OpenUCT :: Browsing by Author "Weimann, Edda"

Browsing by Author "Weimann, Edda"

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Open Access
Assessing the role of temperature and air pollution in exacerbating childhood asthma in Cape Town, South Africa
(2022) Phakisi, Tshepo Kingsley; Rother, Hanna-Andrea; Godsmark, Christie Nicole; Weimann, Edda
Childhood asthma is one of the most common chronic diseases worldwide, including in South Africa. There has been substantial evidence on the role of air pollution in asthma exacerbation but limited research on the role of climate change and how the interaction between climate change and air pollution is affecting childhood asthma, specifically in low and middle-income countries (LMICs). Temperature changes can be used as an effect of climate change to investigate the association between climate change, air pollution and childhood asthma. This study, therefore, used a case study approach aimed at examining the interaction between air pollution and temperature in exacerbating childhood asthma focusing on clinical data obtained from Red Cross War Memorial Children's Hospital, air quality data (City of Cape Town) and temperature data (South African Weather Services) for Cape Town, South Africa for three study years (2009, 2014 and 2019). The protocol (Part A) of the mini dissertation describes childhood asthma literature globally and in LMICs and specifically in South Africa. It also discusses the increasing incidences and prevalence of the disease and possible causes such as air pollution and climate change. Furthermore, it discusses the vulnerability of children to the exposure of interest, being air pollution (PM2.5, PM10, NO2 and O3) and climate change (i.e., temperature). Subsequently, the development of air quality standards is discussed, specifically concerning whether they consider the specific children's vulnerability to exposures. The protocol then describes the study population and methodologies for conducting this study. The journal ready article (Part B) presents the findings of the study. Spearman's correlation was used to measure the degree of association between temperature variables and air pollutants. The results indicated that diurnal temperature was associated with PM2.5 (r=0.579: p< 0.01) and PM10 (r=0.505: p< 0.01). A Poisson regression analysis was applied to evaluate the relationship between asthma exacerbation with air pollutants and temperature variables. In a univariate analysis there was a statistically significant relationship between asthma exacerbation and diurnal temperature for 2019, IRR=0.98 (95% CI,0.97 – 0.99) p< 0.05, maximum temperature 2014, IRR=0.99(95% CI, 0.98 - 1.00) p< 0.05 and for 2019, IRR=0.98(95% CI, 0.97 - 0.99) p< 0.01, average temperature 2014, IRR=0.99(95% CI, 0.98 - 1.00) p< 0.05 and for 2019, IRR=0.98(95% CI, 0.97 - 0.99) p< 0.01. Using a multivariate analysis there v of 110 was no significant relationship between childhood asthma exacerbation and air pollutants (PM10, NO2 and O3) except for PM2.5 IRR=0.12(95% CI, 0.01 - 0.81) p< 0.05. Diurnal temperature statistically significant childhood asthma predictor for 2009, IRR=1.02(95% CI, 1.00 - 1.05) p< 0.05 and for 2014, IRR=0.97(95% CI, 0.96 - 0.99) p< 0.01. Temperature increase, therefore, seems to be related to asthma exacerbation. More research is needed on the relationship between diurnal temperature, childhood asthma, and air pollutants to inform adaptation strategies. The findings of this study are important for the development of climate change and health adaptation and prevention strategies in South Africa, particularly in relation to heat adaptation. These findings are also relevant for the development of air quality guidelines and guidelines to address children, as the most vulnerable population to environmental health exposures. The appendices (Part C) present the analyses that were not included in the protocol (Part A) and article (Part B). These also include documents relating to the study such as ethics approval and permission to conduct research by different entities.
Open Access
Consumers' perspectives on National Health Insurance in South Africa: using a mobile health approach
(JMIR Publications, 2014) Weimann, Edda; Stuttaford, Maria
Background: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective: This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.
