MEDICAL RECORDS MANAGEMENT PRACTICES AND SERVICE QUALITY IN

HEALTHCARE FACILITIES: A CASE OF REACH OUT MBUYA

BY
DERECK MUSOOKA
18/MMS/BA/KLA/MAR/021

A DISSERTATION SUBMITTED TO THE SCHOOL OF BUSINESS AND

MANAGEMENT IN PARTIAL FULLFILMENT OF THE REQUIREMENTS
FOR THE AWARD OF A MASTER’S DEGREE IN MANAGEMENT
STUDIES (BUSINESS ADMINISTRATION) OF
UGANDA MANAGEMENT INSTITUTE

April, 2021

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 DECLARATION

I, Dereck Musooka, declare that this is my original work, that I am the sole author thereof, that

reproduction and publication thereof by Uganda Management Institute will not infringe any

third-party rights and that I have not previously submitted it for obtaining any qualifications.

Signature:………………………………… Date: ………………………………

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 APPROVAL

This work has been submitted for examination with the approval of both my academic

supervisors.

Signed ……………………………… Date ………………………

Mr. Ayias Akra Henry

Signed ………………………………… Date ………………………

Dr. Lwanga K. Elizabeth

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 DEDICATION

This research study is dedicated to my wife, Vickeve, for her steadfast support and

encouragement especially in this research and to my children; Phil, Theo and Asher.

I know no world without you, you are such a blessing.

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 ACKNOWLEDGEMENTS

I acknowledge the grace of God the Almighty in my studies. I am so grateful that He’s given me

the guidance, wisdom, strength and enough resources to complete this study. I thank God for

each person he placed on my path that supported me in my ambition.

My sincere gratitude goes to my supervisors Dr. Lwanga K. Elizabeth and Mr. Ayias Akra H.

for their guidance, advice and effective response at each stage in the conducting this research

paper for examination. Thank you for your support, mentorship and inspiration.

I would also love to thank the Executive Director of Reach Out Mbuya; Ms. Kaleebi N.

Josephine for inspiration and motivation, the senior management team and the entire staff

especially those that participated in this study. You rendered full support and during study

preparation, collection and analysis. Thank you again and again.

To my beloved mother, Ms. Mugerwa Gloria, I am very grateful for the profound research

insights, reviewing and critiquing my research work.

May God bless you all.

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 TABLE OF CONTENTS

DECLARATION...........................................................................................................................i

APPROVAL.................................................................................................................................ii

DEDICATION.............................................................................................................................iii

ACKNOWLEDGEMENTS........................................................................................................iv

TABLE OF CONTENTS.............................................................................................................v

ABBREVIATIONS AND ACRONYMS...................................................................................xi

ABSTRACT................................................................................................................................xii

CHAPTER ONE...........................................................................................................................1

INTRODUCTION........................................................................................................................1

1.1 Introduction..............................................................................................................................1

1.2 Background of the study...........................................................................................................1

1.2.1 Historical background...........................................................................................................1

1.2.2 Theoretical background.........................................................................................................3

1.2.3 Conceptual background.........................................................................................................5

1.2.4 Contextual background.........................................................................................................6

1.3 Statement of the problem.........................................................................................................8

1.4 Objectives of the study.............................................................................................................9

1.4.1 Purpose of the study..............................................................................................................9

1.4.2 Specific objectives.................................................................................................................9

1.5 Research questions.................................................................................................................10

1.6 Research hypothesis...............................................................................................................10

1.7 Conceptual framework...........................................................................................................10

1.8 Scope of the study..................................................................................................................11

1.8.1 Geographical scope.............................................................................................................11

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1.8.2 Time scope..........................................................................................................................11

1.8.3 Content scope......................................................................................................................12

1.9 Justification of the study.........................................................................................................12

1.10 Operational definitions.........................................................................................................12

CHAPTER TWO........................................................................................................................14

LITERATURE REVIEW..........................................................................................................14

2.1 Introduction............................................................................................................................14

2.2 Theoretical Review.................................................................................................................14

2.3 Records management practices and service quality...............................................................17

2.3.1 Medical records maintenance..............................................................................................17

2.3.2 Medical Records Appraisal.................................................................................................18

2.3.3 Medical Records Disposal...................................................................................................20

2.3.4 Service quality of health care..............................................................................................22

2.4 Literature Gaps......................................................................................................................23

CHAPTER THREE...................................................................................................................24

METHODOLOGY.....................................................................................................................24

3.1 Introduction............................................................................................................................24

3.2 Research design......................................................................................................................24

3.3 Study population.....................................................................................................................25

3.3.1 Accessible population.........................................................................................................25

3.3.2 Target population................................................................................................................25

3.4 Sample size determination and sampling strategies...............................................................25

3.4.1 Sample size determination..................................................................................................25

3.4.2 Sampling strategies.............................................................................................................26

3.5 Data collection methods.........................................................................................................27

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3.5.1 Quantitative data collection method....................................................................................27

3.5.2 Qualitative data collection method......................................................................................27

3.5.3 Document Review...............................................................................................................28

3.6 Data collection instruments....................................................................................................29

3.6.1 Questionnaire......................................................................................................................29

3.6.2 Key informant interview guide...........................................................................................29

3.7 Data quality control................................................................................................................30

3.7.1 Validity................................................................................................................................30

3.7.2 Reliability............................................................................................................................31

3.8 Data collection procedures.....................................................................................................32

3.9 Data analysis...........................................................................................................................33

3.9.2 Qualitative analysis.............................................................................................................34

CHAPTER FOUR......................................................................................................................35

PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS......................35

4.0 Introduction............................................................................................................................35

4.1 Response Rate........................................................................................................................35

4.2 Background information on the respondents..........................................................................35

4.3 Descriptive Analysis...............................................................................................................35

4.3.1 Respondents’ sex distribution.............................................................................................35

4.3.2 Age distribution of respondents..........................................................................................36

4.3.3 Respondents’ highest level of education.............................................................................37

4.3.4 Respondents distribution by facility....................................................................................38

4.3.5 Respondents’ length of employment in ROM facility........................................................38

4.3.6 Respondents participation in management of records.........................................................39

4.3.7 Maintenance practice of medical documents......................................................................39

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4.3.8 Frequency of filing client medical records..........................................................................39

4.3.9 Records management system used......................................................................................40

4.4. Service Quality in health care...............................................................................................41

4.4.2 Medical Records Maintenance............................................................................................48

4.4.3 Correlation between medical records maintenance and service quality..............................53

4.4.5 Medical Records Appraisal..............................................................................................55

4.4.6 Relationship between Records Appraisal and Service quality............................................58

4.4.10 Relationship between Records disposal and Service quality............................................66

4.4.11 Regression of Medical records disposal and service quality in healthcare.......................66

4.4.12 Multiple Regression Analysis...........................................................................................67

CHAPTER FIVE........................................................................................................................69

SUMMARY, DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS...............69

5.0 Introduction............................................................................................................................69

5.1 Summary of results.................................................................................................................69

5.2 Discussion of results...............................................................................................................70

5.2.1 Records maintenance and Service Quality..........................................................................70

5.2.2 Records Appraisal Process and Service quality..................................................................70

5.2.3 Records disposal and service quality...................................................................................71

5.3 Conclusions............................................................................................................................71

5.3.1 Records maintenance and service quality...........................................................................71

5.3.2 Records appraisal process and service quality....................................................................72

5.3.3 Records disposal and service quality...................................................................................72

5.4 Recommendations of the study..............................................................................................72

5.4.1 Records maintenance and service quality...........................................................................72

5.4.2 Records appraisal process and service quality....................................................................73

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5.4.3 Records disposal and service quality...................................................................................73

5.5 Limitations of the study..........................................................................................................74

5.6 Areas for future research........................................................................................................75

REFERENCES...........................................................................................................................76

APPENDICES...............................................................................................................................i

Appendix I: Survey Questionnaire For Healthcare Service Staff............................................i

Appendix II: Key Informant Interview Guide For Managers..................................................i

Appendix III: Sample Size Determination Table.......................................................................i

Appendix IV: Introductory Letter..............................................................................................i

Appendix V: Anti-Plagiarism Report..............................................................................................i

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 LIST OF TABLES

Table 3. 1: Study population and sample sizes............................................................................25

Table 3. 2: Presents Content Validity Index Results for the Questionnaire.................................31

Table 3. 3 : Reliability of variables summary..............................................................................31

Table 4. 1: Age distribution.........................................................................................................36

Table 4. 2: Staff length of stay in the organization......................................................................38

Table 4. 3: Storage mechanism of medical documents................................................................39

Table 4. 4: Frequency of filing client medical records................................................................39

Table 4. 5: Kind of records management system used.................................................................40

Table 4. 6: Respondents’ views on Service quality and records management practices.............41

Table 4. 7: Respondents’ views on Medical Records Maintenance.............................................48

Table 4. 8: Correlation between medical Records maintenance and service quality...................53

Table 4. 9: For regression on Medical records maintenance and Service quality........................54

Table 4. 10: Respondents’ views on medical records appraisal practice.....................................55

Table 4. 11: Correlation of Records appraisal process and service quality.................................58

Table 4.12: For regression on Medical Records Appraisal and Service quality..........................58

Table 4.13: Medical Records disposal.........................................................................................59

Table 4. 14: Respondents’ views on medical records disposal....................................................60

Table 4. 15: Correlation of Records disposal and Service quality...............................................66

Table 4. 16: for regression on Medical records disposal and Service quality..............................66

Table 4. 17: Regression model summary.....................................................................................67

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 LIST OF FIGURES
Figure 1. 1: Conceptual Framework showing the relationship of medical records management

practices and service quality of health care................................................................................11

Figure 4. 1: Respondents by sex................................................................................................36

Figure 4. 2: Respondent’s highest level of Education................................................................37

Figure 4. 3: Facility workplace...................................................................................................38

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 ABBREVIATIONS AND ACRONYMS

AIDS Acquired Immune Deficiency Syndrome

ART Anti-retroviral Treatment
CDC Centre of Disease Control and prevention
CVI Content Validity Index
DHIS2 District Health Information System version2
DV Dependent Variable
EDRMS Electronic Document and Records Management System
ERMS Electronic Record Management System
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
Ho Null Hypothesis
ICT Information and Communication Technology
ISO International Organization for Standardization
IV Independent variable
KII Key Informant Interview
MIS Management Information System
MoH Ministry of Health
NARSSA National Archives and Records Service of South Africa
Open MRS Open Medical Records System
ROM Reach Out Mbuya
SERVQUAL Service Quality
UEMR Uganda Electronic Medical Records
UNICEF United Nations Children Fund

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 ABSTRACT
This study examined the influence of medical records management influence the quality of
healthcare services delivered in health facilities in Uganda, with specific interest in Reach Out
Mbuya (ROM). Specifically the study further sought to find out the influence of medical records
maianatiance, medical records appraisal and medical records disposal on the quality of
healthcare services delivered at Reach Out Mbuya (ROM). Both descriptive and survey research
designs were employed considering both qualitative and quantitative approaches. By far, a
sample size of 68 respondents comprising of (Managers and Staff) were selected using both
purposive sampling and simple random sampling techniques. Data was collected using a
questionnaire, interview guide and Documentary review guide. Qualitative data was analyzed
using Thematic Data analysis while quantitative data was analyzed using Statistical Packages
for Social Scientists (SPSS) to generate both descriptive and inferential statistics. Here
descriptive statistics were used to summarize and describe the data, whereas inferential statistics
(Adjusted R-square, ANOVA P-value and F-value, Coefficient Beta- values and t-values) were
also computed for to test the research hypotheses and further establish the relationship and
influence of medical records management on service quality. The results indicate that there was
a moderate positive correlation in the relationship between records maintenance and service
quality in healthcare at ROM. (r = .550, N = 61, p < .001) and a moderate positive correlation
between Records appraisal Process and service quality (R = .429, p < .001). The study
hypotheses were further tested using multiple regressions and results indicated that multiple
correlation coefficient (R=0.529, p<0.001) for the records maintenance dimension Beta
(0.261[0.088 – 0.433]), for Records Appraisal process Beta (0.098[-0.039 – 0.235]) and for the
Records disposal, there is no sufficient evidence to support a relationship to service quality.
Between the independent variable medical records management practices and the dependent
variable (Service quality in healthcare facilities) is a significantly moderate positive correlation.
The study further recommends Reach Out Mbuya (ROM) to regularly reassessment of records
statuses, and further keeping medical records privately and confidential so as to enhance the
quality of services delivered by the institution.

