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The evaluation of an accreditation programme for quality improvement in private physiotherapy practice in South Africa

Bowman, Winifred Edna (2001-11)

Thesis (PhD)--University of Stellenbosch, 2001.


ENGLISH ABSTRACT: "Quality" has different meanings to different people. Even quality experts do not agree on a single definition: Juran's definition of quality revolves around his concept of "fitness for use", Crosby defines quality in terms of performance that produces "zero defects" and Deming defines quality as a "never ending cycle of continuous improvement". One element, however, that is common to all three approaches is that management must accept and demonstrate leadership if quality is to be achieved. Quality is rarely thought of as others perceive it. What is apparent is that if providers of care wish to maintain leadership in defining quality, they need to - Actively participate in the public debate about quality. Review the way in which they have been defining quality. Question whether their definitions are aligned with what the purchasers of health care define as being important. Develop meaningful measures of quality and data collection systems that will allow them to demonstrate quality and value. - Willingly share data not only on outcomes, and also measures that are specific to individual procedures and service providers. The PhysioFocus practice accreditation programme attempted to achieve the above factors. By realising the goal of the research this was determined. The goal of the research was to evaluate the PhysioFocus practice accreditation programme and to make recommendations on the educational programme for accreditation in private physiotherapy practices. This goal was realised by means of an exploratory and descriptive research design with a qualitative orientation. The evaluation of the PhysioFocus practice accreditation programme was performed by means of a validated evaluation instrument. The group interview revealed components of the PhysioFocus practice accreditation programme that require remediation. Recommendations included professional-ethical issues, business management and legislative issues. The recommendations will be implemented by the PhysioFocus practice accreditation committee. The PhysioFocus practice accreditation learning programme was evaluated by means of a semi-structured questionnaire, containing eleven questions and a section for comments. The general consensus was that the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. The implementation of the PhysioFocus practice accreditation programme resulted in the facilitation of quality physiotherapy; professional and personal development; monitoring of quality improvement processes; and the evaluation and remediation of these processes. This supported the central theoretical assumption of the research. Concerns were voiced about the lack of standards, lack of quality improvement skills, the public image of the physiotherapy profession and the lack of basic business management training. The researcher concluded that the implementation of the PhysioFocus practice accreditation programme is essential in private physiotherapy practice in South Africa. At present the current PhysioFocus practice accreditation programme does not address all the needs of private physiotherapy practices. Recommendations based on the research included remediation of the current PhysioFocus practice accreditation programme, formal education included business management, professional-ethical-Iegal issues, standards and scientific methods to analyse process variation and the development of improvement strategies in quality improvement. Other recommendations include informal education, physiotherapy management and structured quality improvement activities. The issue of the image of the professional physiotherapist was also addressed. Topics for future research were identified. The uniqueness of the research lies in the fact that this is the only physiotherapy practice accreditation programme implemented in South Africa. It is also the only physiotherapy practice accreditation programme in South Africa that has been evaluated.

AFRIKAANSE OPSOMMING: "Gehalte" het verskillende betekenisse vir verskillende mense. Selfs kenners op die gebied van gehalte stem nie saam met 'n enkele definisie nie. Juran se omvattende definisie is "gebruikswaarde", terwyl Crosby gehalte in terme van produksie, naamlik "zero defek", definieer. Deming definieer gehalte as "'n nimmereindigende siklus van voortdurende verbetering". Die een aspek wat al drie die kenners egter gemeen het, is dat bestuur leierskap moet aanvaar en demonstreer indien gehalte bereik wil word. Geen twee persone ervaar gehalte eenders nie. Indien diensverskaffers leiding wil behou ten opsigte van gehalte-definiëring, sal hulle verplig wees om: aktief deel te neem aan openbare debat oor gehalte; die aanvaarde definisie van gehalte te herevalueer; die aanvaarde definisie van gehalte op te weeg teenoor dié van die mediese hulpfonds-administrasie; gehalte- en data insamelingsisteme te ontwikkel om gehalte en waarde te bewys; en gewillig alle data te deel - nie net uitkomsdata nie, maar ook data wat spesifiek op individuele prosedures en diensverskaffers van toepassing is. Die PhysioFocus praktyk-akkreditasieprogram het gepoog om bogenoemde te bereik. Die navorsing het gerealiseer deurdat die doelstelling bereik is. Die doelstelling van die navorsing was om die PhysioFocus praktykakkreditasieprogram te evalueer en aanbevelings te maak vir 'n leerprogram vir die akkreditasieprogram. Die doelstelling het gerealiseer deur "n verkennende en beskrywende navorsingsontwerp vanuit 'n kwalitatiewe oriëntasie. Die evaluering van die PhysioFocus praktyk-akkreditasieprogram het deur middel van 'n gevalideerde evalueringsinstrument geskied. Die groepsonderhoud het areas van die PhysioFocus praktyk- akkreditasieprogram wat remediëring benodig, geïdentifiseer. Aanbevelings het professionele-etiese aspekte, besigheidsbestuur en wetlike aspekte ingesluit. Die aanbevelings sal deur die PhysioFocus praktykakkreditasiekommitee geïmplementeer word. Die evaluering van die PhysioFocus praktyk-akkreditasieleerprogram het deur middel van 'n semi-gestruktureerde vraelys met 11 oop vrae, tesame met 'n afdeling vir opmerkings, geskied. Die algemene aanname was dat die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die implementering van die PhysioFocus praktyk-akkreditasieprogram het gehalte fisioterapie, professionele en persoonlike ontwikkeling, die monitering van gehalteverbeteringsprosesse, asook evaluering en remediëring van hierdie prosesse, tot gevolg gehad. Dit het die sentraalteoretiese aanname van die navorsing ondersteun. Daar was egter kommer oor die gebrek aan standaarde, die beeld van die fisioterapieprofessie, asook die gebrek aan besigheidsbestuuropleiding. Die navorser het tot die gevolgtrekking gekom dat die implementering van die PhysioFocus praktyk-akkreditasieprogram noodsaaklik is in privaat fisioterapiepraktyk in Suid-Afrika. Die huidige PhysioFocus praktykakkreditasieprogram voldoen nie aan al die vereistes van privaat fisioterapiepraktyk in Suid Afrika nie. Aanbevelings vanuit die navorsing sluit die volgende in: remediëring van die huidige PhysioFocus praktyk-akkreditasieprogram; formele opleiding, insluitende profesionele-etiese-wetlike aspekte; standaarde; wetenskaplike metodes om die praktykprosesveranderinge te analiseer; en die ontwikkeling van 'n gestruktureerde gehalteverbeteringstrategie. Die beeld van die fisioterapieprofessie is ook aangespreek. Onderwerpe vir toekomstige navorsing is geïdentifiseer. Die navorsing is uniek omdat die PhysioFocus praktyk-akkreditasieprogram die enigste akkreditasieprogram vir fisioterapie in Suid Afrika is. Dit is ook die enigste fisioterapie-akkreditasieprogram wat in Suid Afrika geëvalueer is.

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