الرحيم الرحمن الله بسم

NURSING FACULTY

A presentation about:

The Patient Journey In The Palestinian Governmental Health

System In Hebron

Prepared by :Ayah AlsharawnahMarwan Abo-Fara

Ins. Dr Hussein Jabareen

Introduction:

During our study about the patient journey in the Palestinian governmental health system during the last two months we met eight patients and took their opinion about the health system in Hebron (Governmental Hebron Hospital).The results exceeded our expectation and desired outcomes ,so we decide to show our research result as a study of a phenomenon that has a direct and indirect causes leading to a result.

The research objectives:

*exploring what patients think about their journey in the governmental healthcare system?

*are the changes they need to make this journey smooth and effective?

*what driving these changes?

*how these will impact on service delivery in our Palestinian health care system?

* What are the effect of this system on the patient?

The main themes that we explored initially with the patients about were:

1 .Attitudes toward the system and the health care staff

2 .Anxiety that patients feel and its sources

3 .The financial limitations and its effect on the patient and the system

4 .The degree of satisfaction from services

5 .How we can improve the system quality and quantity

Methodology: We used a qualitative design, a semi structural

interview as a tool to collect qualitative data. The strength and important of using this approach of research is that the qualitative research can provide a much more holistic view of the problem under investigation ,including information that cannot be reduced to numbers ,also it allows researcher to interact with the research subjects in their own language and on their own terms. This approach a deeper understanding of the problems that the patients faced in health care system.

 Statistical tests that used in analyzing data process:We used the 10 version of NVIVO program .

How the data were collected:

After we choose our sample according to the mentioned criteria and take their consent to conduct the interview, stating and explaining to them the main goal of the interview and that recording is for purposes of scientific research and also no one other than the research team will listen to the tapes.

The interviews was emptied and formulated and then translated to the English language have been introduced to NVIVO program for analysis.

The results

Demographic data:Age

3 20-35

4 36-50

1 Above 50

Sex:

4 Male

4 Female

Disease duration

5 1-10 years

1 11-20 years

2 Above 20years

Education level:

6 Tawjihi or lower

2 University

Residence:

7 Village

1 City

Data analysis:

Anxiety from dealing with the system was a very big surprise that all of the patients said that they feel anxious from dealing with the system and emphasize on that the anxiety status from the system is greater than anxiety from the disease experience.We found that there is a direct and indirect reasons for the patients anxiety starting from the staff dealing with ,so we study the patients attitude toward three segments of the staff include doctors ,nurses, and administrative employees ,because they are dealing directly with the patients reflecting the system policy and flexibility .

Many obstacles in the system make them feel anxious :*starting from the registration process.

*the staff dealing with them.

*the long time to inspect and treat them.

*the lack and shortage in the equipment and medication.

*the procrastination process to have some specific services .

* the environment and structure of the hospital.

Direct causes of the patient :

We found that the major sources of patients anxiety were the staff of the system because they are in a continuous direct contact with the patients , so we asked the patients about their attitude toward the three components of the staff:

*administrative employees

*Doctors * Nurses

Attitude toward administrative employees:

“the first line of the system that the patient faces”

The patients have a mixed attitude toward them, the patients who has a negative attitude said that there is a shortage in there manner of dealing with patients and that there is a one window for registration, also patients mentioned that they sometimes make a shortcut for their relative or specific patient .But the other part of the patients with positive attitude said that the of their dealing comes from the huge number of patients.

"Their dealing was unstable due to the pressure"<Internals\\> - § 1 reference coded [1.13% Coverage] Reference 1 - 1.13% Coverage

Attitude toward doctors:

The patients have nearly a negative attitude toward doctors as we found in our study, the patient relating that to many causes like

*doctors take a long time to inspect and assess them and when they do they did it is a not probable manner according to the patients

*the ambiguity of the doctors discussion

* the refusal of them to describe what happening to the patient lead to form negative attitude toward them.

“But unfortunately, up till now, I have not seen the doctor and he haven't told me anything about my case.”

<Internals\\NA J> - § 1 reference coded [2.21% Coverage]

 Reference 1 - 2.21% Coverage

 

Attitude toward doctors:

But, also all the patient have a ppositive attitude toward the doctors explaining this that they are a qualified doctors and competitive, the patient said that huge number of the patients that the doctor need to see daily make the doctors dealing in the negative manner, in addition to the shortage of the doctors number in the system was a reason that the patient excuse the doctors in their dealing.