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 CHAPTER ONE

INTRODUCTION

1.1 Introduction

World over, the decreasing rates of quality services delivered in among health facilities has

been the talk of the day to many stakeholders, such undesirable phenomena is to many

attributed to medical records management practices implemented by relevant authorities.

None the less, there are fragments of empirical studies demonstrating the causality between

medical records management practices and service quality. This therefore sought to examine

the effect of medical records management practices on service quality in healthcare facilities

using a case of Reach Out Mbuya. In this study medical records management practices was

perceived as the independent variable (IV) conceptualized into records maiantance, records

appraisal process and records disposal. On a flip side, service quality was perceived as the

dependent variables (DV) measured in terms of assurance, reliability, responsiveness and

empathy. This chapter thus presents the background of the study, statement of the problem,

purpose of the study, objectives of the study, research questions, hypotheses, conceptual,

framework, significance, justification, scope of the study, operational definitions and ethical

considerations.

1.2 Background of the study

The background section comprises of the historical, theoretical, conceptual and the contextual

setting to the study.

1.2.1 Historical background

The first known medical record was Egyptian from 1600 BC, it was not a proper patient

record but rather a written document on papyrus. It described surgical treatment of war

wounds. It also listed some cases perhaps part of a textbook (Al-Awqati 2006), then followed

the Greeks with Hippocrates who was occasionally called the father of medicine, active 2400

1
years ago at the god Asclepius’ temple of healing on the island of Kos which is eastern

Greece today. Hippocrates well thought out medicine as a science separated from religion and

magic. He took careful records of his patients on their symptoms, and social situation etc.

These records were used to choose appropriate treatment. He also recommended that these

records should be maintained. New medical practitioners involved in the treatment of the

patient would use them as a practice to ensure service quality in health care (Cheng 2001).

According to Wisniewski and Donnelly (1996), service quality is the degree to which a

service meets clients' needs or desires. Service quality as the contrast between client desires

of a service and perceived service. Also, Lewis and Mitchell (2000) asserts that if desires are

greater than performance, at that point perceived quality is less and thus client dissatisfaction

happens.

Ngoepe (2008) asserts that better service quality begins with better records management

practices. The organizations act appropriately and decide correctly as long as they have

adequate information at their fingertips. Legitimate records management supports proficiency

and viability in service delivery in a variety of ways that incorporate, among others,

documentation of approaches and systems that educate service delivery, for example, the kind

of services given; who are to be answerable for doing the work; and what costs included

(Peterson, 1991).

The work of Adeleke (2014), is seen as an example as he followed the advancement of

medical records back to the seventeenth century, when he portrayed that, in 1752 A.D.

Benjamin Franklin set up a consolidated Hospital in Philadelphia in United State of America

(presently known as Pennsylvania Hospital). He presented medical records by getting ready

document of uncommon cases on which a patient's name, admission date, discharge date, and

so forth were composed. From that point forward and thinking about the significance of

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medical records, no hospitals and health centers are opened without establishing a separate

and well-prepared medical records section.

1.2.2 Theoretical background

This study is guided by the Upward (2000)’s Records’ Continuum theory in managing

medical records in contrast to the Lifecycle theory and SERVQUAL model. SERVQUAL

model in this case will explain the elements of quality service while Records Continuum

theory will expand on records management practices.

The Records Continuum theory was advanced by Upward 2000’s. In the view of Upward,

much as the Lifecycle approach shows clearly designated phases in the management

of records, the Records continuum model goes beyond to conceptualize these individual

elements as continuous and not as discernable parts. Records continuum thinking is a

response to the new guidelines of the game. The theory argues as a change in perspective

driven by technology. The records continuum is the entire degree of a record's presence. This

alludes to a steady and coherent system of system forms from the hour of the creation of

records (and before creation, in the structure of record keeping frameworks) through to the

protection and utilization of records as files (Upward 2000). Records continuum thinking can

basically be viewed as a methodology that replaces life-cycle based viewpoints with a

persistent and a period/space development (McKemmish, 2001). The records continuum

model expands on four standards. As the first principle, Upward (1998) proposes an idea of

records that incorporates their continuing value; it stresses record uses for value-based

evidentiary and memory purposes. It consequently binds together ways to deal with archiving

and recordkeeping, regardless to records are kept for short or long term. The second principle

focuses on records as logical instead of physical entities independent of their form (paper or

electronic). The third principle underscores the need to incorporate recordkeeping into

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business, societal procedures and purposes. The fourth principle brings out archival science is

the establishment for arranging information about recordkeeping (Upward, 1998).

The continuous value of records likewise suggests persistent care inferring that organizations

should encourage better recordkeeping practices within all components of recordkeeping

(Upward, 1998). When applying the model in an organization, each individual must adapt the

model to its circumstance, that is, the organization needs a procedure and a program that is

fitting for its business needs and the way of life in which it exists (Reed, 2000). Notably

maximizing the service quality for the person consuming that service to or beyond their

expectation as the model of service quality states below.

SERVQUAL model on the other hand was developed by Parasuraman, Berry and Zeithaml in

the year 1985. Service quality is a theory that has stirred extensive attention and argument. In

research literature difficulties both in defining it and determining it with no overall consensus

evolving on either (Wisniewski, 2001). There is a sum of diverse descriptions as to what

service quality means. The one generally used, describes service quality as the degree to

which a service meets customers’ needs or expectations (Parasuraman, Zeithaml, & Berry,

1985). Service quality can thus be explained as the difference between customer expectations

of service and perceived service. If expectation is greater than performance, then the

perceived quality is less than satisfaction, therefore customer dissatisfaction happens (Lewis

and Mitchell, 2000). The SERVQUAL model was developed by Parasuraman and it identifies

four precise gaps leading to a fifth overall gap between customers’ expectations and

perceived service (Zeithaml and Bitner, 2003). ROM to continue to attract large number of

patients should ensure that the services offered to the patients are high class and customers

must be satisfied. its implications for future research argues that for one to maximize quality,

4
a person needs to maximize the difference between perceived performance (P) and customer

expectations (E), for instance (P-E) in short, to exceed customer expectations.

1.2.3 Conceptual background

A medical record, health record or medical chart as used interchangeably describe the orderly

recording of a sole patient's medical history and care in a given time within a particular health

care provider's jurisdiction. A medical record is a sequentially composed record of a patient's

assessment and treatment that incorporates the patient's restorative history and complaints,

the doctor's physical findings, the results of symptomatic tests and procedures, and

prescriptions and remedial methods (Alemayehu, 2009). As a result, medical record of a

patient is the clinical portrayal of the patient that is worked over some undefined time frame

by different clinicians with the assent, trust, protection and certainty of the patient. It

empowers continuity of care and once more, over time, it turns into a far reaching, clinical

database from which different and salient clinical records is assembled through research. In

favor of patients, the records work as medical identification. (MoH, 2016)

Proper documenting of patient's medical records guarantees simple recovery and adds to

decreased patient waiting time, guaranteeing continuity of care. It is thusly, basic, that

medical records are constantly kept in light of a legitimate concern for both the clinician and

the patient (Lafond, 2015). The medical folder should consistently be in the authority of the

health facility, as the patient appreciates the privilege of records (Kyayise et. al., 2018).

Medical records are utilized for various research purposes that is; to advance biomedical

science, comprehend healthcare usage, assess and improve healthcare practices, and

determine causes and patterns of infections. While such research is once in a while directed

without data attached to recognizable patient records, other research depends on personal

5
identifiers to follow treatment of a person after some time, connect different sources of

patient records, or check such records (Were, 2018).

Medical records, regardless of whether in paper or electronic structure, fill numerous needs

within healthcare. They are intended to: make a reason for the verifiable record; facilitate

correspondence among providers; foresee future medical issues; record standard preventive

measures; distinguish deviations from anticipated patterns; give a lawful record; and facilitate

clinical research (Shortliffe & Barnett, 2011)

Every medical record is the property of the medical center. It is kept up to assist every patient

and for the medical services providers. Records might be expelled from the medical clinic's

ward just as per a suitable court request, subpoena, or rule. On account of re-admission of the

patient, previous records might be accessible upon solicitation for use of the attending doctor

(Lafond, 2015).

To ensure that patient’s care can be continued during a disaster where access to medical

records may be restricted, it is vital that medical histories are accurate, kept up to date and

included within the key data sets in a continuity of operations plan. The medical records need

to be accessible when disaster strikes (Were, 2018). Medical history is vital for doctors

providing treatment because they reveal sensitivities to medication types, allergies, and parts

of the body that may be vulnerable based on familial or personal health conditions. If these

records are unavailable at the time of an emergency, the quality of care can drop considerably

and risks of malpractice increase (Roberts, 2012).

1.2.4 Contextual background

Reach Out Mbuya-HIV/AIDS Initiative (ROM) was established under Our Lady of Africa

Catholic Church Mbuya in 2001. It evolved from a volunteer of HIV and AIDS Initiative

with 4 volunteers serving 14 clients through home visits to a Non-Government Organization,

6
registered in 2006. Currently, it is highly donor dependent, with over 130 staff (Reach Out

Mbuya, 2018).

ROM (2018) provides HIV prevention, care and treatment services to individuals who are

infected and affected by HIV and AIDS in its catchment regions through an all-encompassing

model of consideration working in the catchment territories; such as Mbuya Catholic

community in Kampala Kasaala catholic community in Luweero and the neighboring

districts. The organization provides care and treatment to over 7,400 patients on

Antiretroviral Treatment (ART) plus support to more than 1,500 orphans and most vulnerable

children.

According to ROM (2018), the medical records perform a number of functions such as

maintaining the history of patient care, captures choices identifying with the care plan of the

individuals, underpins the work process of the clinical and regulatory capacities and supports

the communication. Records are an important asset due to the information they contain and

therefore the need to be aligned to ensure a good management practice. It is pertinent that

appropriate medical records management practices facilitate planning and informed decision

making to support continuity, consistency and adequacy of health service delivery (ROM,

2018). It is against this foundation that this study seeks to examine the impact of medical

records management practices on service quality in healthcare facilities, a case of Reach Out

Mbuya.

Record management responsibilities at ROM cut across different departments beyond the

department that manages these records. This records management department comprises of 1

manager, 3 officers, 3 assistants and 5 data clerks. However once in a while temporary

records staff and records volunteers are engaged when need for extra effort arises. The role of

each title is as follows; the Clerks are responsible for archiving patient medical records,

7
records maintenance (that is; entry, cleaning) in an organized manner and maintenance of all

records in the ROM records management systems namely Open MRS, DHIS2 and ROM-MIS

while observing their confidentiality. The Assistant ensures extraction of medical records for

reporting needs is done accurately and completed in a timely manner and all the records IT

related needs are addressed at all sites to help the smooth running of the records management

systems. The officers are responsible for tracking records as per program activities through

field visits, records report assessment and compiling of reports. They also conduct routine

medical record checks and provide feedback on service quality to the manager. The manager

oversees and coordinates records management and use in all ROM sites. Being part of the

ROM senior management, the manager regularly updates senior management committee on

quality of services provided in health care based on the records analytics. S/He ensures all

reports and other information products from medical records meet the desired standard so that

ROM staff rely on them when serving a client.

1.3 Statement of the problem

Service quality is a persisting challenge and a public concern as far as healthcare is

concerned. Reach Out Mbuya like other sensitive national and international health services

organizations such as CDC and UNICEF, continually strategizes to mitigate this challenge.

Much as Reach out Mbuya is focused on providing high quality health services there are

prevailing hindrances to this standard that could be emerging from the way medical records

are managed within the organization. It is noticeable that the quality of services can be

affected by the way medical records are maintained and archived. Service assurance,

reliability, responsiveness and empathy of a doctor to a patient and a stakeholder highly

depend on the medical records that are maintained and archived.

Abuki (2014)’s study on the challenges facing records management in health facilities in

Kenya, revealed that 91.7% of the respondents cited lack of automated records management

8
program. 30% cited lack of clear records management policy, standards, guidelines for both

paper and electronic records, 28% cited low priority being awarded to records management,

22.2% cited lack of equipment, supplies and registries in facilities. ROM currently, employs

qualified records assistants to file patients’ data which is largely a paper based. Electronic

data storage management practices are also used to store the patient’s medical records but the

extent of their effectiveness is unknown. It is deemed beneficial to use both the records

management framework that is; integrative of records in various formats, mediums for easy

management of records like paper-based and electronic, this enhances accuracy and easy

retrieval processes and disposal mechanisms.

