An Assessment of activity completion time in a health care delivery program: a five year study of the kidney transplantation program at Kenyatta National Hospital, Nairobi-Kenya

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dc.contributor.authorNgigi, John
dc.date.accessioned2022-06-15T07:23:42Z
dc.date.available2022-06-15T07:23:42Z
dc.date.issued2021
dc.descriptionA Dissertation submitted in partial fulfillment of the requirements for the award of the Degree of Master of Business Administration in Healthcare Management at Strathmore Universityen_US
dc.description.abstractThe health and economic burdens due to non-communicable diseases (NCD‘s) in Kenya is on the rise and requires multi-sectorial engagements and collaborations to contain. Chronic kidney disease (CKD) is one of the NCD‘s with significant morbidity and mortality affecting about 10% of the Kenyan population. The healthcare system should be able to provide quality healthcare to the citizens in line with the sustainable development goals (SDG) where universal health coverage (UHC) is one of the deliverables. The Interlife kidney transplantation program at the Kenyatta National Hospital (KNH) is one of the initiatives set up within the healthcare system with the aim to provide specialized healthcare within the CKD care continuum. This study focused on the Interlife program as a case model on timeliness of healthcare delivery. This was a retrospective review of medical records of patients who were evaluated for suitability for kidney transplantation and eventually underwent kidney transplantation surgeries at KNH between 2010 and 2014. The study investigated the timeliness of various key processes involved in the pre-transplant and immediate post-transplant periods. The primary objective was to determine the throughput time within the transplant evaluation process. Specific objectives were:- To determine the turnaround time for some key routine diagnostic blood tests required for safety in kidney transplantation; (Human immunodeficiency virus (HIV), Hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibodies (HCV) and cytomegalovirus antibodies (CMV)), to establish the timeliness of access to consultations with two key specialties (cardiology and anesthesiology) within the kidney transplant program, to determine adherence to the kidney transplant pathway for two key processes (kidney ultrasound and blood assay for calcineurin inhibitor (CNI) in blood), to determine average hospital length of stay among kidney transplanted patients and to establish the frequency and reasons for cancellations of planned kidney transplant surgeries. The deviations of the timings from the transplant protocol which ultimately contributed to the overall delay in the program were noted. Categorical data had counts and percentages calculated. For normally distributed continuous data, means and standard deviations were calculated. For skewed data, the median and interquartile ranges were calculated. Inferential statistics were reported at 95% confidence with the p value ˂ 0.05 considered statistically significant. Analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Ninety nine individual patients‘ medical records were traceable. Males were the majority at 73(73.7%). Twenty patients had their elective kidney transplant surgeries cancelled at least once for reasons which were medical, social, financial or logistical. In conclusion, the pre-transplant evaluations and the peri transplant processes in the program are not timely and it is recommended that measures be undertaken to address the preventable causes of delays and cancellations of elective transplant surgeries as part of the program quality improvement initiatives.en_US
dc.identifier.urihttp://hdl.handle.net/11071/12834
dc.language.isoenen_US
dc.publisherStrathmore Universityen_US
dc.subjectKidney transplantationen_US
dc.subjectNon-Communicable Diseases (NCD‘s)en_US
dc.subjectChronic Kidney Disease (CKD)en_US
dc.titleAn Assessment of activity completion time in a health care delivery program: a five year study of the kidney transplantation program at Kenyatta National Hospital, Nairobi-Kenyaen_US
dc.typeThesisen_US
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MBA-HCM Theses and Dissertations (2021)