Barriers to Quality Care in Medical Imaging at a Teaching Hospital in Ghana: Staff Perspective.

ABSTRACT

BACKGROUND: The goal of quality care is to ensure that the health care services provided to individuals and patient populations improve desired health outcomes. However, as medical imaging services increase in Ghana, empirical evidence show a low level of care. Despite this, there exists no study in the public domain on the barriers to quality care. This study, therefore, sought to identify barriers to quality care in medical imaging at a teaching hospital to provide evidence that will enable optimization of care and in improving the overall medical imaging care delivery system. METHODS: This research was a descriptive, cross-sectional study using a mixed method approach based on the dimensions of quality of care of medical imaging services from medical imaging professionals' perspective capacity and sustainability, timeliness, safety, equity, patient-centeredness, effective communication, and appropriateness of examination. QUANTITATIVE METHOD: A 5-point Likert scale questionnaire was used. The study population included all medical imaging professionals (n = 47) at the imaging department of the hospital. However, a total of 36 agreed to participate in the study. Data were analyzed using Stata Version 13. Descriptive analyses were carried out. QUALITATIVE METHODS: Purposive sampling strategy was applied to recruit 12 management team members and key staff with vast experience in medical imaging for the study. Data collection was done using a reflective in-depth interview guide. Data were analyzed using thematic analysis. QUANTITATIVE RESULTS: The quantitative findings show more than half of the respondents (n = 23, 63.9%) currently play supervisory roles, 10 (27.8%) work more than 40 hours a week, a minority group (n = 7, 19.4%) examine more than 100 patients per week, and 21 (58.5%) reported quality improvement programs are not carried out. Overall, half (50.0%) of the respondents are unaware of the availability of standard operating procedures, 28 (77.7%) reported imaging machines are not always functional, 34 (94.5%) reported lack of adherence to equipment servicing practices, and 27 (75%) agreed that broken-down equipment are left for more than 3 months before being fixed. In addition, 26 respondents (80.5%) reported staff number is inadequate compared with the workload, whereas only 11 (30.6%) stated supervision by management is adequate. Furthermore, 12 respondents (33.4%) reported management seem interested in quality of care only after adverse event, only 5 (38.5%) of the radiologists stated they are able to meet image reporting deadlines for clients, and only 8 (22.2%) of the respondents reported the availability of means of communicating results to referring clinicians aside the normal report. QUALITATIVE RESULTS: The qualitative findings show a lack of commitment to equipment servicing, frequent nonfunctionality of imaging machines, and an undue delay in repairs of broken-down machines. In addition, there exists inadequate human resource, inadequate supervision, a lack of quality improvement programs, and educational advancement opportunities for staff. The findings further show inadequacy of hospital gowns for patients, a lack of equity, and a poor organizational culture. In addition, the study identified a lack of means of communicating urgent imaging findings and a lack of promptness and timeliness to care from the consultant radiologists. CONCLUSION: The low level of care of medical imaging services observed in Ghana is reflected in the large number of barriers to quality care identified in this study. Most barriers identified are in the capacity and sustainability, timeliness, and effective communication dimensions of quality of care. The findings have important implications for policy makers. Improvement in these areas will enable optimization of care and in improving the overall medical imaging care delivery system.