This problem is being appreciated by those who bear the burden, especially the health

workers who retrieve these patients’ records to facilitate accurate and timely services due to

difficulties in fast records retrieval hence delaying the formulation, implementation and

monitoring of patient condition’s progress by health professionals which is unacceptable in

this information era. However, ROM management is striving to improve their records

management framework but what is not clear is the level of effectiveness of their initiatives.

This study, therefore seeks to examine the impact of medical records management practices

on service quality using Reach Out Mbuya as a case.

1.4 Objectives of the study

This section introduces the purpose and the specific objectives of the study.

1.4.1 Purpose of the study

The purpose of this study examines the influence of medical records management practices

on the quality of service delivered at Reach Out Mbuya (ROM).

1.4.2 Specific objectives

1. To establish the influence of medical records maintenance on the quality of service

delivered at Reach Out Mbuya (ROM).

9
 2. To establish the influence of medical records appraisal on the quality of service delivered

at Reach Out Mbuya (ROM).

3. To find out the influence of medical record disposal on the quality of service delivered at

Reach Out Mbuya (ROM).

1.5 Research questions

1. What is the influence of medical records maintenance on the quality of service delivered

at Reach Out Mbuya (ROM)?

2. What is the influence of medical records appraisal on the quality of service delivered at

Reach Out Mbuya (ROM)?

3. What is the influence of medical records disposal on the quality of service delivered at

Reach Out Mbuya (ROM).?

1.6 Research hypothesis

Ho: Medical records maintenance do not significantly influence the quality of service

delivered at Reach Out Mbuya (ROM).

Ho: Medical records appraisal do not significantly influence the quality of service delivered

at Reach Out Mbuya (ROM).

Ho: Medical record disposal does not significantly influence the quality of service delivered

at Reach Out Mbuya (ROM).

1.7 Conceptual framework

Records management practice is an essential part of medical service. A compelling records

management program enables the organization to render better patient care, provides

legitimate faultlessness and prompts improved benefit. In the conceptual framework, figure 1,

the independent variable is medical records management practices measured by the

dimensions; medical records maintenance, records appraisal, and records disposal and while

the dependent variable is service quality of Healthcare measured by the dimensions;

assurance, reliability, responsiveness and empathy. The study assumes that the availability

10
and proper management of medical records will lead to improved service quality of

Healthcare using Reach Out, Mbuya as a case study. See the illustration in the figure below.

Source: Adopted from Upward (2000), and El Saghier N. M., (2015) and modified by the researcher

Figure 1. 1: Conceptual Framework showing the relationship of medical records

management practices and service quality of health care.

1.8 Scope of the study

The scope identified the boundaries of the study in terms of the geography, time and content

of this research as presented below.

1.8.1 Geographical scope

The study was conducted at Reach Out Mbuya HIV/AIDS Initiative located at Mbuya Head

office on Plot 1 Boazman Road Mbuya 11 Hill, P.O. Box 7303, Kampala – Uganda. It

included the 4 Health centres overseen by ROM office that Mbuya health centre, Banda

health centre and Kinawataka health centre, all in Kampala district, and Kasaala health

centre, in Luwero district.

11
1.8.2 Time scope

The study focused on the time period from 2013-2019, because this period has seen Reach

Out Mbuya medical records management practices faced a lot of challenges due to increasing

volumes of patients accessing the facility, making it difficult to retrieve patients’ information

fast.

1.8.3 Content scope

The study was confined to the different aspects of the Medical Records Management Practices at

Reach Out Mbuya, such as medical records maintenance, records appraisal and records disposal and

how they affect service quality of Healthcare facilities

1.9 Justification of the study

There is lack of easily transferable medical records between health facilities, which

discourages treatment. Most health facilities in Uganda still rely on decentralized paper

records, and this adds another challenge to tracking patients as they change health facilities.

Without records of how a patient responded to certain drug say, ART, doctors are much less

effective and may start them at the beginning stages of antiretroviral therapy (ART) again and

again. Therefore, the study findings may certainly provide resolutions to decision makers,

health workers on how to organize, arrange and keep transferrable medical records to

strengthen the service quality of healthcare delivery service to users.

The findings of this study structure an establishment for future studies around this area. In

spite of the fact that the findings of this research were restricted to the area considered, they

make a significant commitment to information relating to the effect of medical records

management practices and service quality of healthcare in ROM and the health sector.

1.10 Operational definitions

Record: It’s a document irrespective of form created, received, maintained, and used by an

organization (public or private)

12
Medical record: this is a multifunctional document that is used to document, communicate

information about patients’ health status, medical care of a patient among health care

professionals.

Records management practices: Shepherd and Yeo (2003) is a deliberate role that is

operative in setting, monitoring procedures and standards for records management. This

maintains and provides easy access to records.

Quality: Uganda’s Ministry of Health defines quality as “Doing the right thing right, the

right away.” In this study it also refers to “How good the HIV/AIDS care services are”.

Service quality: In this study, service quality as a multiphase collaborative act which

matches with dimensions of excellence, assurance of competence, attentiveness, presentation

of evidence by workers and flexible practicality that add valuable meaning to the users.

This chapter has covered among others the background of the study that included; the

historical, theoretical, contextual and conceptual backgrounds, the problem statement, the

objectives, research questions, hypothesis, conceptual framework. The next chapter covers

literature presented based on theoretical and actual Literature based on the study objectives.

13
 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter presents the review of literature. The chapter begins with Records management

today, then presents the theoretical framework and then reviews the actual literature based on

the themes from the objectives: records maintenance, records appraisal and records disposal

and ends with summary of literature.

2.2 Theoretical Review

The study reviews the Records Life Cycle Theory and The Records Continuum Model which

form particular relevance and significance to the study.

2.2.1 The Records Life Cycle Concept

One of the main notions in records management is the record’s life cycle. It is consistently

used in records management textbooks and commonly acknowledged by experts in the field.

By way of a noteworthy notion, it provides the utmost possibility for actual management of

documented information, mainly where records are held in paper form.

Yusof and Chell (2000) point out that in the American context, the concept of records life

cycle starts when records are initially organized, preserved, and actively used by the creators.

The records are kept for an extra period of uncommon or inactive use in off-site records

centers, and ends after their effective use ends completely, or when they are nominated as

archives and moved to an archival institution, or declared of no value and destroyed. The life

cycle of records mirrors the belief that all records, regardless of form and purpose, pass

through firm well-defined stages (Newton, 2003). ROM must work to ensure that their record

management system is defined through phases for it to be effective.

14
Gill (2000) stresses that the record’s life cycle indicates a movement of records in rational

stages from its creation, through its usage, maintenance, retaining in active files, to its

transference to inactive records, then lastly disposal. The development of the life cycle

concept began in the United States of America in the 1930s (Hare and McLeod, 1997). It

consisted of three phases which involved the creation phase, maintenance and disposition.

ROM must function to ensure that logical steps in records management are adhered to.

Taylor (2007) states that life cycle concept has also been regarded by way of a model that

offers a basis aimed at the action of a records management program; that a record has a ‘life’

identical to a biological organism. The concept clarifies the reality and management of

records as undergoing through discrete life-cycle segments that can be observed in two

perceptions of age and usage. The age viewpoint states that records go through three steps of

current, semi-current and non-current stages. The usage perception states that a record goes

through the three stages of its usability which are active, semi-active and non-active use.

2.2.2 The Records Continuum Model

The introduction of the life cycle concept and its division into several stages clearly indicates

that records are managed as objects. Custody is clear and vital to the management of paper

records. (Yusof and Cheli, 2000); many scholars have identified the weaknesses of the life

cycle concept especially with the advent and use of Information Communication

Technologies (ICTs). Heywood (2007) argues that the old-style paper-based record’s life

cycle controls records management.

The Australian Society of Archivists (2010) emphasizes that it is the content of the record

and no longer the medium that becomes the focus of managing records. As records depend on

technology, the content is inclined to transformation and conversion. Therefore, the concept

of the records continuum has been promoted in the world of managing records. Where the life

cycle of records concept seemingly works well for paper-based records, the records

15
continuum model poses to be the best concept in managing a combination of both paper and

electronic records.

Kemoni (2008) perceives that the records continuum model is broadly recognized for

managing records and archives both in paper and electronic form. In the records continuum

model, archivists and records handlers are involved in managing each step in the lifecycle of

a record. The records continuum model supports a records management process where both

records handlers and archivists are involved in the constant management of records.

Consequently, the records continuum concept is more ideal for electronic records

management dissimilar from the records life cycle theory that was based only on paper

records. Frank Upward presented a variant of records continuum model thus considering it a

paradigm shift. It’s of four dimensions (create, capture, organize, pluralize) and four continue

axes (identity, transactional, recordkeeping, evidential) Upward (2000).

2.2.3 Service Quality Model (SERVQUAL)

Service quality is a theory that has stirred extensive attention and argument; in research

literature difficulties both in defining it and determining it with no overall consensus evolving

on either (Wisniewski, 2001). There is a sum of diverse descriptions as to what service

quality means. The one generally used, describes service quality as the degree to which a

service meets customers’ needs or expectations (Parasuraman, Zeithaml, & Berry, 1985).

Service quality can thus be explained as the difference between customer expectations of

service and perceived service. If expectation is greater than performance, then the perceived

quality is less than satisfaction, therefore customer dissatisfaction happens (Lewis and

Mitchell, 2000). The SERVQUAL model was developed by Parasuraman and it identifies

four precise gaps leading to a fifth overall gap between customers’ expectations and

perceived service (Zeithaml and Bitner, 2003). ROM to continue to attract large number of

16
patients should ensure that the services offered to the patients are high class and customers

must be satisfied.

2.3 Records management practices and service quality

This sub section of literature review presents scholarly paper reviews on existing information

incorporating applicable outcomes, as well as speculative and practical benefits to the topic,

discussed based on intentions of the study as follows;

2.3.1 Medical records maintenance

Maintenance of records is vital to certify that records are safe and preserved against any

hazardous threats in the storage atmosphere, and they must be reachable always, as required

by the organization. Proper management of records is mostly about “establishing physical

and intellectual control over records that are entering the records system” (Chinyemba &

Ngulube, 2005).

When deciding about the storage media, one must consider the records retention period

(Ismail and Jamaludin, 2009). The organization should identify and alleviate risks by

ensuring that there is a disaster recovery strategy. System disaster recovery ought to maintain

records integrity before and after the recovery (ISO 15489-1, 2001).

A centralized preservation repository prepares the organization to improve in “digital

document and record management processes” (Decman and Vintar, 2013). Documents and

records are preserved in an “intermediate storage site” for a short term or a long term. This

depends on the value to end-users and if it is be destroyed or advanced to an archive

repository for lasting preservation. The vital rewards of an intermediate storage site are

transparency, security and records are centrally accessed by all authorized or involved

persons and institutions controlled by guidelines (Decman and Vintar, 2013).

17
Mathebeni- Bokwe (2015) emphasizes that organizations should to save the records they

create in a public workstation to enable information sharing and re-usage. An ideal strategy is

cloud computing because records are saved centrally in digital format, to access any public

record and the records administrator manages both the records and user rights.

The records preserved in a trusted central repository are consistent and authentic, containing

the verified data with integrity. The central repository maintains records quality, for there are

no record transfers from or to institution and persons. Decman and Vintar, (2013) argue that

digital preservation should be planned and encouraged with the focus on technical and

organizational challenges that can affect records, user-friendliness, validity, integrity and

sustainability. Green (2011) argues that the documentation centre ought to be composed to

establish more space for filing equipment and take into consideration conceivable file

increase. Marutha (2011) notes that an absence of a documenting space was the significant

reason for misfiling, missing records and harm to records. ROM must target increased

funding towards acquisition of digital platforms for the recording and storage of patient

information.

The physical records storage is usually kept with one organization, but the creating

organization or authorized person is responsible for the records as long as the legal and

regulatory setting permits. This ensures positive maintenance of the records. When deviations

during the structure existence arise, variations to any procedure should effortlessly be traced

and documented (ISO 15489-1, 2001).