“ I thought he did explain that due to the enormous pressure for the patients.”

<Internals\\> - § 2 references coded [1.57% Coverage]

 Reference 1 - 0.92% Coverage

Attitude toward nurses:

Those patients have a negative attitude toward nurses, explaining that*they did not care about the patients and *they make the patient wait a long time to give him/her medications or care *when they do they do in a not serious manner.

"They do not care about patient upon arriving to the hospital, for example, they put the patient on the bed in emergency department and procrastination starts from doing examination and registration"<Internals\\A.H> - § 1 reference coded [2.92% Coverage] Reference 1 - 2.92% Coverage

The patients who have appositive attitude said that they are good as doctors and dealing with the patients complaisance, also there is a shortage in their number.

They are as good as doctors". <Internals\\R B> - § 1 reference coded [0.57% Coverage] Reference 1 - 0.57% Coverage

Indirect causes:

The patients also mentioned other indirect causes that increase their anxiety toward the system which we will talk about in the subsequent slides which they are:

*Flexibility of the system

*The equipment efficiency

*Medications availability

Flexibility of the system:

The patient's opinion fluctuates about the flexibility of the system.

Part of them see the system not flexible enough ,because of the complex process to enter the system starting from the registration process to the emergency room ,the lab and other services like the services of the X-ray department ,ending in the difficult admission process.

"It is difficult. This process affected my health situation. I have an experience happened with

my grandson. We suffered a lot to get a medical transference in Al-Ahli hospital. Until this

moment, we have not received it and we are not satisfied about this."

<Internals\\N A J> - § 4 references coded [12.92% Coverage] Reference 1 - 3.56% Coverage

Another part of the patients saw the system as flexible and easy to get the service from it with some obstacles that fixed in the nature of any governmental system.

"Regarding coordination between departments, I can say it is a good one"

<Internals\\R B> - § 1 reference coded [1.29% Coverage] Reference 1 - 1.29% Coverage

Equipments:

This is another aspect that we found it increasing and exceeding the patient's anxiety feeling, in which the patient emphasized that many of the important equipments always are not efficient

"When I needed x-rays, I used to go to Shawar center. The x-rays and televised images were not available in the hospital and we used to do them outside“

<Internals\\R B> - § 1 reference coded [2.81% Coverage] Reference 1 - 2.81% Coverage

 

Medications availability:

This is one of the important matters that annoying the patients and made them to complain all the time.

They said that it is a major problem that they cannot find their necessary medications in the hospital, so they forced to buy them from out sources from their own money.

"Most of the time not, I used to buy medicine from outside"

<Internals\\R B> - § 2 references coded [2.40% Coverage] Reference 1 - 1.13% Coverage

The patients who said that they get their medicine from the system said that they just find the analgesics and some necessary drugs that they need.

"The expensive drugs don't find in the pharmacy just the cheap drugs“

<Internals\\F H> - § 3 references coded [2.55% Coverage] Reference 2 - 0.78% Coverage 

Aiding causes:

There is another cluster of factors that emphasize the anxious state of the patients, but they occupied little space in the patient's concentration, we can put them in the category of environment

Waiting time:

All of the patients complain from the very long waiting time to achieve the service from the system, many of them named the day of the registration or admission as a "struggle day".

"What bothers me most is the long waiting time that lasted sometimes between 4 to 5 hours“

Internals\\AF Al> - § 3 references coded [5.23% Coverage]Reference 3 - 1.86% Coverage

 

There is another patient that saw the waiting time as acceptable rationalizing by the huge number of patients.

Environment &Waiting room:

The waiting room is the first place that the patient spends several times in it, so it has to be suitable and comfortable.

The patient complains about the narrow space of the room and the shortage in the seats and other componetnce that help them to spend time.

"This is exactly the core problem and the basis of suffering. We used to come early with the first hours of dawn. There were large and big queues, rather massive, and we used to make turns between us in order to facilitate registration, in addition, we used to wait for long times."

<Internals\\AFA> - § 1 reference coded [5.92% Coverage] Reference 1 - 5.92% Coverage 

This lead to talk about the whole environment of the hospital in which the patients opinions fluctuate but many of them see that it is a good environment with a good hygiene emphasizing on the problem of crowded people that give no chance to achieve more better environment by organizing the system and the process of cleaning.

