**5. Content of the chapter**

### **5.1 The assessment of the capabilities of staff members who can manage the quality assurance office**

The assessment of the staff members who can manage the QA office depends on the culture and the goals or objectives of the organization. Being appointed as AQ manager is very important because this is attached to greater responsibility and accountability regarding the reputation of the organization.

Therefore, the person should have experience in clinical practice and quality assurance and be passionate about working with all stakeholders both internal and external. Furthermore, the manager should embrace Ubuntu's philosophy to work with all stakeholders with Ubuntu as a global concept derived from a South African Zulu word, promoting love, caring, sharing, respect, kindness, compassion, and cooperation. It encourages equal interaction without feeling less human.

Managers are crucial in maintaining control and strategic decisions in the quality assurance department. They ensure that the department operates at high standards, complies with corporate rules, and meets quality requirements. Their primary tasks include client satisfaction, collaboration with subsidiary companies, and maintaining project quality standards [19].

Quality assurance manager ensures successful implementation in:


*The Importance of Quality Assurance in Rural Public Healthcare Facilities DOI: http://dx.doi.org/10.5772/intechopen.113992*


### **5.2 Healthcare needs, resources, and assessment approaches for quality maintenance**

Despite the importance of quality, managers must be active in patient care delivery. Managers must prioritize numerous quality aspects, take into account the demands of providers and patients, and manage resources given to them by the government, commercial entities, and the community. It is critical to address resource distribution, fee schedules, personnel patterns, and management procedures.

Quality, as a multidimensional notion, is especially useful for managers who prioritize access, effectiveness, technical competence, and efficiency. The QA, on the other hand, involves monitoring healthcare professionals' provision of patient care using cost-effective resources and motivating nurses to deliver excellence. It involves nurses taking accountability for their care and ensuring services are regulated by professional members.

Quality assurance aims to create an environment that produces consistent, reliable, and high-level products, detects challenges, and corrects problems that may affect quality. It is a proactive process that prevents quality failures by setting core standards and ensuring compliance. Procedure and policy manuals, healthcare standards, and the South African Nursing Council's scope of practice guide healthcare staff in providing quality patient care. However, the strategies were put in place with limited positive results. Patient satisfaction is not met. There are a lot of complaints in most rural public healthcare facilities that lead to various litigations. The study by Madaka [20] reveals that despite numerous quality improvement initiatives, South Africa's healthcare facilities have not achieved high-quality service delivery, posing a challenge for the government to ensure long-lasting improvement. Below are the challenges faced by relatives, patients, and quality assurance managers handling complaints.

#### **5.3 Challenges faced by relatives, patients, and quality assurance managers handling complaints**

The two components of quality management are quality assurance and quality control, with QA activities encompassing the full quality system and QC being a subset of QA activities [21]. The evaluation of healthcare quality is becoming

more and more important in developing nations, with outcomes serving as a major indicator. Some African nations are creating national quality programs and policies, such as South Africa's National Policy on quality in Healthcare and Zambia's National Quality Assurance program [22, 23]. Ghana is putting into practice a national health quality program, and it is anticipated that quality assurance systems will become essential to the regular provision of health services. Through the implementation of quality assurance systems, Nigeria's health sector reform seeks to increase access to high-quality healthcare. All reform plans and programs must include quality improvement measures according to the Federal Ministry of Health. To establish a quality culture in healthcare systems, health professionals must participate in the quality program and be aware of the required behaviors. An example was the study conducted by Romdhane et al. [24], which showed three key problems in Africa's healthcare system:


More than two-thirds of the perceived problems are attributed to these obstacles, which focus on leadership and governance, the healthcare workforce, the provision of health services, and financing [5]. Furthermore Broadhurst et al. [22], revealed that inadequate training facilities, brain drain, and adverse governmental policies are overt problems. Another significant issue is inadequate funding with low budgetary allocation and poverty being the two main financial obstacles that African healthcare systems must overcome. The approaches for restoring Ubuntu in healthcare facilities are described below.

