Browsing by Author "Gebhardt, Gabriel Stephanus"

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    A critical evaluation of health care reform in maternity services in the Western Cape Province of South Africa, 2007-2012
    (Stellenbosch : Stellenbosch University, 2016-12) Gebhardt, Gabriel Stephanus; Theron, Gerhardus Barnard; Stellenbosch University. Faculty of Medicine and Health Science. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: This thesis is a critical evaluation of the impact of service delivery shifts within maternity care on the clinical governance of a well-defined geographical service delivery area (Metro East section of the Cape Town health district) during 2007 to 2012. This period saw the implementation of a comprehensive health plan that envisaged the provision of safe maternity care at a non-specialist hospital within the metropolitan area. The data presented in the first part of the thesis shows that well defined levels of maternity care can provide safe management of pregnancies in a large, well-functioning district hospital. A central event in this time period was the opening of a newly-built district hospital in Khayelitsha and the major change in the drainage boundaries of Tygerberg hospital to include referrals from this new hospital. The thesis presents all the clinical governance aspects that went into the planning and eventual execution of a maternity service and the impact it had on the base hospital. The second part investigates the role of the regional maternity service in Tygerberg hospital as it relates to the clinical governance of the regional and district service in the Metro East sub-district. To this extent a few chapters place quality of care aspects such as structural audits, caesarean section rates, maternal and perinatal mortality data, medico-legal liability, patient and provider satisfaction and protocol compliance within this context. An in-depth root-cause analysis was made of all the obstetrics and gynaecology medico-legal cases within the Western Cape which showed that poor clinical note keeping was a major factor hampering defence of cases. The information obtained from this thesis builds on the Western Cape healthcare plan for 2030 aimed at improving quality of care and wellness with an outcomes-based approach and the prioritisation of evidence-based interventions. It concludes with the description of a maternity dashboard for the Tygerberg labour ward and the Metro East maternity service based on the information obtained from this thesis. The tool can inform the hospital management on progress, successes and challenges within the system on a regular basis.