2.3.2 Medical Records Appraisal

Ngoepe and Nkwe (2018) observe that appraisal as like a way or process of separating chaff

from the wheat, which means separating records with long-term value from records with only

short-term value. They use wheat to refer to long-term value records as they are permanently

18
important and chaff used to refer to short-term value records as they are only used for short

period before they are destroyed. Records appraisal brings about a lot of benefits if properly

planned and implemented, such as compliance to legislations, easy destruction of ephemeral

records to keep only enduring value records, and the smooth running of an organization (The

National Archives of UK, 2013).

The evaluation choice has turned out to be progressively troublesome because of the

developing volume of records and changes in research philosophies (Chaterera, Ngulube and

Rodrigues, 2014). As institutions grow their tasks and technology advances, quicker records

creation must be embraced to keep pace with eruption in volume.

The National Archives of UK (2013) underscore those proper records appraisal requires

consideration of five key principles, which are timing, methodology, engagement,

documentations and guidelines. This means appraisal needs to be done in time so that the

records may also be disposed of in line with the set retention period. In the process of

appraisal, several things need to be considered.

Records appraisal is a process of planning for the organizational records, they are created

during business transactions and also determine how long each category of records are

preserved; for example, identifying the records to keep for a long term and others to keep for

a short term in business accountability (Ismail and Jamaludin, 2009).

Maryland State Archives (2015) notes that Records appraisal is an investigation of all records

to decide their authoritative, financial, verifiable, legal, or other authentic worth. The reason

for this procedure is to decide to what extent, in what position, and under what conditions a

record arrangement should be preserved. Appraisal is not only focused on one kind of record

or paper-based record per se. It is also applicable to electronic records, but unlike other

19
formats, records must likewise be appraised at an initial phase (National Archives and

Records Service of South Africa, 2006).

The National Archives and Records Service of South Africa (NARSSA) (2006) argues that

keeping records that are less important to the organization might pose direct and indirect

costs. Direct costs comprise of disk space, bandwidth, hardware, software and records

migration while indirect cost include maintenance staff, records retrieval time, back-up and

disaster recovery.

The decision about the records preservation period ought to be taken in collaboration or

consultation with records handling staff, managers and stakeholders (Sichalwe, et al., 2011).

The decision should be considered and to comply with both internal and external guidelines,

standards, statutory or regulatory requirements and other organization activity requirements

(Sichalwe, et al., 2011).

2.3.3 Medical Records Disposal

Medical records disposal is keeping medical records for a time period according to its value

in a records storage space until it reaches its disposal date to be destroyed or relocated to an

archival repository for permanent preservation (Marutha, 2016). The organization should

have its own documented records disposal program to protect records with monetary, lawful

and commercial continuity value are well preserved (Ismail and Jamaludin, 2009)

Proper records disposal rules should be applied only after the national archivist has issued a

written disposal permission, much as there are some delays or lack of support for disposal

approval from the NARSSA (Sichalwe et al., 2011). Asogwa (2012) also confirms that South

Africa, different from other African countries, has developed and established disposal rules

for execution of the relevant guiding policies for records management, destruction and

disposal subsequent to proper disposal authority.

20
There are many benefits out of appraisal. For instance, at the end of an appraisal, the end

product includes a records retention schedule, containing the records retention periods for all

the records identified during the evaluation or assessment (Ismail and Jamaludin, 2009).

Moreq2 (2008) argues that an organization has to put in place a disposal schedule which

guides in governing the ultimate destiny of records from operation ongoing. Chinyemba and

Ngulube (2005) approve that a records disposition is essential to the records management of

the organization.

ISO 15489-1 (2001) highlight that the records disposal process must be considered during the

framework design. An Electronic Record Management System (ERMS) should be considered

to simplify implementation of records disposal through activated automatic alerts for disposal

with an audit stream showing completed disposal of records and records unsettled for

disposal (Sichalwe et al., 2011).

Additionally, Decman and Vintar (2013) stress that, cloud as an ERMS records preservation

approach is a commendable tactic for public records management practices as a form of

centralized solution for transitional preservation and archiving. This can appropriately be

relevant for hospitals for centralization and sharing of medical records, their preservation,

their accessibility and archiving technology. Different institutions ought to have their own

Electronic Document and Records Management Systems (EDRMS) or Health Management

Information System (HMIS) connected to the government cloud structure. This ensures that

records maintenance and sharing of all categories of records that is; active, semi-active and

inactive records through the central repository system are possible.

21
2.3.4 Service quality of health care

The purpose in part of the study was to assess the understanding of health staff about how

practices of health records management influence healthcare service quality. Looking at the

healthcare service quality setting, qualified healthcare experts such as doctors and nurses are

answerable for treating the sick (Sinha & Shenoy, 2013).

The records formed should be appropriately managed so that they are accurate, complete, up

to date and accessible always, because appropriate recordkeeping promotes good medical

care to patients. Once records are not appropriately managed, healthcare service is negatively

affected (Dang, Francois, Batailler, Seigneurin, Vittoz, Sellier and Labarere, 2014). For

example, that results into poor treatment, diagnosis and prescriptions.

Effective hospital records management requires, among others, policy, models, lawful

entitlements and responsibilities, workers, funding, constructions, apparatus and other

resources (Chinyemba and Ngulube, 2005). Henceforth, medical records management

practices may either negatively or positively influence on the healthcare service quality

depending on how it’s managed, whether it is managed appropriately or erroneously.

Nonetheless, the healthcare quality improvement process also depends on better medical

records management practice that brings about accessibility of reliable medical records. For

example, the process of delivering an appropriate healthcare service depends on the

accessibility of reliable information about previous health service encounters which is also

useful for consistent quality improvement of healthcare service (Bordoloi and Islam, 2012)

Weeks (2013) argues that most healthcare professionals are now changing from the paper-

based records management practices to electronic best management practices there seems to

be a paradigm shift affecting the service approach. The healthcare experts perceive the move

22
from paper-based management practices to electronic management practices as a tough task

for them to easily deliver a healthcare service (Boonstra & Broekhuis, 2010).

2.4 Literature Gaps

From the exhaustive intellectual deliberations in here above, empirical evidence

overemphasis the nexus between records management practices and service quality (Mazher

et al, 2013; El Saghier N. M., (2015). Further to mention is the fact that existing literature in

here above provides a mixed result when found reporting sometimes positive or negative

association (Marutha, 2016; and Ismail and Jamaludin, 2009) hence justifying that the

association debate on the variables under investigation was not closed but rather still open for

advanced ponderings. It is also true that a significant body of knowledge is reviewed on the

same phenomena in different context / settings (international, regional and national) but not

in Ugandan health sector specifically in Reach Out Mbuya (ROM) as proposed by the current

study. More note worth still, is the fact that mainstream of the studies adopted purely

quantitative approach and many of them tend to have ignored a mixture of both qualitative

and quantitative approached as is the case for the currently proposed study. At this point

investigator does not stand to discredit any of the existing body of knowledge, but aimed at

adding empirically noteworthy and testimony to support the existing intellectual submissions.

Hence providing a basis for examining the influence of medical records management

influence the quality of healthcare services delivered in health facilities in Uganda, with

specific interest in Reach Out Mbuya (ROM).

23
 CHAPTER THREE

METHODOLOGY

3.1 Introduction

In this chapter, the methods used to conduct this research are elaborated. The research design,

the study population, sample size and selection, sampling techniques and procedure, data

collection methodologies and instruments, validity and reliability of instruments, the

procedure of data collection and data analysis are discussed.

3.2 Research design

Research design is the overall plan preferred to fit in the different components of the study.

This is in a clear and logical approach, to ensure an effective address of the research problem;

it’s comprised of the blueprint for the collection and analysis of data (Sacred Heart University

Library, 2019). To this dot therefore, this study will adopt to a descriptive and Survey

designs. a descriptive design as according to Creswell (2012) was used to describe the

characteristics of study elements in terms of gender, age, academic background and longevity

but also in the view of Orondo (2003) descriptive research design comprises collecting data

by administering a questionnaire to a sample of respondents. . Finally, the survey design was

adapted to because the study considered a sample size of above 30 respondents and that the

researcher intended to generalize of results in other cases (Amin, 2005).

Considerably also, both qualitative and quantitative approaches were used as a way of

expediting on both numeric data and non-numerical data respectively. In the view of Flick

(2014), adoption to both approaches (qualitative and quantitative) facilitated to elimination of

bias in the study because each approach was used to check and fill the gaps of the other

approach (Creswell, 2009).

24
3.3 Study population

The study population is the group of health workers taken from the health facilities that deal

with records as their common characteristic. This section introduces the accessible population

and the target population of the study.

3.3.1 Accessible population

For purpose of this study, the accessible population was the portion of the target population

officers who directly deal with records and working closely with and providing services in

Reach Out Mbuya health facilities. These included all registry staff, clinicians, doctors,

laboratory staff, pharmacy staff playing a role in records handling.

3.3.2 Target population

The target population for this study was 80 respondents (75 staff in the 3 facilities that is;

Mbuya, Banda and Kinawataka and 5 key unit head/managers) of Reach Out Mbuya involved

in Healthcare service delivery. The 4th facility which Kasaala health centre was used to pilot

the questionnaire and key informant interview guide

3.4 Sample size determination and sampling strategies

This section introduces the aspects of determining the sample size of the respondents and the

sampling methods to use in the study.

3.4.1 Sample size determination

The sample size for this study was selected from the population size using a table by Krejcie

and Morgan (1970) table as follows.

Table 3. 1: Study population and sample sizes

Category Target Population Sample size Sampling technique
Managers 5 5 Purposive sampling
Staff 75 63 Simple Random Sampling
Total 80 68
Source: Reach Out Mbuya HR Department (2019) sampled using Krejcie and Morgan (1970)
table (Appendix I)

25
3.4.2 Sampling strategies

The researcher used both Simple random sampling and purposive sampling for quantitative

and qualitative respectively.

Simple random sampling was used because it’s the most appropriate random sampling

procedure for the case of a particular finite population with a quantitative approach (Wayne,

2011) in this case; the list of all staff in the organization of ROM was accessed and used to

select the sample. Simple random sampling technique was executed by selecting a truly

random sample, yet statistically representative sample that could be generalized to a better

understanding of the greater population. The Krejcie & Morgan sample size determination

table (1970) was used to get a sample size of 63 respondents from the target population of 75

respondents using the list of health workers in ROM.

Simple random sampling was employed because it is highly representative if all subjects

participate JSTOR (2011). Leveraging on its advantages of being free of classification error,

requiring little advance information of the people other than the frame. It is also easy making

it relatively informal to understand data collected in this way. Based on these reasons, simple

random sampling best suits circumstances where less evidence is existing about the

population and collection of data can efficiently be done on randomly distributed items”

Purposive sampling was used in the qualitative approach because it is a careful choice of a

respondent because of their qualities (Etikan, Musa, & Rukayya, 2017); therefore, less

expensive and time saving. Purposive sampling was employed primarily to select knowledge-

rich respondents whose responses will illuminate the inquiry under study for the desired

research objectives to be met.

This was done through targeting senior management officers for interviewing as they have a

direct linkage to the maintenance, creation and use of records as well as their level of

knowledge in the functioning of ROM.

26
3.5 Data collection methods

The study employed a mixed method that is; qualitative and quantitative methodologies to

collect the data since it’s a basic part of the research design. A questionnaire was the

quantitative data collection method used while both key informant interview method and

document review method were the qualitative data collection methods used.

3.5.1 Quantitative data collection method

Questionnaire method for a face-to-face interview was used. This made it possible to contact

many respondents who could not be reached. It covered a large group of health workers at the

same time. The researcher had limited time to make the necessary interview. With the

questionnaire method for a face-to-face interview information about certain personal, secret

matters was easily obtained that is to say; information about marital relationship by keeping

the details of the participants anonymous.

This data collection method was comparatively easier to plan, construct and administer

without much technical skill and knowledge. The same method helped in concentrating the

participant’s consideration on all the substantial matters. It was framed, in a written form, its

consistent instructions for recording answers ensured some uniformity without permitting

much variation. This method is of greater validity because it had some exclusive qualities in

respect to information validity. The reliability of responses depended on the way the

researcher recorded them. Questionnaire method ensured anonymity to its respondents. The

respondents had more assurance that they will not be recognized by anyone for disclosing a

particular opinion. They felt more relaxed expressing their opinion in this technique.