Open Access
Identifying non-value added waste that delay emergency CT brain workflow using lean management principles
(2020) van Zyl, Carike; Weimann, Edda; Ahmed, Nazir
Introduction: The Department of Radiology at Groote Schuur Hospital receives numerous emergency CT brain requests especially from the Emergency and Trauma departments. Improvement in emergency CT brain workflow should reduce waiting times for CT scans resulting in earlier diagnosis and treatment of these patients. Identification of the nonvalue-added waste (NVAW) (steps regarded as wasteful to the customer) in the CT brain workflow can be determined by use of a lean management tool namely a value stream map (VSM - a flow analysis of information required to provide service to the customer). AIM: The study aims to identify non-value-added waste in the CT brain workflow value stream map which may result in delay in emergency CT brain reporting. Method: This study investigated NVAW in emergency CT brain workflow for 5 working days between 08h00 to 22h00 from Monday to Friday. Nineteen patients booked for an emergency CT brain scan by the Emergency Department (ED) only between 08h00 and 22h00 over the specific 5 day working period were randomly selected using convenience sampling. The indications for emergency CT brain scans in the sample were similar to the wider group of patients undergoing emergency CT brain scans. A VSM identifying all the relevant steps in the emergency CT brain workflow was constructed. The investigator accompanied each of the nineteen patients from the ED to the CT scanner and back and manually recorded the time elapsed in minutes for each separate step on the data collection sheet. The outstanding information required was obtained from the Xiris system on the Phillips PACS (Picture Archiving and Communicating System). The average time interval for each of the steps as indicated on the VSM was calculated, and the rate limiting step(s) which resulted in a delay in emergency CT brain reporting was identified. Results: Overall, the longest step was the time interval from the time of completion of the scan to the generation of the report (turnaround time (TAT)) with an average time of 72.21 minutes (p value of < 0,01). Conversely, the time interval from placing the request by the clinician on the PACS to the time of annotation by the radiologist was the shortest with an average time of 5.84 minutes. Discussion: The lean management system was used to identify the rate limiting step(s) which resulted in delay in emergency CT brain reporting. Possible reasons identified for the delay caused by the rate limiting step include the backlog in reporting of the large number of already scanned cases which may be due to staff constraints as only one radiologist was on duty during most of the study period. Additional contributory factors include clinician telephonic query interruptions to radiology registrars during reporting sessions and delay in the emergency doctor authorising and facilitating transport of the patient from the emergency unit to the CT scanner. Conclusion: The value stream map tool in lean management can be utilised to identify non value added waste in emergency CT brain workflow.
Open Access
Informing BPM practice in Emergency Units of South African hospitals for improved patient flow
(2018) Loriston, Izienne P; Weimann, Peter; Weimann, Edda
Globally, higher healthcare demand strains existing systems, already overburdened by a lack of resources and funding while longer life expectancy and increased disease burden force higher patient loads. A majority of the South African population is medically uninsured and therefore depend on emergency care; consequently, the healthcare service demand easily exceeds available acute care to prevent life threat. When this happens, emergency centres suffer from overcrowding and long patient waiting times, which increases morbidity and mortality, associated patient risk. Moreover, critical resources such as staff and hospital beds are required for an even flow of patients through hospitals, but are distributed inefficiently. The South African healthcare system configuration therefore delays access to and compromises the delivery of equitable, unbiased life-saving healthcare in an environment moreover challenged by economic pressures. This calls for sustainable, cost-effective reform. Therefore, more efficient healthcare can save more lives by improving access to life-saving care. Research on current Healthcare Information Systems (HIS) shows an incoherent knowledge body with conceptual gaps in theories on healthcare, which disengages transformation potential. Comprehensive reform tactics thus require a priori concept discovery and diagnostics to make research practically useful. The systematic use of BPM theories allowed for the qualitative assessment of as-is process activity at patient touch-points at three hospitals – two public and one private – in the Western Cape of South Africa. Because a strategic Information Systems (IS) methodology, Business Process Management (BPM) poses business process activity improvement, this research draws from successful BPM activity as a means to improve patient flow processes in Emergency Centres (ECs). Success is evaluated by drawing from empirically supported enabler categories and prescriptive guidelines because BPM practice is not yet fully understood. The results show a clear correlation between the improvement areas at the three hospitals; improvements on aspects of actions and decisions taken during patient-flow process activity, therefore support a pragmatic approach to reform. The data confirms disparity between public and private healthcare. Healthcare appears to be a “doctor driven” service, which, based on qualitative decision-making, navigates patients along defined flows, enabled by supporting human capital and hospital assets. Optimal patient flow is a product of symbiotic working relationships and depends on efficient integration with wider hospital functions. Shorter waiting times and hospital stays reduce process burden. This leads to more efficient resource usage and regulated access to healthcare. However, integrated healthcare reform must consider the time demands and rigidity of clinical processes. The challenge lies in finding the space to invite parallel business agility to drive the reform of the stricken healthcare industry in South Africa.
