Determining the root causes of low bed utilisation rates in public hospitals in the Northwest Province, South Africa

Abstract

Public hospitals in the North West Province have experienced a gradual increment of low bed utilisation rates from the financial years 2015/16-2017/18 of -16.20% to -22.3%. The discrepancy between the projected high demand for hospital beds and the measured low rates of bed occupancy in the North West Province, constituted a critical area of concern for resource management. The study's aim was to determine the root causes of low bed utilisation rates in the North West Province's public hospitals. The study sought to identify possible challenges to the optimal management of bed utilisation rates in public hospitals through a literature review, and explored the main challenges experienced by hospital staff to achieve optimal management of bed utilisation rates in public hospitals in the North West Province. Lastly, the study proposed an operational process to improve the management of bed utilisation rates in public hospitals in the North West Province. The study employed a qualitative descriptive approach which used semi structured interviews as a data gathering tool with 22 participants comprising of healthcare administrators, clinicians and nursing managers involved in hospital bed management, drawn from a sample size (n) 11 hospitals. Thematic analysis was applied to the gathered data, identifying patterns and emergent themes related to bed allocation, admission process, patient flow, discharge planning and challenges faced by healthcare professionals in optimising bed utilisation rates. Three themes were identified in the study: digital transformation, healthcare operations and organisational governance. Against the three themes, the study found that the limited use of digital systems, inconsistent reporting frameworks and underfunding of hospital infrastructure collectively contribute to poor service delivery outcomes. The human factor in communication and admission processes introduces risks of overcrowding, misallocation of resources and ultimately, low bed utilisation rates. Taken together, the study results reinforce the argument that without systemic reform that is anchored in improved planning, automation and consistent policy alignment, public hospitals in the province will continue to face avoidable inefficiencies and compromised quality of care. In conclusion, the study has established that there are no automated systems that are used across the hospitals in the province for the management of bed utilisation. The study also established that resource constraints like inadequate budgets, poor hospital facilities, insufficient medical personnel in hospitals and fewer serviceable ambulances, might be a contributing factor to especially low bed utilisation in hospitals. The study has noted the policy implication to the effect that across the North West Province, the Department of Health must set a standard policy to manage and report data. Another policy implication that was discovered during the study was that the process of approving or issuing of bed certificates must be improved to shorten the time it takes for a hospital to get a new bed certificate, and that the process can further be decentralised to provinces to shorten the time it takes for approvals. The North West Department of Health could introduce and implement digital transformation to improve their data management systems and processes. This could be done while also collaborating with municipalities to craft a plan that will assist patients who reside far away from hospitals who, due to social determinants of health in the province and economic realities, find it difficult to reach hospitals. The proposed framework may incorporate a mandate for municipalities to provide periodic, dedicated transport services facilitating patient transfer to and from healthcare facilities. For future research, the study found that it would be valuable to conduct research across different settings to include all healthcare facilities in the province, including private facilities, community health centres and clinics. Lastly, the study found that further studies could explore inter-provincial research that will make comparisons and system disparities between the nine South African provinces on the same subject.