3.5.2 Qualitative data collection method

Key informants that is; the 5 managers of ROM were interviewed using a Key informant

guide by 2 research assistants to access the thoughts and views on how the service quality in

health care can be influenced by records management practices hence understanding their

27
experiences. Interviewing managers was appropriate in order to supplement on the

information gathered from heath workers. This data collection method was also applied in the

study due to its suitability in assessing complex situations and social processes hence giving

more accurate data where expert knowledge was paramount.

Interviewers captured the responses in writing but also used audio recorders to during the

session as a fall back in case they missed anything in writing. After the interviews, both

written and recorded data was reviewed to align and assemble it into a standard order of the

study.

Furthermore, it was suitable for learning from respondents’ experiences, beliefs, motivations,

opinions and to construct a theory from collected data. This aided a deeper and detailed

understanding. Key informant interview method provided a rich, detailed picture to asses why

people act in certain ways, and their feelings about these actions (Jane sutton & Zubin Austin

2015).

3.5.3 Document Review

The following documents within ROM among others were reviewed in hard or soft copy;

ROM annual reports of 5 years (2015-2019), ROM strategic plan, ROM performance

management plan of 2019, ROM monthly program meeting minutes, ROM quality

improvement action points of 2019, newsletters and articles written by ROM staff.

Document analysis encompassed reassessing existing published and unpublished information

relating to medical records management practices and service quality of health care facilities.

These included; reports, journals, magazines, minutes of meetings, newspapers, the internet

abstracts relating to the study (Ahmed, 2010).

28
3.6 Data collection instruments

The data collection instruments used for this study were; the questionnaire, the key informant

interview guide and the document review guide.

3.6.1 Questionnaire

A questionnaire was developed to test the staff response on medical record management

practices and service quality in health care facilities. The questionnaire was then

electronically configured using the kobo tool box application and installed on 3 smart phones

of the 3 interviewers. The electronic questionnaire was pretested on 4 respondents in Kasaala

health facility to ensure data collection runs smoothly and is saved to the online destination

from the phone as required.

The closed ended electronic questionnaire was used to gather quantitative data from sampled

ROM staff. This instrument was preferred for it constrains irregularity and saves time. The 5-

point Likert scale dimension of Strongly-agree, Agree, Not-sure, Disagree and Strongly-

disagree was applied to ensure measurable outcomes for the study.

3.6.2 Key informant interview guide

A key informant interview (KII) guide was used to collect data from the purposively selected

staff working with Reach Out, Mbuya who were the managers. A key informant Interview

guide was developed, reviewed and pretested before it was used for the study. Copies were

then printed out and sheets of paper for writing responses were carried along with the guide.

The data was then used to collect qualitative information from 5 managers for the study.

3.6.3 Document Review Guide

To review an assortment of existing sources (e.g. archives, reports, information documents,

and other composed Artifacts) with the goal of gathering relevant information and data, the

researcher put much emphasis on; medical records maintenance, records appraisal process

29
and records destruction policy during literature review. The document review considered

various types of documents:

Health organization documents and publications relevant to the assessment of records

management practices. These included strategic plans, policies and procedures in various

areas of organizational effectiveness in medical records maintenance, records appraisal

process and records destruction.

Other documents included Reach Out Mbuya evaluations, reviews, or assessments (external

or internal) about the organization’s health care quality performance achieved were also

consulted. The ROM context (strategic management, operational management, welfare

management and knowledge management) and about the organization’s contributions to

health care quality.

Comprehensive examination of publicly available documents by various authors’ studies on

medical records and health care quality with references to the systems, practices and

behaviors considered to be important factors in an organization’s records management

effectiveness. These studies were found in the journals, organization’s websites and other

publications

3.7 Data quality control

Quality control was integrated as an endeavor and methodology by the researcher to ensure

quality and exactness of information being gathered utilizing the strategies picked for a

specific study.

3.7.1 Validity

Validity of the instruments was established utilizing both construct and content validity tests

as suggested. The researcher discussed the instruments with his research supervisors. Content

30
Validity Index (CVI) was used by the researcher to get content validity value. Content

Validity Index was computed as formulated below;

Table 3. 2: Presents Content Validity Index Results for the Questionnaire

Variables Content Validity Index (CVI) Number of items

Service Quality 0.875 16

Records management 0.916 24

Records Appraisal 0.833 6

Records Retention & Disposal 0.888 18

Since almost all the variables had a CVI that was above 0.7 (0.875, 0.916, 0.833 & 0.888

respectively), imply that the tool was validity since it was appropriately answering /

measuring the objectives and conceptualization of the study. According to Mugenda &

Mugenda (2003), the tool can be considered valid where the CVI value is 0.7 and above as is

the case for all the four variables provided above.

3.7.2 Reliability
Reliability Statistics
Cronbach's N of Items
Alpha
.911 64

Table 3. 3 : Reliability of variables summary

Variables Number of Variables Cronbach's Alpha
Service Quality 16 0.641
Records management 24 0.897
Records Appraisal 6 0.788

Records retention & Disposal 18 0.952

As shown in table 2 above, the study tools were pre-tested to ensure reliability. The study

used the Cronbach’s Coefficient Alpha. Cronbach’s Alpha Coefficient (α) was calculated by

means of the Statistical Package for Social Scientists (SPSS). The data collection tools were

31
pretested on 6 respondents in Kasaala Health Centre IV in Luweero one of ROM’s sites. This

site was used as a control site in the study because it has similar characteristics as the other 3

sites where the study was done. Reliability coefficients were 0.91, which portrays a high

reliability of the survey instruments and data collection procedure. This ensured the

Questions being asked accurately reflect the information the researcher desires and that the

respondent can and will answer the Questions. “Sheatsley & Sudman 1983 says pre-testing

the tools range is at least 5.”

3.8 Data collection procedures

After the approval of the research proposal, the researcher got an introductory letter from the

School of Management Science, Uganda Management Institute to help the researcher

lawfully access the information on the study institution. The institution, through their

research office authorized the researcher to conduct research activities. The researcher

identified 5 competent research assistants who were graduates from university and had the

experience in data collection. They were re-trained in collecting data using the questionnaire,

key interview guide and document review guide. The researcher appointed researcher

assistants based on experience in content areas, conducting evidence-based reviews and skill

in research design and methods which backstopped the entire data collection process. The

researcher executed the method by asking specifically arranged questions for the ROM

managers. The researcher set the interviewers to have formal face to face verbal exchange

with key informants to acquire thorough evidence about service quality influenced by

management practices of medical records.

This exercise took 5 days, afterwards the research Assistants were equipped with the data

collection tools and consent forms for their readiness to go to the field. The research

assistants made each respondent aware of the intension of the study emphasizing information

32
confidentiality, and then an informed consent with a signature was sought from each of the

respondent before the interview was conducted.

Using the questionnaire, 3 appointed research assistants collected quantitative data from 61

respondents out of the 63 accessible health workers by the using the electronic questionnaire

that was installed on their phones. For each questionnaire completed, the data was saved

locally on the interviewer’s phone and submitted instantly online onto the server of the

researcher using internet. This data collection activity took 14 days reaching respondents

from 3 ROM health facilities that is; ROM Mbuya, ROM Banda and ROM Kinawataka

health facilities.

Using a Key informant interview guide, qualitative data was collected by 2 appointed

research assistants from 5 managers. Responses were written and recorded as the interviews

were carried out. The researcher reviewed the responses and collated them to the study.

3.9 Data analysis

3.9.1 Quantitative analysis

Prior to data collection process, tentative codes were developed during the research design

stage. Data was then edited to ensure completeness, uniformity and accuracy (Amin, 2005).

The investigator also check for errors and edited to ensure accuracy, generate numerical

codes based on the Likert scale, and then enter data in Statistical Package for Social Sciences

(SPSS) version 21 to be considered for further analysis (SPSS Guide, 2012). Bio data

information was analyzed using ‘Descriptive analyses where both tables and pie charts were

presented in percentages frequencies, Mean and standard deviation. More so, Correlation

analysis was also conducted so as to establish whether there is a significant or there is no

influence between the variables under study (Sig value < or > 0.005 and R-value).

‘Regression analyses were also carried out so as to establish the extent to which the

33
Independent variable (IV) and its dimensions cause change/variability in the dependent

variable (DV). The decision here was based on R-Square from the Model summary table; P-

value from the ANOVA table and Beta values from Table of Coefficients respectively (Amin,

2005; & Mugenda and Mugenda, 2003). The following regression model was used to show

effect of Medical records management on Service quality;

Y = a + β1X1 + β2X2 + β3X3+ e

Where Y = Service quality; a =constant, β1, β2 and β3, = Regression coefficients; X1=

Medical records maintenance; X2= Medical records appraisal; X3= Medical records disposal;

e = Error term.

3.9.2 Qualitative analysis

According to Gay (1996), the process of Qualitative data analysis involves making sense/

meaning out of the text and images. The study applied a “Thematic Data Analysis”. Here the

researcher first prepared data for analysis were participant’s voice recording were transcribed

into verbatim so as to generate a tertiary document (Yin, 2009).The researcher then read

through the data to validate accuracy of the information and familiarize or obtain a general

sense of information, code the data using predetermined codes were paragraphs were also

labeled with terms or descriptive label, themes were also generated based on/ aligned to the

research objectives, integrate themes and finally interpreting the meanings of the themes by

comparing findings with past literature/ theoretical information so as to enhance effective

data presentation (Creswell, 2008).

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 CHAPTER FOUR

PRESENTATION, ANALYSIS AND INTERPRETATION OF FINDINGS

4.0 Introduction

This chapter presents the analysis and interpretation of the study that seeks to examine the

influence of medical records management practices on service quality in healthcare facilities

using a case of Reach Out Mbuya. The researcher applied descriptive, correlation and

regression analytics in this study.

4.1 Response Rate

This section shows in detail the proportion of respondents interviewed to those sampled in the

study.

4.2 Background information on the respondents

A data set generated from 61 respondents was used to study the demographic characteristics

of the target population to enable the researcher get a deeper understanding of the various

parameters that affect healthcare service quality. Data was computed using percentages as

shown in section 4.3.

4.3 Descriptive Analysis

The study targeted 63 respondents with interviewer administered questionnaires and of these

61 (96.8%) completed and returned the questionnaires while all the 5 (100%) key informants

were interviewed with the KII guide. The overall response rate was 98.4%, which was above

the two-thirds (67%) recommended response rate (Amin, 2005; Mugenda & Mugenda, 1999).

This indicates that the researcher was able to obtain enough data for a comprehensive and

conclusive report.

4.3.1 Respondents’ sex distribution

In relation to gender disaggregation, the study included both female and male participants at

the selected healthcare facilities of Reach Out Mbuya. The study reveals that of the reached

35
respondents (n=61), female participants were more 57.4% (n 1=35) than male 42.6% (n2=26)

that are involved in medical records management in the healthcare facilities of Reach Out

Mbuya. This finding implies that in Reach Out Mbuya, more females are engaged in the

management of medical records as compared to the male counterparts. The pie chart below

shows the distribution of respondents by sex.

Figure 4. 1: Respondents by sex

In figure 4.1, males were 43% while females were 57% which shows that more female

participated in this study compared to male and that there are more female staff than male in

Reach Out Mbuya generally.

4.3.2 Age distribution of respondents

Table 4. 1: Age distribution

Age Category Frequency Percent

18-22yrs 1 1.6
23-27yrs 11 18
28-32yrs 8 13.1
33-37yrs 9 14.8
Valid 38-42yrs 11 18
43yrs and
21 34.4
above
Total 61 100

36
From table 4.1 above, most of the study participants (34.4%) were 43years and above. Two

age-groups 38-42years and 23-27years registered 18.0% of the participants, 33-37years

registered 14.8% of the participants, 28-32years registered 13.1% and the least proportion

1.6% was registered by 18-22years as shown in figure 4.2. The results show that more than a

third (34.4%) of the participants are 43years and above and more than half (52.4%) of the

participants are 38years and above. This implies that most of the people involved in

managing medical records are 38years and above. There are fewer youth and elderly persons

who responded implying very low participation by these particular groups in the managing of

medical records. These unequal proportions of respondents categorized by age are a basis of

policy formulation and implementation by policy organs in the improvement of medical

records and healthcare service quality at large.

