Exploration of intensive care unit nurses' opinion and barriers experienced toward costing in a central hospital in Gauteng

Abstract

Background: The cost of healthcare is rising worldwide and placing a heavy financial burden on health systems and populations globally, nationally and locally. In 2007, the Gauteng Health Department introduced the “Uniformed Patient Fee Scheduled Charge Sheet” (UPFS) for tertiary, regional and district hospitals, whereby every health-service activity rendered to the patient is costed daily by the nursing personnel. However, since the introduction of the UPFS in the government sector hospitals, no studies have been done in South Africa, on the opinion of Intensive Care Unit (ICU) nurses in public hospitals with regard to costing for the healthcare rendered. Aim: The purpose of this study was to explore the opinion of ICU nurses and the barriers experienced towards costing in a Central Hospital in Gauteng. Design: An exploratory qualitative design. Methods: Professional nursing staff was chosen from the nursing staff working in ICUs. A purposive sample was selected as determined by data saturation. Semi-structured interviews were conducted on twelve (N=12) participants, over four months. Data analysis was done using Clarke and Braun’s (2013) thematic analysis. Lincoln and Guba’s (1985) method of trustworthiness was applied. Findings: The study demonstrated that ICU nurses focus is quality, safe patient care. ICU nurses have negative and positive feelings associated with costing whilst understanding the reasons for costing. Despite being overloaded with work, ICU nurses are prepared to assist with the costing but felt that the multidisciplinary team should be responsible for costing for activity-based costing and not just the ICU nurse. Factors that influenced costing negatively were identified as ethical dilemmas, workload issues, continuity of care, lack of consultation, lack of support and inappropriate use of resources. Facilitators of costing were identified to be role clarity and responsibility, the costing process, review of the costing document and system review. Recommendations: Role clarification and responsibility is vital. Review and standardization of the costing document, costing process and system needs to be done. Management support is vital for changing attitudes towards costing and setting up and implementing evidenced-based accurate costing using a resource specialist in the ward. The multidisciplinary team’s responsibility and accountability to resource costing will lighten the work load for ICU nurses with. Further research would be beneficial in developing a source document, testing its applicability in the broader population with further testing of its efficacy. Conclusion: ICU nurses feel that the successful control of activity-based costing at the patient’s bedside is vital as this affects the budget and resource allocation. This is, however, dependent on multidisciplinary teamwork and management support.