"The cleanliness of the place is bad due to overcrowding section with devices and people who prevent to reach the Janitorial acquired degree.“

<Internals\\MH> - § 1 reference coded [2.42% Coverage] Reference 1 - 2.42% Coverage

The results of the previous issues on the patients

All the discussed factors that lead to the anxious state of the patients result in many important manners that we try to measure across our sample

*Loss of confidence in the system

*Low satisfaction state

•*The treatment achievement

*A personal financial problem

Satisfaction & Confendtiality:

All of the patient are not satisfied about the system staff and services. Using their experience in dealing with the system to form this picture ,they said that there is a chance to improve the system and existing process can be modified to be more efficient ,flexible, and productive,

"I can touch a shortage in the number of doctors and nurses, the matter that affects the value of the treatment provided to the patients due to the large number of patients and crisis."

<Internals\\Khalil Ajwa> - § 2 references coded [3.26% Coverage] Reference 1 - 2.56% Coverage

The mentioned speech and description move us to talk about a related items that is fixed with satisfaction which is Confendtiality.

Many of our patients showed an acceptable level of confidence even through one of them who had a complication due to diagnostic mistake said that he still believe in the system, but dealing with it carefully.

Treatment achievement:

All of the patients said that they achieved their treatment even so in a minimum degree but they are satisfied about this issue.

" The most important thing to me is to do the kidney dialysis.“

<Internals\\MH> - § 1 reference coded [1.07% Coverage] Reference 1 - 1.07% Coverage

Finance problem:

One of the major and important aspect that the patients talked about it repeatedly and put it as desktop to their problem, because the poor financial state of our patients they was forced and have no choice to deal with an alternative health system and all of them have a governmental insurance that make them pay little money to get the service.

" His financial situation does not allow us to buy expensive medications.“

<Internals\\Nadia Abu Juhesha> - § 1 reference coded [1.57% Coverage Reference 1 - 1.57% Coverage

 

Another aspect that lead to the financial problem among the patient the lack of equipments and medications which made them to seek an outdoor alternative service that cost them a lot.

Conclusion :

From our study we found that the system affect directly the patients that deal with it .leading to put the patients in an anxious state come from the manner of staff dealing that make the patients have a negative attitude toward the system and its staff. The patients think that the circumstances which lead to anxiety are modified and can be improved to a good state if the system try to invest more effort on it .We conclude that the system can improve its services by making the patient journey smoother and easy by building up a matrix that fit the Palestinian patients and separate the facilities of the ministry with wide responsibilities for each facility to cover the large number of patients that need the system services.As of our patients said " it’s a good system but it can be better".

Limitations:

•The long time to get the ministry approvement

•There was no separated space to interview our patients

•There was no previous studies that talk about our issue

•There was no accurate fresh data measuring the patients attitudes and satisfaction

* the waste of time trying to get the envivo program

Recommendations:

Because the kind of our study we found that it's better to write down the recommendations of our patients because any modifying in the system affects them directly.

*I can suggest more windows for the registration department.*Having larger number of medics in each department of the outpatient clinics and emergency. *The availability of ECHO device. *Expanding the space of outpatient clinics with more than one window for registrations.* Improving the administrative side, transference, shortage of doctors, and some medications and equipments.

*It would be better if we have more seats.*Regulating the distribution of medicines to whoever needs them urgently, and whoever has the same medicines at home shall not get them. *Increasing the number of caretakers and security guards. * By having special committee to decide who need the Ext hospital rapidly more than others. *I think it should have a doctor for each patient who has a kidney dialysis to help him in the case of emergency. * By building an infrastructure; for example, kidney department in Alia Hospital is not suitable where was expanded through patching and imperceptibly boring. * I would like to put doctor in the right place and the specialist attendants with patient. He should replay to the patient's inquiries. The crews' dealing is easier and more professional.

The research team recommendations:

*take the patients recommendations and try to use them in improving the system.

*put a suitable plan that makes the patient journey smoother.

*find a source of information about the patient journey in Palestine that we did not find when we did our study.

*The staff should be more effective when dealing with the patients.

*explain every procedure to the patient to remove the ambiguity .

Direct causes*doctors

*nurses

*employees

Indirect causes:•Sys is not flexible

• non efficient equipments

•Low medication availability

Aid causes:*long waiting time

*not suitable waiting room

*neglected facility environment

anxiety

Low satisfactionLow confidence

Personal financial problem

THANK YOU

QUESTIONS?