4.3.3 Respondents’ highest level of education

Figure 4. 2: Respondent’s highest level of Education

From Figure 4.2: In terms of the highest level of education obtained, 34.4% had acquired

certificate level of education, 29.5% had acquired diplomas, 4.9 had acquired masters level,

1.6 post graduate level, 29.5% undergraduate level as shown in the table above implying that

the highest number of respondents had acquired certificate level of education and the least

number of respondents had obtained the post-graduate level of education. This implies a

37
significant number of educated persons did partake in giving a response on how records

management affects service quality in health care.

4.3.4 Respondents distribution by facility

Figure 4. 3: Facility workplace

From figure 4.3, the distribution of respondents by site as shown in the table above was; 44%

from Mbuya, 30% from Kinawataka while 26% were from Banda implying that the highest

number of respondents were from Mbuya and the least number was from Banda. This implies

that people from Mbuya were more concerned in participating in answering the

questionnaires on records management aimed at improving healthcare service quality while

the least were from Banda, a distance away from the health facility who seemingly did not

pick interest in answering the questionnaires.

4.3.5 Respondents’ length of employment in ROM facility

Table 4. 2: Staff length of stay in the organization

Period Frequency Percent
0-1yrs 12 19.7
2-3yrs 8 13.1
Valid 4-5yrs 5 8.2
6yrs and above 36 59
Total 61 100

Table 4.2 above shows that majority (59%) of the respondents had worked at ROM for a

period of over 6 years. This implied that the most of the staff of the organization have served

for long thus having a long-term experience in healthcare service provision with various

38
practices of medical records. This high number of long serving employees responding to the

questionnaires implies that the longer serving staff are aware of the importance of their

responses and opinions on the subject towards the improvement of healthcare service quality.

4.3.6 Respondents participation in management of records

On participation of respondents in management records, all (100%) responded in agreement

that they participate in management of records. This implies that all the staff sampled

participate in records management and therefore a means of improving healthcare service

quality.

4.3.7 Maintenance practice of medical documents

Table 4. 3: Storage mechanism of medical documents

Mechanism Frequency Percent
Both 50 82
Electrically 2 3.3
Valid
Manually 9 14.8
Total 61 100

From table 4.3 above, most of the medical documents (82%) are stocked both electrically and

manually with 3.3% stored electrically, 14.8% stored manually. This implies that most of the

records are stored manually and electronically. This indicates how diverse the management of

records is done using various approaches for easy access, prevention of damage & Loss. The

use of electronic means of data storage shows the appreciation of technology in the

advancement of proper records management aimed at improving healthcare service quality.

4.3.8 Frequency of filing client medical records

Table 4. 4: Frequency of filing client medical records
Period Frequency Percent
Daily 48 78.7
Monthly 2 3.3
Valid
Weekly 11 18
Total 61 100

Table 4.4 above shows the frequency of filing medical records as shown in the table indicates

that daily filing (78.7%), Weekly filing (11%) and Monthly filing (2%). This indicates that

39
data is frequently stored thereby eliminating a chance of mismatch and disorganization of

data as recorded against the time it was taken, which shows improved method of data

management thus better healthcare service quality in this respect.

4.3.9 Records management system used

Table 4. 5: Kind of records management system used

Category Frequency Percent
Centralized 45 73.8

Decentralized 15 24.6
Valid
others specify 1 1.6
Total 61 100

Table 4.5 above shows the centralized records management system (73.8%), decentralized

(15%) and others (1.6%) indicating that the most practiced system is the centralized

management system. This is preferred because it increases the efficiency of facility data flow

and boosts file security even though the documents are kept under unitary management. The

1.6% is due to loss of control, lack of coordination hence being the least practiced.

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4.4. Service Quality in health care

Respondents’ views on Records management practices.

Table 4. 6: Respondents’ views on Service quality and records management practices

D (%) A (%)

Not Sure
Variable

Std Dev.
Likert scale Questions

Mean
(%)
Ineffective and unreliable records management guidelines affect 4.1 0.9
service quality of healthcare 6.6 3.3 90.2
Medical records are always available as and when needed by the 4.1 0.5
staff in service delivery 1.6 1.6 96.7
The stored medical records are trusted not doubted when providing 4.3 0.5
a service 0.0 1.6 98.4
Medical staff confide in the stored medical records to provide a 4.2 0.5
service to clients 0.0 3.3 96.7
Medical records management approach helps save time during 4.1 0.5
service delivery 1.6 3.3 95.1
Stored medical records are comprehensive enough in enabling 4.4 0.5
Service quality in health care

medical staff understand the client’s condition 0.0 3.3 96.7

Medical records Management procedures enable ROM perform the 4.2 0.7
promised service accurately 3.3 4.9 91.8
Medical records management approaches influence the willingness 3.8 0.9
of ROM staff to help clients 14.8 3.3 82.0
Medical Records management practices affect the provision of a 3.8 0.9
prompt service by staff to clients 14.8 4.9 80.3
Medical records management procedures inform the knowledge of 4.2 0.5
ROM staff about their clients to serve them better 0.0 4.9 95.1
ROM staff help clients receive services timely 4.9 1.6 93.4 4.1 0.7
A client file is quickly prepared upon registering at ROM 0.0 3.3 96.7 4.3 0.7
A client’s medication is always captured in the medical records for 4.4 0.7
easy follow up 0.0 3.3 96.7
A client has ever been delayed a service due to missing or 3.9 0.8
misplaced file 9.8 3.3 86.9
A client has ever missed a service provision due to a lost record ® 65.6 3.3 31.1 2.5 1.4
Clients are always notified on the return date to pick drugs basing 4.4 0.7
on their individual medical record 0.0 1.6 98.4
(Mean = 4.1, Standard deviation = 0.9)

In table 4.6 above, the ineffective and unreliable records management guidelines affect

service quality, 90.2% agreed, 6.6% disagreed whereas 3.3% were not sure. The average

response was 4.1 with a standard deviation of 0.9 which implies strong agreement that

ineffective and unreliable records management guidelines affects service quality and medical

records management.

41
In the dimension of availability of medical records whenever needed by the staff in service

quality, 96.7% agreed, 1.6% disagreed whereas 1.6 % were not sure. The average response

was 4.1 with a standard deviation of 0.5 which implies strong agreement that the availability

of medical records to staff whenever needed affects service quality and medical records

management.

In Strong Agreement the informant argues that,” there should be a database.” This is in

contrast with Marutha (2011) who notes that an absence of a documenting space was the

significant reason for misfiling, missing records and harm to records.

In agreement the informant argues that, “integrate all records for a bigger picture

management.”

Under the parameter that store medical records are trusted not doubted when providing a

service, 98.4% agreed, 0.0 % disagreed whereas 1.6 % were not sure. The average response

was 4.3 with a standard deviation of 0.5 this implies that they agree that that trust in the store

medical records affects service quality and medical records management.

In agreement the informant argues that; “Accurate records collection and data quality checks

from the beginning through sample checks and follow ups from the beneficiary is key in trust

of medical records.” (Dang, Francois, Batailler, Seigneurin, Vittoz, Sellier and Labarere,

2014) argues that the records formed need to be appropriately managed so that they are

accurate, complete, updated and available always for appropriate recordkeeping promotes

decent healthcare to patients. Where records are not appropriately managed, healthcare

services are negatively affected. For example, the result could be deprived treatment,

diagnosis and prescriptions.

The study assessed that medical staff confidence in the store medical records to provide

service quality was responded to as, 96.7% were in agreement, 0.0% responded in

42
disagreement whereas 3.3% expressed indecisiveness over the matter. The average response

was 4.2 with a standard deviation of 0.5 which implies agreement that staff confidence in the

store medical records to provide service quality affects service quality and medical records

management.

In agreement the informant argues that, “real time and accurate data entry increases

confidence.” In contrast (Chinyemba and Ngulube, 2005) argues that effective hospital

records management requires, among others, policy, models, lawful entitlements and

responsibilities, workers, funding, constructions, apparatus and other resources. Medical

records may either negatively or positively influence on the quality of healthcare in facilities.

This is dependent on how records are managed whether appropriately or erroneously.

In regard to saving time as a resulting from the medical records management approach,

95.1% agreed, 1.6% disagreed whereas 3.3 % were not sure. The average response was 4.1

with a standard deviation of 0.5 which implies that the respondents agree that the medical

records management practice saves time during service delivery and affects service quality.

In agreement the informant argues that, “team work and availing of records whenever needed

and having the clients’ files back in their storage shelves in time.” (Sinha and Shenoy, 2013)

argues that the intention was to establish the understanding of the target population, about

how management practices of healthcare records influences healthcare service quality.

Looking at the healthcare service quality setting, qualified healthcare experts such as doctors

and nurses are held accountable for treating the patients in hospitals.

When asked whether store medical records are comprehensive enough in enabling medical

staff in understanding the client’s condition, 96.7% agreed, 0.0% disagreed whereas 3.3%

were not sure. The average response was 4.4 with a standard deviation of 0.5. This implies

very strong agreement that store medical records are comprehensive enough in enabling

43
medical staff in understanding the client’s condition affects service quality and Medical

records management.

In agreement the informant argues that, “run back-ups for record security, have an online

database and assign different tasks to different personnel.” help in comprehensiveness.

The study assessed whether records management procedures to enable ROM perform the

promised service accurately. 91.8% agreed, 3.3% disagreed and 4.9% were not sure. The

average response was 4.2 with a standard deviation of 0.7 which implies strong agreement

that medical records management procedures enable ROM perform the promised service

accurately affects service quality and medical records management.

In agreement the informant argues that, “recording precisely and accurate.” is a key

management procedure

In agreement another informant argues that, “give records management a priority.”

In regard to the effect of medical records management approach’s influence on the

willingness of ROM staff to help clients, 82.0% agreed, 14.8% disagreed while 3.3 were not

sure. The average response was 3.8 with a standard deviation of 0.9 which implies agreement

that the effect of medical records management approach’s influence on the willingness of

ROM staff to help clients affects service quality and medical records management.

In agreement the informant argues that, “The records management Approach does influence

Quality however relevant trainings on recording and reporting are key to attain the desired

goal”

In agreement the informant argues that, “There should be real time data entry, though there

are power outages and insufficient man-power.” (Bordoloi and Islam, 2012) argues that, the

procedure of refining the quality of healthcare service of reliable medical records. For

example, the procedure of rendering appropriate healthcare quality depends on the

44
accessibility of true information about previous encounter visits also used for steady

improvement of quality the healthcare service

In regard to how medical records management affects the provision of a prompt service by

staff to clients, 80.3% agreed, 14.8% disagreed while 4.9% were not sure. The average

response was 3.8 with a standard deviation of 0.9. This implies there was agreement that

medical records management affects the provision of a prompt service by staff to clients

thereby affecting service quality and medical records management.

In agreement the informant argues that, “There is need to stick to one system, either the

computerized or manual system should be maintained to avoid duplication.” Weeks (2013) in

agreement argue that most healthcare professionals are now changing from the paper-based to

the electronic based records management. This paradigm shift affects the way they used to

render their service. (Boonstra and Broekhuis, 2010) argues that the healthcare experts realize

the change from paper-based records to electronic records management is a serious challenge

for them to easily render healthcare service. However, this is in disagreement with Kemoni

(2008) who perceives that the continuum model is broadly recognized for handling records

and archives both in paper form and electronic form. In agreement, an informant argues that,

“one should make records focused exchange visits to the different facilities.”

The study assessed medical records management procedures inform the knowledge of ROM

staff about their clients to serve them better was responded to as, 95.1% were in agreement,

0.0% responded in disagreement whereas 4.9% expressed indecisiveness over the matter. The

average response was 4.2 with a standard deviation of 0.5 which implies agreement that

medical records management procedures inform the knowledge of ROM staff about their

clients to serve them better affects service quality and medical records management.

45
In agreement the informant argues that, “Medical records management procedure does

influence decision making since, it has a100% dependence.”

In regard to how ROM staff help clients receive services timely, 93.4% agreed, 4.9%

disagreed while 1.6% were not sure. The average response was 4.1 on a scale of 5, and

standard deviation was 0.7. This implies there was agreement that the manner in which ROM

staff help clients receive services timely affects service quality and medical records

management.

In agreement the informant argues that, “trainings for the data capture should be done.” for

timely service delivery.

“In agreement another informant argues that, integrate the system file location.”