### **5.4 Restoring Ubuntu in healthcare facilities**

Ubuntu relates to humanity. It is a worldwide concept derived from a South African Zulu word. The concept is based on a saying in Zulu, which states that "umuntu ngomuntu Ngabantu" which means I am because you are Um and Lau [25]. In this chapter, "Ubuntu" refers to embracing love, caring, sharing, respect, kindness, compassion, and cooperation in promoting quality assurance. It is very difficult to ensure that QA is maintained in rural health facilities without embracing the Ubuntu philosophy. Therefore, incorporating Ubuntu in daily activities by health workers is very important.

Caring in nursing and Ubuntu have many parallels because both emphasize caring and other caring ideals, such as respect and dignity. The notion that "a person is a person through other people," which is a direct translation of practically all African languages, is at the center of Ubuntu moral theory, and is known in Tshivenda as "Muthu ndi Muthu Nga Munwe." Ubuntu ethics encourage people to share their belongings for the benefit of all and to care for all people.

The study conducted by Maphumulo and Bhengu [18] mentions Ubuntu as what is ethically decent for individuals and communities, and it is assessed by dignity, respect, and contentment to promote the well-being of others, all of which are frequently shared fairness ideas. Hence, the following Ubuntu principles need to be of value. Ubuntu principles can help clinicians gain a deeper understanding of patients

#### *The Importance of Quality Assurance in Rural Public Healthcare Facilities DOI: http://dx.doi.org/10.5772/intechopen.113992*

and others in their daily lives. These include humaneness, empathy, compromise, learning, change, renewal, restorative justice, love, spirituality, and hope. By incorporating these concepts, clinicians can develop relationships with patients, and harnessing their energy to be the healers, they are meant to be. By embracing these principles, clinicians can create a more compassionate healthcare system.

On the other hand, QA integrated with Ubuntu is a crucial aspect of quality management, ensuring the fulfillment of quality requirements for both management and external stakeholders. It involves systematic activities within the quality system to demonstrate confidence in a healthcare service. For instance, [19] found that Ubuntu can affect how nurses provide care. It involves nurses taking accountability for their care and ensuring services are regulated by professional members. Furthermore, QA involves monitoring healthcare professionals' provision of patient care using cost-effective resources and motivating nurses to deliver excellence showing Ubuntu throughout the caring practices.

Quality assurance aims to create an environment that produces consistent, reliable, and high levels of quality patient care, detects challenges, and corrects problems that may affect quality. It is a proactive process that prevents quality failures by setting standards and ensuring compliance providing quality patient care using autonomy in whatever decision is taken.

#### **5.5 Barriers to maintaining quality care in healthcare facilities**

Financial obstacles to healthcare services with high rates of out-of-pocket spending are further issues with the continent's healthcare system that are common [20]. These issues are caused by an ineffective national health insurance system and insufficient service integration. According to some research, nurses working in rural locations frequently deal with few resources, erratic staffing schedules, and unpredictably high patient census and acuity levels [5, 8].

*Inadequate resources*: A particular level of output is unachievable with inadequate infrastructure, tools, funding for ongoing costs, and employees.

*Personnel issue*: The standard of treatment is impacted by a lack of properly trained, skilled, and motivated staff members.

Patients and staff who are unreasonable: Illness, anxiety, delayed response to therapy, unreasonable, and uncooperative behavior, which, in turn, impacts the quality of care.

*Poor maintenance*: To be used effectively, buildings and equipment need to be properly maintained.

*Lack of an informed public*: In order to increase the quality of nursing care, it is important for individuals to become informed and assert their legal and ethical obligations to receive high-quality care.

*Lack of accreditation regulations*: Hospitals are not adequately inspected to make sure that the minimum requirements are met: Investigate significant instances of neglect and punish the negligent health providers.

*Lack of incident review procedures*: Several occurrences that may occur, while a patient is hospitalized and have an impact on their care and eventual recovery, include wrong medicine, burns caused by substandard practices, or equipment.

