A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Carolina Hospital was old and dilapidated, paint was peeling off all the walls, roof leakage and floor tiles broken. Nosocomial infections rate was very high at 7% monthly. The cleaning systems were inadequate with no colour code cloth and mops leading to higher nosocomial rates. The waiting times for patients were very long up to 6 hours per patient. The ground of premises was dirty and had long uncut grass. This led to dissatisfaction and very high patient complains about service delivery and staff attitude. This tarnished the image of the hospital and staff members were also demoralised with high staff turnover. Hand hygiene adherence was poor, top of system of soup dispenser used.

B. Strategic Approach

 2. What was the solution?
Improve staff attitude and increase patient satisfaction about the services rendered. Reduce long queues and waiting time for patients. Reduce hospital acquired infection.

 3. How did the initiative solve the problem and improve people’s lives?
New cleaning system was introduced which was never used in public hospitals consisting of the following: > Colour coded cloths and buckets used for different areas to prevent cross infection. > The chemical removes odours. > Peals the floor and prevent infection. > Provides long lasting shinning floors up to a year. Infection surveillance tools were developed with a software program to analyse data. Patient feedback system was introduced which include waiting time, cleanliness, staff attitude and infection control tools with a soft ware to analyse data. Staff motivation programs were initiated which was funded by staff. staff conducted fun days and paint the hospital and worked in the garden.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Cleaning schedules was developed and implemented. Toilet monitoring tools was developed and implemented. IMPROVE SERVICES TO CLIENTS Waiting times are monitored monthly. infection control surveillance conducted monthly. Training of staff on customer care and team building exercises conducted. Feedback from clients collected every day on developed tools

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The hospital management designed the project. Hospital staff contributed their time and money in funding and working on the project. No budget was allocated specifically for the project, resources used was from the normal hospital budget. The cleaning company used to procure cleaning material trained cleaner and mentored free. The clients were actively involve in giving feed back about the quality of care.
 6. How was the strategy implemented and what resources were mobilized?
The project was funded through public funds through our normal budget. Staff contributed in team building exercises which they funded. The computer programs and tools were developed by the staff.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The long queues were reduced from 6 hours to below 3hours. The hospital acquired infection rate reduced from 6 to 0.25. The patient satisfaction rate with services including staff attitude has improved from 20% to 80%. The hospital is clean, shinny and odourless. The grounds are clean and well kept

 8. What were the most successful outputs and why was the initiative effective?
The waiting time is monitored monthly and discusses in the management meeting monthly and corrective measures implemented. The surveillance for hospital acquired infection done monthly and results discussed in management meetings and corrective measures implemented. The cleaning system and hospital grounds is audited weekly and corrective measures instituted . The painting and tilling project still going some sections still needs painting. Feed back from clients is done every month information collected and analysed and discussed in management meetings.

 9. What were the main obstacles encountered and how were they overcome?
The main problem encountered was the procurement system since we cannot procure goods with one quotation and the company that supply cleaning material is the only one available. The hospital management have to request approval to procure from a sole supplier which was eventually granted. The limited resources was also a problem ,the painting and tiling project is done in phases. The hospital management budget every year and use available resources for the improvement. The public sector does not budget for activities directed towards staff motivation this is done from own initiative.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The long queues were reduced from 6 hours to below 3hours. The hospital acquired infection rate reduced from 6 to 0.25. The patient satisfaction rate with services including staff attitude has improved from 20% to 80%. The hospital is clean, shinny and odourless. The grounds are clean and well kept.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The project is sustainable and has won several awards since started in 2006. The project was rolled out to the whole district and province. The project has influence the criteria developed for norms and standard for cleanliness. The project has won seven award since it started

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
We learnt that team work is important to achieve and sustain achievement. Providing team building and debriefing activities to staff can help in building positive staff attitude. We learnt that motivated staff enquires minimal supervision and can work effectively on their own.

Contact Information

Institution Name:   CAROLINA HOSPITAL
Institution Type:   Government Department  
Contact Person:   Ester Dladla
Title:   Project Leader  
Telephone/ Fax:   +27178431130
Institution's / Project's Website:  
Address:   P.O BOX 472 CAROLINA
Postal Code:   1185
City:   Carolina
State/Province:   Mpumalanga

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