In regard to how quickly a client file is quickly prepared upon registering at ROM, 96.7%

agreed, 0.0% disagreed while 3.3% were not sure. The average response was 4.3 with a

standard deviation of 0.7. This implies that the respondents agree that how quickly a client

file is quickly prepared upon registering at ROM affects service quality and medical records

management.

In agreement the informant argues that, “when records are not handled well, it is hard to serve

clients or patients”

According to another informant, “Need to do away with double reporting, marginalize

systems to run accurate and comprehensive reports.”

In regard to the arrangement that a client’s medication is always captured in the medical

records for easy follow up, 96.7% agreed, 0.0% disagreed while 3.3% were not sure. The

average response was 4.4 with a standard deviation of 0.7. This implies that the respondents

agree that the arrangement that a client’s medication is always captured in the medical

records affects service quality and medical records management.

46
In agreement the informant argues that, “arrangement that a client’s medication is always

captured does influence since records track patients and talk for patients and also provide a

basis for research.”

“In agreement another informant argues that According to another informant, reduce on the

workload and increase on the health workers and records staff.”

In regard to the occurrence that a client has ever been delayed a service due to missing or

misplaced file, 86.9% agreed, 9.8% disagreed while 3.3% were not sure. The average

response was 3.9 with a standard deviation of 0.8. This implies that the respondents strongly

agree that the occurrence that a client has ever been delayed a service due to missing or

misplaced file affects service quality and medical records management.

In agreement the informant argues that, “A database should be maintained to track clients’

appointments in case of missing registers.”

In agreement another informant argues that, “files should be kept near the clients’ waiting

area and models that ease reach-outs on clients in communities should be adopted.’’

In regard to the notification of clients on the return date to pick drugs basing on the individual

medical record, 98.4% agreed, 0.0% disagreed while 1.6% were not sure. The average

response was 4.4 with a standard deviation of 0.7. This implies that the respondents strongly

agree that the notification of clients on the return date to pick drugs basing on the individual

medical record affects service quality and medical records management.

In agreement the informant argues that, Notification of clients on the return date basing on

the medical record does influence since services given depend on the records captured.”

In agreement another informant argues that, “make patients aware of their appointment time

and sensitive them on keeping their appointment deal with records of those who meet their

appointments first.”

47
4.4.2 Medical Records Maintenance

Respondents’ views on Medical Records Maintenance

Table 4. 7: Respondents’ views on Medical Records Maintenance

D (%) A (%)

Not Sure
Variable

Std Dev.
Likert scale Questions

Mean
(%)
ROM has records management guidelines manual 9.8 6.6 3.9 0.9
procedures 83.6
ROM goes by the records management guidelines 13.1 1.6 85.2 3.8 0.9
Guidelines describe staff responsibilities in records 14.8 3.3 3.7 0.9
management 82.0
Guidelines describe how to create a new record 16.4 11.5 72.1 3.6 0.9
Guidelines describe how to update existing records 14.8 3.3 82.0 3.8 0.9
Guidelines regulate records file movement 13.1 0.0 86.9 3.9 0.8
Medical records security and safety measures are 8.2 3.3 4.1 0.8
adequate 88.5
Clients medical records are filed individually 8.2 1.6 90.2 4.1 0.8
Medical Records Maintenance

Medical records are categorically and sequentially 3.3 0.0 4.1 0.6
arranged 96.7
The organization has cords maintenance schedule to 13.1 8.2 3.8 0.8
mitigate the file misplacement or loss 78.7
The organization restricts Sharing of medical records 4.9 0.0 95.1 4.3 0.7
Medical Records are kept Undisturbed 8.2 3.3 88.5 4.2 0.9
There is regular backup of medical records 6.6 4.9 88.5 4.0 0.7
The institution has a File tracking register 16.4 4.9 78.7 3.8 0.9
The institution has File tracking card 29.5 6.6 63.9 3.5 1.1
The institution uses barcodes to track files 60.7 18.0 21.3 2.6 1.1
Physical check of files records in the storage areas is 9.8 3.3 4.0 0.9
frequently carried out 86.9
The medical records storage capacity is adequate 21.3 1.6 77.0 3.6 1.0
Shelving equipment and facilities are adequate 14.8 1.6 83.6 3.8 0.9
Records Administration and Resources are adequate 19.7 9.8 70.5 3.5 1.0
Records are easily accessible when needed by staff 3.3 1.6 95.1 4.2 0.6
The Institutions restricts access to sensitive records 9.8 1.6 88.5 4.1 0.9
There is ease retrieval of records from the shelves 3.3 0.0 96.7 4.2 0.6
Medical Records Supplies are well managed 3.3 1.6 95.1 4.2 0.6
(Mean = 3.9, Standard deviation = 0.8)

In table 4.7, the respondents generally agreed strongly that ROM has records management

guidelines manual procedures (83.6%), ROM goes by the records management guidelines

(85.2), guidelines describe the staff responsibilities in records management (82%), the

guidelines describe how to create a new record (72.1%), guidelines also describe how to

update existing records (82.0) and that guidelines regulate file movement (86.9%). All these

48
imply that respondents agree that all the above-mentioned records maintenance practices

affect service quality and medical records management.

In agreement the informant argues that, “recording starts from stores which need monthly and

bi-monthly reporting. He argued that there is need to always have a standard reporting tool to

avoid double reporting as a records maintenance practice.” In agreement (Decman and

Vintar, 2013) argues that the records preserved in a trusted central repository are reliable,

authentic, and contain provenance. The central repository maintains the quality of records,

since there are no medical records transfers from institution to institution as well as from

requester to request.

The respondents further strongly agree that medical records security and safety measures are

adequate (88.5%), client’s medical records are filed individually, medical records are filed

individually (90.2%), the organization has records maintenance schedule to mitigate the file

misplacement or loss (78.7%) and that the organization restricts sharing of medical records

(95.1%). All these responses in strong agreement imply that respondents agree that all the

above-mentioned records maintenance practices affect service quality and medical records

management.

The respondents responded in strong agreement that, the medical records are kept

undisturbed (88.5%), that there is regular backup of medical records (88.5%), that the

institution has a file tracking register (78.7%) and that the institution has an file tracking card

(63.9%) All these responses imply that respondents agree that all the above mentioned

records maintenance practice affects service quality and medical records management.

In agreement the informant argues that, “records should be laminated, sealed in a cabin and

kept in files of good quality.” However (Decman and Vintar, 2013) in disagreement argues

that it is the digital preservation that should be planned and encouraged with the focus on

49
technical and organizational challenges. These affect records, accessibility, authenticity,

integrity and sustainability.

On whether the institution uses barcodes to track files, 60.7% disagreed, 21.3% agreed while

18.0% were not sure. The average response was 2.6 with a standard deviation of 1.1. This

implies that the respondents disagree that whether the institution uses barcodes to track files

affects service quality and medical records management.

In agreement the informant argues that, “patient files and registers have unique identifier

codes as investigation is done on patients and results are attained. Most records are in hard

copies and these are in the Ministry of Health tools. Patients are not met in private since they

are met in a single hall. There is need to increase restrictions while accessing client files. The

medical unit should have its own office and the registry should be expanded to accommodate

increasing files.”

About if physical check of files records in the storage area is frequently carried out, 86.9%

disagreed, 9.8% agreed while 3.3% were not sure. The average response was 4.0 with a

standard deviation of 0.9. This implies that the respondents agree that the conduct of physical

check of files records in the storage area is frequently carried out affects service quality and

medical records management.

“(ISO 15489-1, 2001) argues that the organization must also identify and alleviate risks by

ensuring existence of a disaster recovery plan for the framework. The plan must ensure

records integrity before and after the disaster recovery.

On whether the medical records storage capacity is adequate, 77.0% agreed, 21.3% disagreed

while 1.6% were not sure. The average response was 3.6 with a standard deviation of 1.0.

This implies that the respondents agree that whether the medical records storage capacity is

adequate affects service quality and medical records management.

50
In agreement the informant argues that, “so far so good, but the records should be free from

dampness and rodents for example rats, termites among others and also keeping windows of

the registry block closed to avoid rains from reaching clients records.” In agreement (Ismail

and Jamaludin 2009) argues that when deciding about the storage media, the organization

should deliberate the length the records should be kept and preserved.

On the adequacy of shelving equipment and facilities are adequate, 83.6% agreed, 14.8%

disagreed while 1.6% were not sure. The average response was 3.8 with a standard deviation

of 0.9. This implies that the respondents agree that adequacy of shelving equipment and

facilities are adequate affects service quality and medical records management.

In agreement the informant argues that, “they are well preserved because each file is in its

suspension pocket however, space increase is required.’’ In agreement Green (2011) argues

that the documentation center ought to be composed to establish more space for filing

equipment and take into consideration conceivable file increase. Furthermore Marutha (2011)

notes that an absence of a documenting space was the significant reason for misfiling,

missing records and harm to records. ROM must target increased funding towards acquisition

of digital platforms for the recording and maintenance of patient information.

On the adequacy of records administration and resources, 70.5% agreed, 19.7% disagreed

while 9.8% were not sure. The average response was 3.5 with a standard deviation of 1.0.

This implies that the respondents agree that adequacy of records administration and resources

affects service quality and medical records management.

In agreement the informant argues that, “records are and should be both soft and hard copies

(in case systems fail).” In agreement Mathebeni- Bokwe (2015) emphasizes that

organizations should save the records they create in a public workstation for information

availability. Cloud computing is essential in this regard, because the cloud computing

51
strategy is when records are stored centrally in digital setup to access any public record,

controlled by the record officer answerable on managing the user rights.”

On the easiness of access to records when needed by staff, 95.1% agreed, 3.3% disagreed

while 1.6% were not sure. The average response was 4.2 with a standard deviation of 0.6.

This implies that the respondents agree that the easiness of access to records when needed by

staff affects service quality and medical records management.

In agreement the informant argues that, “files are opened in the registry after clinical services

are given to a client. Client files from outreaches are separated from clients’ files at facilities.

However, the facility needs to add space in the registry because clients keep increasing

therefore files also keep increasing.” (Decman and Vintar, 2013) argues that a centralized

preservation repository prepares the organization to advance in digital records management.

Records are maintained in an intermediate storage site for a short or a long term, reliant on

the value to end-users. Eventually they are destroyed or kept in an archive repository for

lasting reference. Rewards of a transitional storage site are; transparency and protection, and

records are lawfully accessed centrally and securely.

On the institution’s restriction of access to sensitive records, 88.5% agreed, 9.8% disagreed

while 1.6% were not sure. The average response was 4.1 with a standard deviation of 0.9.

This implies that the institution’s restriction of access to sensitive records affects service

quality and medical records management.

In agreement the informant argues that, “it is better to have a computerized system not

forgetting to provide better training to the health worker on how to use it.” In agreement (ISO

15489-1, 2001) argues that the physical records maintenance is usually kept with one

organization, but the creating organization or authorized person continually has

accountability for the records when the legal and regulatory setting allows (ISO 15489-1,

52
 2001). This ensures successful management and maintenance of the records. Once deviations

during the framework existence happen, variations to any arrangement must be traceable and

documented.”

About the easiness of retrieval of records from the shelves, 96.7% agreed, 3.3% disagreed

while 0.0% were not sure. The average response was 4.2 with a standard deviation of 0.6.

This implies that the easiness of retrieval of records from the shelves affects service quality

and medical records management.

In agreement the informant argues that, “records are organized per location and all files are

referenced. There is need of updating records in time and also have the profile progress

reports assessed on a quarterly”

On the proper management of medical records supplies, 95.1% agreed, 3.3% disagreed while

1.6% were not sure. The average response was 4.2 with a standard deviation of 0.6. This

implies that the proper management of medical records supplies affects service quality and

medical records management.

In agreement the informant argues that, “records should be kept manually and computerized

in folders.”

4.4.3 Correlation between medical records maintenance and service quality

Table 4. 8: Correlation between medical Records maintenance and service quality

Correlations
I.V.1 mean D.V. mean
Medical Pearson Correlation 1 .525**
records Sig. (2-tailed) .000
maintenance N 61 61

Service Pearson Correlation .525** 1

quality Sig. (2-tailed) .000
N 61 61
**. Correlation is significant at the 0.01 level (2-tailed).

53
In Table 4.7 above, revealed that Medical records maintenance produce a statistically

significant positive influence the quality of service delivered at Reach Out Mbuya (ROM).

