, we repeated the survey, using a slightly modified questionnaire. The greatest improvement in patient satisfaction was in privacy. However, there had been a dramatic drop in satisfaction with the speed of receiving emergency treatment, which we attributed to a change in the remuneration policy for staff on-call instituted at the beginning of 2003. We continue to look for ways to improve this service within budget limitations.

Our staff have found this quality assurance exercise very helpful and stimulating. We plan to continue this as an annual activity, continually updating our questionnaire.