The document summarizes a study on the efficiency of healthcare service delivery in Gauteng hospitals in South Africa. It finds that public hospitals have sub-standard performance compared to private hospitals. Key issues identified include poor governance, inadequate resources and staffing, lack of electronic health records, long wait times, and high patient dissatisfaction. Technical efficiency analysis shows district hospitals have the lowest efficiency at 40%, while private hospitals have 100% efficiency. Recommendations include improving facilities and communication, appointing qualified managers, engaging stakeholders, and considering privatization to remedy the crisis in public healthcare performance.

1. GSTM Symposium: 2013
HEALTHCARE SERVICE DELIVERY EFFICIENCY:
PERFORMANCE OF GAUTENG HOSPITALS
Name: Oliver Nwauka
Study Leader: Dr Richard Weeks
Tel: +27824896240
E-mail: onwauka115@mweb.co.za
MEM SYMPOSIUM
GSTM Symposium: 2013

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Introduction
Rationale
• South Africans are not healthy.
• Healthcare ranks low in performance.
• Poor performance and service failure
concerns.
• Challenge of transformation and
reorganisation.
• Weakness in policy planning and
facility management.
• Shortage of medical expertise.
Importance
• Great dissatisfaction effects on all
stakeholders.
• Inappropriate planning, monitoring and
managing service delivery.
• Existing service inequality.
• Societal loss of confidence and trust
• Several staff strikes and patients’
complaints .
• Evidence of waste of resources.
 The service performance efficiency of healthcare delivery in the state
hospitals and clinics is sub-standard relative to private hospitals within the
same demographic and geographic region.

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Research Objectives
Nature of service and performance level of Gauteng healthcare sector.
The extent, influence and the use of e-service and information access.
Influence of governance on healthcare service delivery.
Service availability and utilisation, facility capacity and resource
allocation level.
Health policies and strategies usage, implementation and influence.
Identifying service gaps existing between the healthcare sectors.
 To gain insight into the cause-effects of this minimal performance, patients’
dissatisfaction and the waste of resources in Gauteng public healthcare service
sectors

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Gauteng Health
Demographics
11.9 million Surging
and ‘Hospicentric’
Health
Expenditure
utilization crises
Burden of
diseases
Complexities
Integrated
Informatio
n System
Inadequacies
Human
Resources
Deficiency
Policy and
Strategy
Incoherence
Service
Performance
& Efficiency
Crisis
Spends 8.7% of GDP
Absorbs only 39% of budget
Consumes 50-60% (AV.) of the resources
25.6% Unemployment rate97%Urbanely
habituated
Accounts for 80%
Administrators’ failure to focus on
efficiency and effectiveness
Non effectiveness of
the referrals
Obsolete Equipment
HIV and Infant Mortality Pandemic
TB co-infection rate 73%
• Excessive waiting
period
• Overprescribing
• Excessive length
of stays
• Storage wastes
• Low health
outcome
• Vandalism, poor
maintenance, and
theft
• Patient lost of
confidence
• Staff burnout
• Rude and uncaring
staff
• Frequent out of
stock of essential
drugs
• Lack of managerial
accountability
Asthma, Hypertension, Overweight
Appointments of unqualified managers
Uniform salary schedule
Slow pace in categorising hospitals
Lack of policy guide on
standardised wage rate
Low remuneration
Staff shortage due emigration
Absorbs 39% of doctors
Decrease in enrolment of nurses
Absenteeism and late coming
Struggle to fill > 60% existing posts
Patient Information
not linked
Hospital s’ information not linked to each other
The Gauteng public healthcare service performance Overview:
The Cause-Effects

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Concept of Healthcare and
System Performance
2
Information
System &
Technology
Innovation
1
Leadership
co-ordination,
supervision
and Service
Delivery
4
Resources/
Org. Capacity
Carries out
health mandate
5
Models of
Care
Health Care
Approach
3
Policy and
strategy
Health
regulation
6
Patient and
Population
Engagement
Assists patients in leading a healthier life
Increases the probability of safe and effective service deliveryMinimizes service delivery gaps
Regulates and enforces services operation
Adopts specific health standards
Entrust resources, and responsibilities
Translates policy to practice
Personalized and evidence based care
Use of management guidelines
Avoidance of medical errors
Quality of care/ health reassurance
Communication with patient
1
6
5
2
3
4
Performs health
care audits
Monitors and evaluates information
Ensures patients, and
professional support
Ensures resource Mgt.
Better health related choices
Patient education in self-care

