Adopting total quality management to enhance service delivery in medical records. Exploring the case of the Korle-Bu Teaching Hospital in Ghana
| Date | 18 July 2016 |
| Pages | 140-169 |
| DOI | https://doi.org/10.1108/RMJ-01-2015-0009 |
| Published date | 18 July 2016 |
| Author | Emmanuel Adjei,Monica Mensah |
| Subject Matter | Information & knowledge management,Information management & governance |
Adopting total quality
management to enhance service
delivery in medical records
Exploring the case of the Korle-Bu Teaching
Hospital in Ghana
Emmanuel Adjei
Department of Information Studies, University of Ghana, Accra, Ghana, and
Monica Mensah
The Balme Library, University of Ghana, Accra, Ghana
Abstract
Purpose – The purpose of this study is to determine the extent to which total quality management
(TQM) initiatives can improve the quality of services delivery at the medical records unit of the Korle-Bu
Teaching Hospital (KBTH) to help meet the expectations and aspirations of patients and customers of
the hospital.
Design/methodology/approach – This research adopted the survey strategy as its research design.
The total study population consisted of 114 medical records staff of the KBTH. Questionnaires and
personal observations were employed as the data collection instruments. The study recorded a response
rate of 98 per cent. Data gathered from respondents were analysed in qualitative terms.
Findings – The overall nding of this study was that, although the medical records department of the
KBTH had a fair degree of understanding on the benets of TQM to records management service
delivery, the exiting values for TQM did not meet the framework of good TQM practice, principles and
standards.
Research limitations/implications – Even though the subjects for the study were from the biggest
hospital in Ghana, the ndings of this study may not be generalised to the whole country.
Practical implications – The study has demonstrated the need for the medical records department
of the KBTH to have and develop good TQM standards to improve the quality of services to patients
and varied customers of the hospital.
Originality/value – The literature reviewed indicated that this study is a maiden attempt to examine
how TQM initiatives including sensitivity, customer satisfaction, commitment of top management,
team work, effective leadership and participatory management, people development and effective and
open communication can improve the quality of medical records service delivery at the KBTH in Ghana.
Keywords Ghana, Hospitals, Korle-Bu Teaching Hospital, Medical records, Service delivery,
Total quality management
Paper type Research paper
Introduction
To function effectively as an instrument of patient care, all medical records departments
must be well organised to meet the standards required of the medical staff, and the
hospital’s patient administration services. Paramount, of course, is patient care, for
which hospital medical records – indeed, hospitals – exist. It is not overstating the case
The current issue and full text archive of this journal is available on Emerald Insight at:
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RMJ
26,2
140
Received 20 January 2015
Revised 30 July 2015
24 November 2015
Accepted 17 December 2015
RecordsManagement Journal
Vol.26 No. 2, 2016
pp.140-169
©Emerald Group Publishing Limited
0956-5698
DOI 10.1108/RMJ-01-2015-0009
to say that the medical record and its contents play an important role in the delivery and
quality of service the patient receives in a hospital, clinic or some other type of medical
institution or health facility. The accuracy of information contained in the patient’s
medical record, its speedy retrieval and the availability of this information for utilisation
by medical, nursing and other hospital staff are essential. This not only underlies the
importance of the role of the medical records staff but also highlights the responsibility
they shoulder for locating and delivering the records as well as the necessity to create
and maintain efcient and effective medical records.
In general medical records departments exist “to collect, process, maintain, retrieve,
and distribute patient records to [those staff or personnel] with legitimate reason to have
[access]”. In addition, medical records staff have a responsibility to “maintain and
review the records for completeness” before and after each episode of care and before the
record is returned to the ling area (Huffman, 1994). Medical records are a source of
statistical information for the administrative apparatus of the health service, medical
research and educational and public information planning. They are also a reliable
source of reference in the event of litigation and to insurance companies (Pegano, 1992)
in which connection the compilation of diagnostic information for legal and insurance
purposes is another of the tasks that is often performed by medical records staff. In
response to these developments, the mandate of the contemporary medical record
department far exceeds the traditional conception of the record-keeper’s brief (Adjei,
2000).
The reliance of all manner of government agencies, as well as a wide range of
healthcare schemes and projects, on data obtainable only from medical records,
continually intensies the burden of pressure on medical records departments in all
kinds of ways. Standards of efciency and effectiveness within medical records
department inevitably vary from hospital to hospital. The quality of performance is,
however, dependent on factors such as the availability of both physical and nancial
resources and the calibre of personnel providing the many medical records services.
Equally important is the priority which hospital administrators attach to their medical
record services; their recognition of the importance of the medical records service and
their support for the service. This, in particular, refers to recognising that if the medical
records department is well equipped, staffed and well organised, then the completeness,
accuracy and availability of the patient le are likely to be assured, and the hospital and
its constituent departments as a whole will be in a better position to organise and
manage the patient’s care and general well-being through the curative process to which
the hospital is committed (Adjei, 2000).
The Ghana Health Service has undergone many intensive changes in recent years.
The strong focus on improvement of the quality of service available to patients has been
among these important changes (Adjei, 2003). In the past, poor quality of service
delivery has been partly blamed on the absence of institutional quality assurance
programmes, lack of a formal system of peer and medical audit and poorly developed
performance monitoring systems. As part of the many policies and reforms have come
new quality assurance programmes, new techniques of resource management, formal
systems of medical audit and peer review programmes, the introduction of a national
health insurance scheme and the monitoring and evaluation of health programmes with
clear processes and output indicators to assist in decision making (Ministry of Health,
2013).
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Adopting total
quality
management
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