Open Access
nalysing Change Resistance to an Information Systems-Supported Process in a South African Public Hospital
(2019) Foli, Matilda; Weimann, Peter; Weimann, Edda
Introducing technological change to an organization’s normal processes can potentially bring about positive or negative results, depending mostly on the manner in which the change was facilitated and integrated into the organization. However, very little research has been done on information technology (IT) investment among hospitals, its effect on the personnel, as well as how it influences patient care and financial performance. Consequently, little is known about users’ resistance to new technologies and the precedents of technology rejection in healthcare. Therefore, this study seeks to fill the gap of understanding South African hospital staffs’ perceptions towards change, caused by introducing an information system into one of the hospital’s daily processes. Where resistance towards change is identified, the study aims to understand the reasons behind such resistance. Finally, it aims to find appropriate intervention strategies to deal with and minimize resistance. In doing so, the study seeks to contribute to the body of research regarding change resistance to information systems in public South African hospitals. By adopting a descriptive and exploratory interpretivist paradigm, in conjunction with an inductive approach, the study aims to get a better understanding of hospital staffs’ perceptions through shared meaning. The study adopted a case study research strategy, as it affords the researcher the opportunity to participate in the study, and as such contributes to the subjective interpretation of the findings. Data was collected using a mixed method approach, and was used to describe the difference between the current and proposed process. In addition, it was used to explore the reasons for change resistance to information system-supported change, and to explore methods of successfully introducing change to tertiary public hospitals in South Africa. Fourteen participants (7 medical interns and 7 ward clerks) who were directly involved in the process being studied, were interviewed. Two other participants (the head of the pharmacy and the patient flow manager), who were indirectly involved in the process, were interviewed, to verify the observed and mapped process. Interview data was analyzed qualitatively, firstly through coding techniques before using sentiment and thematic analysis. While the mapped process followed Business Process Modelling Notation conventions. In addition to a mapped proposed process, a change resistance conceptual model was developed from a conjunction of the findings and extensive review of literature. The conceptual model asserts that five main factors contribute to change resistance: unclearly defined duties; fear of job security and technology usage; years of service; resource availability and resource mismatch; as well as insufficient training resulting from the lack of a learning culture. These factors can be moderated by: the existing state of affairs referred to as status quo; management involvement; and communication. The conceptual model can be used to better understand the causes of change resistance, as well as how to minimize change resistance and successfully introduce change into a health organization. Change agents should aim to understand the status quo that exists in the organization and find ways of incorporating that into the change process. Furthermore, management should aim to involve and communicate with all affected stakeholders during a change process. This research has provided a better understanding of hospital staffs’ reactions to change, their reasons for resistance, and ways to minimize change resistance while successfully introducing change into a health organization.
Open Access
The National Health Insurance (NHI) in South Africa : scaling up health care provision: the consumers' perspectives.
(2013) Weimann, Edda; London, Leslie; Stuttaford, Maria
Globally, there are major shifts taking place in health care provision to achieve universal health coverage. In 2011, the South African Department of Health released a Green Paper outlining its vision for implementing a National Health Insurance (NHI). The NHI wants to improve the service provision and promote equity and efficiency to ensure that all South Africans have access to affordable quality health care services. Public participation is important to raise public awareness, consult the public and promote major programs of change. This research aims to analyze the gaps between the everyday lived reality of publicly provided health care consumers and intended health policy reform.
Open Access
On the Road to Net Zero Health Care Systems: Governance for Sustainable Health Care in the United Kingdom and Germany
(Multidisciplinary Digital Publishing Institute, 2022-09-26) Weimann, Léa; Weimann, Edda
Health care lies at the forefront of the impacts of climate change. Since the health sector is a major polluting and emission intensive sector, it remains a crucial challenge to address sustainability. The English National Health System (NHS) aims to be the first in the world to achieve net zero in all emission classes (Scope 1–3). In Germany, sustainability in health care is being driven bottom-up, while the Federal Ministry of Health at the time of the research in early 2021 takes no active stance on a net zero health care system. This article analyses the approaches to sustainability in the two different health care systems, explores common challenges, and draws recommendations to support the transition of the sector to a net zero future. An exploratory mixed method approach was taken applying qualitative and quantitative methods. This includes high-level expert interviews and an online survey from the United Kingdom (UK) and Germany. Results reveal the complex nature of health care systems and the need for engraining a systems-thinking approach. The findings call for the legal embedding of sustainability into the key principles of health care in Germany, endorses the ambition of the national health care systems in the UK, recommends collaborative cross-sector approaches for sustainability, and highlights the need for increased public awareness on the interrelation between human and planetary health to enable governance for sustainable health care.
Open Access
On the Road to Net Zero Health Care Systems: Governance for Sustainable Health Care in the United Kingdom and Germany
(Multidisciplinary Digital Publishing Institute, 2022-09-26) Weimann, Léa; Weimann, Edda
Health care lies at the forefront of the impacts of climate change. Since the health sector is a major polluting and emission intensive sector, it remains a crucial challenge to address sustainability. The English National Health System (NHS) aims to be the first in the world to achieve net zero in all emission classes (Scope 1–3). In Germany, sustainability in health care is being driven bottom-up, while the Federal Ministry of Health at the time of the research in early 2021 takes no active stance on a net zero health care system. This article analyses the approaches to sustainability in the two different health care systems, explores common challenges, and draws recommendations to support the transition of the sector to a net zero future. An exploratory mixed method approach was taken applying qualitative and quantitative methods. This includes high-level expert interviews and an online survey from the United Kingdom (UK) and Germany. Results reveal the complex nature of health care systems and the need for engraining a systems-thinking approach. The findings call for the legal embedding of sustainability into the key principles of health care in Germany, endorses the ambition of the national health care systems in the UK, recommends collaborative cross-sector approaches for sustainability, and highlights the need for increased public awareness on the interrelation between human and planetary health to enable governance for sustainable health care.

Browsing by Author "Weimann, Edda"

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