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Key Hospital Performance Dimensions
Performance Assessment Tool for quality improvement in
Hospitals (PATH ) Framework
Safety (Evidence of Risk Reduction)
Patient- Centeredness (Satisfaction and Experience)
StaffOrientation
(welfare,absence,and
Satisfaction)
ClinicalEffectiveness
(AppropriatenessofCare)
ResponsiveGovernance
(Answerstoneedsand
Demands)
TechnicalEfficiency
(Reductionofwaste)

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Healthcare
Team
Healthcare
Organisation
Patient
Resource
Stewardship/
Emancipation
Satisfaction
Satisfaction
and Support
Nature of
Support,
resources and
Expectations
Operational Design of
Healthcare delivery
Nature Of Relationship
Health
Outcomes
and Impacts
Performance
Measures
Service Delivery
(Inputs)
Performance
Measures
Performance Measures and Service Delivery
Outputs
(Services)
Functional Process

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Technical Efficiency Measures
Service Delivery
Process
What is done
Inputs
Available and
accessible
Resources
Outputs
Outcomes and
Impacts
Data Envelopment Analysis
(DEA)
LP method that measures DMUs for complex
institutions
Technical
Efficiency (TE)
Operates Standard
of the best practice
production Frontier
• Multiple input-output quantities
• Random noise less of a problem
• Price data is difficult to find
• Compares DMU’s directly against a
peer or combination of peers.
• IRS = Output increases by a large
proportion more than Input
• CRS= Operating at Optimal Scale
• VRS= DRS or IRS
• DRS = 2xinput ≠ 2xoutput
• The most efficient DMU (TE =100%)
relatively ‘envelopes’ DMUs.
• Higher the ratio, the higher
efficiency.
• Uses less weighted inputs
per weighted output

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Technical Efficiency Data and Graphs
0
2
4
6
8
10
12
District Regional Private
D/B
E/B
0
1
2
3
4
5
6
0 2 4 6 8 10 12
NoofDischarges/BedCapacity
Number of Admissions/Bed Capacity
Efficiency FrontierDMUs D/B E/B Technical
Efficiency
Score
(TE) %
Variable
Return
to Scale
(VRS)
Constant
Return
to Scale
(CRS) %
Scale
Efficiency
Score %
SE=VRS/
CRS (%)
District 4.2
(0.40)
1.9
(0.35)
40 60 65 92
Regional 6.5
(0.63)
1.6
(0.29)
63 37 71 52
Private 10.4
(1.00)
5.5
(1.00)
100 100 100 100

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Performance Results
• A dissatisfaction rate of 76%, an evidence of
service failure.
• No reliable means of tracking patients’
information and records.
• Excessive length of hospital stays.
• Shortage of speciality doctors
• Increased workload due to burden of diseases
• Low staff-patient ratio.
• Non-enabling working environment

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Performance Results cont’d
• Theft, poor decision-making, Vandalism, fraud.
• Frequent unavailability of essential medications.
• Managerial incapability to match Service with
demand.
• Abuse of resources by patients due to loose policies
• Loose communication gap among stakeholders.
• Non engagement of patients by other stakeholders’
• Ineffective referrals system due to non electronic
data exchange.

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Recommendations
• Update facilities, and enhance communication Link.
• Precise management review for all the core hospital
and clinic functions’.
• Establish common and well functioning integrated
information system.
• Continuously engage healthcare team in decision
making.
• Assess periodically practice performance of the
healthcare team.

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Recommendations Cont’d
• Introduce risk and efficiency management short training
courses
• Appoint professionals at the top-level positions.
• Continuously engage Leaders through a learning process.
• Use activity based payment to improve the system’s ability.
• Privatisation is recommended as the final remedy to this
crisis.

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Conclusion
• Develop a robust Information
Infrastructure
• Accessibility
• Responsiveness /
Timeliness
• Strive for good Service
Perception
• Build a culture of Value, shared
accountability and Innovation
• Focus on prediction, prevention
and early detection/ treatment
• Help patients lead a healthier
Lifestyles
• Enable Self management
and shared decision

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Recommendations
for Further Research
• Conduct efficiency study among all Gauteng
health clinics and all levels of hospitals.
• As a lifecycle process involving people and
technology, research shall be directed on
healthcare service delivery, aimed at tailoring
the requirements for the satisfaction of all
the stakeholders’ .

16. GSTM Symposium: 2013
HEALTHCARE SERVICE DELIVERY EFFICIENCY:
PERFORMANCE OF GAUTENG HOSPITALS