*Delayed attendance by doctor or nurse*: A patient dies in a hallway without a doctor or nurse present.

*Not enough effective healthcare information systems*: An effective management information system is crucial for evaluating the quality of care.

*Patient satisfaction surveys not conducted*: surveys that will be conducted by social workers, hospital management students, and consultant groups using questionnaires, interviews, etc.

*Lack of nursing care records*: Nurses should consistently record the care they provide using the nursing process or a problem-oriented record system.

*Lack of oversight*: Absence of supervision, ignorance of the philosophy of nursing care, absence of a policy and administrative manual, absence of a process manual, inadequate quality and quantity of professionals, and subpar education and training.

*Poor management*: Lack of evaluation methods, ineffective departmental and cross-departmental collaboration, absence of formal job descriptions, and job specifications.

*Inadequate programs for nurse education*: Lack of continuous education and inservice training opportunities.

#### **5.6 The effects of poor healthcare services**

Poor healthcare services are increasing illness burdens and health costs globally, hindering progress in all income levels [12]. Besides, the study conducted by Mosadeghrad [26] showed that poor healthcare services failure endangers patients' health and safety. Therefore, QA is crucial to measure quality patient care and put quality control in place to mitigate deviations. For example, inadequate resource distribution, particularly inadequate medication supply, increases the risk of malaria, tuberculosis, and HIV/AIDS, which leads to more complications in patients.

The main causes of poor healthcare, which may be prolonged waiting times for treatment and surgery, negative outcomes, poor cleanliness, inadequate infection control procedures, limited resources, and poor record-keeping if well addressed can ensure quality care. In addition, inadequate training of staff members leads to inadequate knowledge and a lack of competency. As a result, it is critical to explain the interventions for the purpose of raising the standard of quality of patient care, see below.

#### **5.7 The improvement interventions**

Quality is every health worker's responsibility and accountability. This means that in every healthcare facility, the developed policies and procedures in place should be defined to reinforce compliance to the standard of service. Therefore, remedial actions should be suggested in case of deviations between the performance and the standards for QC. QA strategy integrates organizational approach, management, staff, and quantitative techniques to meet client needs and expectations. It is an orderly managerial improvement strategy aimed at addressing the demands and prospects of all organizations as they attempt to deal with rising change, complexity, and pressure within their organizations. Hence, the following interventions are implemented to improve the quality. Healthcare managers should contact non-returning patients for information and implement generic measures to improve service quality and patient well-being. Furthermore, suggestion boxes for survey questionnaires are used to determine patient satisfaction with services rendered.

Healthcare managers need to understand the importance of service quality dimensions in patient satisfaction and how dissatisfied patients react to service failures in order to intervene further to improve the quality of care. Ref. [27] affirmed that healthcare is dependent on patient-provider collaboration and supportive surroundings. Furthermore, [28] demonstrated that change can result from visionary

#### *The Importance of Quality Assurance in Rural Public Healthcare Facilities DOI: http://dx.doi.org/10.5772/intechopen.113992*

leadership, sound planning, education, training, resource availability, proficient management, and provider collaboration. For example, peer reviews and audits must be completed within the agreed-upon time frame, and sometimes unannounced audits are required to improve the quality of care. Furthermore, the buildings must be evaluated in order to increase the security and safety of both clients and health personnel. To avoid unintended consequences, risk officers and occupational health safety personnel should conduct risk assessments in collaboration with quality and infection control practitioners.

The study conducted by Polizzi et al. [28] showed that quality improvement must be a long-term, ongoing activity aimed at reducing errors and creating a trusting atmosphere for both health workers and patients. The healthcare nursing service manager is not solely responsible for quality assurance. All staff members are responsible for assessing and controlling all accidents or hazards. In addition, stated that QA and improvement program is an ongoing assessment of internal audit and consulting work, aiming to enhance the quality and commitment of auditors. As a result, the purpose of the chapter was to explain the significance of quality assurance in public rural healthcare facilities.
