Bedside rationing by frontline healthcare workers: a case study of St.Francis community Hospital
Studies on bedside rationing in developing countries such as Kenya are scanty. Bedside rationing entails implicit or explicit withholding of essential healthcare services from clients. The existing literature on bedside rationing in developed countries cannot be generalized to middle-income countries because of contextual differences. This study examined bedside rationing among frontline healthcare workers in St. Francis Community Hospital, which is a faith-based hospital located in Nairobi County off the main Thika High way 2 kms to Kasarani Mwiki Road in Kenya. The study used an explorative case study methodology and collected data using in-depth qualitative interviews. A purposive sample of 10 nurses was selected. A thematic analysis approach was used for data analysis. The study found that four forms of bedside rationing are practiced at St. Francis Community Hospital. The rationing includes deflection, deterrence, delay, and termination. Medical, patient, and hospital-related considerations determine the criteria used for bedside rationing. Additionally, factors affecting bedside rationing include unavailability, resource optimization policies, and skill empowerment at the management and operations levels. Bedside rationing was reported to compromise the quality of care provided at the hospital. Hiring more specialized doctors and nurses, providing extra beds, construction of new wards, new sources of funding, collaboration with medical training institutions and more support from the government to deal with negative effects of bedside rationing were reported as possible ways to reduce the negative effects of bedside rationing on care delivered. The study recommends development of new resource optimization guidelines consultation nurses. The hospital should undertake ethical rationing training to maintain quality of the care services. Financial partnership and liaising with the government for resource allocation will be imperative St. Francis Community Hospital offers complimentary services during strike. Future studies should focus on bedside rationing decisions among frontline healthcare workers in public hospitals and other faith-based hospitals.