This was because the calculated P-value / Sig – value of 0.000 was below 0.01 level of

significance hence recommending dropping of rejecting the null hypothesis that (Medical

records maintenance do not significantly influence the quality of service delivered at Reach

Out Mbuya (ROM). And further considering the alternative hypothesis Medical records

maintenance produce a statistically significant influence the quality of service delivered at

Reach Out Mbuya (ROM). Further still, a Pearson Correlation Coefficient Value / R-value of

.525** also indicated that association took a positive direction. Conclusively therefore, the

Correlation statistics established that Medical records maintenance produce a statistically

significant positive influence the quality of service delivered at Reach Out Mbuya (P-value =

0.000 & R-value = .525** ).

4.4.4 Regression for Medical records maintenance and Service quality.

Table 4. 9: For regression on Medical records maintenance and Service quality

Variables Regressed R-square F-value Sig-value Interpretation
Medical records maintenance Significant influence
Vs. Service quality .276 22.456 0.000
Coefficients Beta t-value Sig.
(Constant) 2.767 10.103 0.000 Significant influence
Medical records maintenance .525 4.739 0.000 Significant influence
Source: Primary Data (2020)

Results in table 4.8 provides a 0.276 R-square indicating that the Model Medical records

maintenance explains a 27.8% ( 0.276*100) influence of variability on service quality at

ROM. Further still, a Sig-value of 0.000 that was less than 0.01 level of significance and an

F-value of 22.456 being above 1 also indicates that Medical records maintenance

significantly influences the of service delivered at Reach Out Mbuya (ROM).The table also

presented a Beta-value of 0.525 which indicates that medical records maintenance

significantly produce a 52.3% causality on service quality at ROM, this therefore stood to

means that 52.5% of the total variations in service quality are explained by records

54
maintenance. Further still, a t-value of 4.739 being greater than 2 and a sig-value of 0.000

being below 0.01 level of significance also signposts that indeed the indeed the Model

Medical records maintenance was significant.

4.4.5 Medical Records Appraisal

Respondents’ views on medical records appraisal practice.
Table 4. 10: Respondents’ views on medical records appraisal practice
D (%) A (%)

Not Sure
Medical Records Appraisal Practice Variable

Std Dev.
Likert scale Questions

Mean
(%)
The institution identifies and separates records of 14.8 8.2 3. 0.8
short-term value and long-term value 77.0 7
The Archival value of records is assessed to 11.5 4.9 3. 0.9
categorize them as active, semi and inactive 83.6 9
Archival records value is managed through the 14.8 6.6 3. 0.9
records management system 78.7 8
The institution labels medical records as active 8.2 1.6 4. 0.8
semi active and inactive 90.2 1
Records are kept separately as active semi active 3.3 0.0 4. 0.6
and inactive 96.7 3
16.4 13.1 3. 0.9
Records status is reassessed on a regular basis
70.5 7
(Mean = 3.9, Standard deviation = 0.8)

According to table 4.9, On the matter that the institution identifies and separates records of

short-term value and long-term value, 77.0% agreed, 14.8% disagreed while 8.2% were not

sure. The average response was 3.7 with a standard deviation of 0.8. This implies that matter

mentioned affects healthcare service quality.

In agreement the informant argues that, “the records should be organized and add an aspect of

years and months.” This is in agreement with Ngoepe and Nkwe (2018) who observes that

appraisal as like a way or process of separating chaff from the wheat, which means separating

records with long-term value from records with only short-term value. They use wheat to

refer to long-term value records as they are permanently important and chaff used to refer to

short-term value records as they are only used for short period before they are destroyed.

Records appraisal brings about a lot of benefits if properly planned and implemented, such as

55
compliance to legislations, easy destruction of ephemeral records to keep only enduring value

records, and the smooth running of an organization (The National Archives of UK, 2013). In

contrast The National Archives and Records Service of South Africa (NARSSA) (2006)

argue that keeping records that are less important to the organization might pose direct and

indirect costs. Direct costs contain; disk space, bandwidth, hardware, software and migration

while indirect cost contain; staff, records maintenance, recovery time, back-up and disaster

recovery.”

The respondents replied in string agreement that, the archival value of records is assessed to

categorize them as active, semi and inactive (83.6), that the institution labels medical records

as active, semi active and inactive (90.2%), and that records are kept separately as active,

semi active and inactive (96.7%). This implies that matter mentioned affects healthcare

service quality.

In agreement the informant argues that, “records are appraised as active (current clients) and

inactive (lost to follow, dead and transferred out clients).” This is in agreement with the

National Archives of UK (2013) underscore that proper records appraisal requires

consideration of five key principles, which are timing, methodology, engagement,

documentations and guidelines. This means appraisal needs to be done in time so that the

records may also be disposed of in line with the set retention period. In the process of

appraisal, several things need to be considered.”

On the other hand, in contrast (Sichalwe, et al., 2011) argues that the decision about the

records disposal period must be taken in collaboration with designated records managers and

all other stakeholders.

On the matter that archival records value is managed through the record management system,

semi and inactive, 78.7% agreed, 14.8% disagreed while 6.6% were not sure. The average

56
response was 3.8 with a standard deviation of 0.9. This implies that matter in question affects

service quality and medical records management.

In agreement the informant argues that, “records are appraised as either active or inactive.

However, for the inactive files, access to files is difficult because files have no barcodes

(unique numbers) to ease the retrieval process.” This is in agreement with (Ismail and

Jamaludin,2009) who points out Records appraisal is a process of planning for the

organizational records during business transactions and also to determine how long each

category of records are preserved; for example, identifying the records to keep lastingly and

the ones to keep shortly in the service quality assurance.

Concerning the matter that record status is reassessed on a regular basis, 70.5% agreed,

16.4% disagreed while 13.1% were not sure. The average response was 3.7 with a standard

deviation of 0.9. This implies that matter in question affects service quality and medical

records management.

In agreement the informant argues that, “the current method is the best.” This is in agreement

with Maryland State Archives (2015) who notes that records appraisal is an investigation of

all records to decide their authoritative, financial, verifiable, legal, or other authentic worth.

The reason for this procedure is to decide to what extent, in what position, and under what

conditions a record arrangement should be preserved. Appraisal is not only focused on one

kind of record or paper-based record. It is also applicable to electronic records, but unlike

other formats, electronic records should also be appraised at an early phase (National

Archives and Records Service of South Africa, 2006).”

57
4.4.6 Relationship between Records Appraisal and Service quality

Table 4. 11: Correlation of Records appraisal process and service quality

Correlations
Records Appraisal Service quality
Pearson Correlation 1 .434**
Records
Sig. (2-tailed) .000
Appraisal
N 61 61

Pearson Correlation .434** 1

Service quality Sig. (2-tailed) .000
N 61 61
**. Correlation is significant at the 0.01 level (2-tailed).

In Table 4.10 above, revealed that Medical Records Appraisal produce a statistically

significant positive influence the quality of service delivered at Reach Out Mbuya (ROM).

This was because the calculated P-value / Sig – value of 0.000 was below 0.01 level of

significance hence recommending dropping of rejecting the null hypothesis that (Medical

Records Appraisal do not significantly influence the quality of service delivered at Reach Out

Mbuya (ROM). And further considering the alternative hypothesis Medical Records

Appraisal produce a statistically significant influence the quality of service delivered at

Reach Out Mbuya (ROM). Further still, a Pearson Correlation Coefficient Value / R-value of

.434** also indicated that association took a positive direction. Conclusively therefore, the

Correlation statistics established that Medical Records Appraisal produce a statistically

significant positive influence the quality of service delivered at Reach Out Mbuya (ROM).

4.4.4 Regression for Medical Records Appraisal and Service quality.

Table 4.12: For regression on Medical Records Appraisal and Service quality
Variables Regressed R-square F-value Sig-value Interpretation
Medical Records Appraisal Significant influence
Vs. Service quality .188 13.661 0.000
Coefficients Beta t-value Sig.
(Constant) 3.200 13.677 0.000 Significant influence
Medical Records Appraisal .219 3.696 0.000 Significant influence

Source: Primary Data (2020)

58
Results in table 4.11 provides a 0.188 R-square indicating that the Model Medical Records

Appraisal explains only a 18.8% ( 0.188*100) influence of variability on service quality at

ROM. Further still, a Sig-value of 0.000 that was less than 0.01 level of significance and an

F-value of 13.661 being above 1 also indicates that Medical Records Appraisal significantly

influences the of service delivered at Reach Out Mbuya (ROM). The table also presented a

Beta-value of 0.219 which indicates that medical records maintenance significantly produce a

21.9% causality on service quality at ROM, this therefore stood to means that 21.9% of the

total variations in service quality are explained by Records Appraisal. Further still, a t-value

of 3.696 being greater than 2 and a sig-value of 0.000 being below 0.01 level of significance

also signposts that indeed the indeed the Model Medical Records Appraisal was significant.

4.4.8 Medical Records Disposal

Table 4.13: Medical Records disposal

Medical Records disposal Response Frequency (%)

Do you have a records retention schedule No 21 34.4

for paper records? Yes 40 65.6
Do you have records retention schedule for No 28 45.9
electronic documents? Yes 33 54.1
Do you have a standardized naming No 10 16.4
convention for medical records? Yes 50 82.0

From table 4.12 above, ROM has a records retention schedule for paper records (65.6% and

34.4% for the ‘Yes’ ad ‘No’ responses respectively) by frequency, records retention schedule

for electronic documents (54.1% and 45.9% for the ‘Yes’ ad ‘No’ responses respectively) by

frequency and the standardized naming convention for medical records (82.05 and 16.4% for

the ‘Yes’ ad ‘No’ responses respectively) by frequency.

59
4.4.9 Respondents’ views on medical records disposal
Table 4. 14: Respondents’ views on medical records disposal
D (%) A (%)

Not Sure
Variable

Std Dev.
Likert scale Questions

Mean
(%)
Short lived records are destroyed quickly® 73.8 11.5 14.8 2.1 1.1
Records retention period are determined for each category 3.1 1.3
of medical records 34.4 14.8 50.8
Records are kept for a maximum of 5 years then are 2.0 0.9
destroyed® 80.3 11.5 8.2
Records sorting and registration is carefully carried out 3.0 1.3
before disposal 41.0 8.2 50.8
Disposal permission application is sought from the 2.7 1.2
Archivist records manager® 47.5 14.8 37.7
If disposal authority is granted records disposed off 42.6 16.4 41.0 2.8 1.4
Medical Records Disposal

Disposal certificate is issued by the records manager 2.5 1.2

before disposal is carried out® 55.7 14.8 29.5
Disposal register is created for safe keeping for future 2.7 1.3
reference and accountability® 45.9 18.0 36.1
Disaster preventive measures are in place and effective 34.4 4.9 60.7 3.2 1.3
There is routine mechanism for record disposal® 45.9 11.5 42.6 2.8 1.3
The date of destruction is captured by the records officer® 59.0 13.1 27.9 2.5 1.2
There is Description of Disposed Records 42.6 13.1 44.3 2.9 1.3
Signatures of individuals supervising and witnessing the 2.6 1.2
destruction are captured® 52.5 16.4 31.1
There is a statement that records were destroyed within the 2.5 1.2
agreed terms® 54.1 19.7 26.2
There is a records retention schedule in place 31.1 16.4 52.5 3.1 1.2
There is Classification of Records Inventory 18.0 23.0 59.0 3.4 1.0
There is legislation which affects how long records should 2.9 1.3
be kept 39.3 13.1 47.5
Archived Records are private and kept confidential 0.0 1.6 98.4 4.4 0.5
(Mean = 2.8, Standard deviation = 1.2)

According to table 4.13, On how short-lived records are destroyed quickly, 73.8% disagreed,

14.8% agreed while 11.5% were not sure. The average response was 2.1 with a standard

deviation of 1.1. This implies that the respondents disagree that the frequency of destruction

of short-lived records affects service quality and medical records management.

In agreement the informant argues that, “disposal of records was tried but failed in the year

2015.” In disagreement Asogwa (2012) as well confirms about South Africa being different

from many other fellow African countries because it has established relevant guiding

guidelines for electronic records management and disposal subsequent to suitable disposal

60
authority. Proper disposal instructions should be applied only after the national archivist has

authorized, much as some delays exist or lack of NARSSA support for disposal endorsement

from NARSSA.

On the matter of according different retention periods for different categories of medical

records, 50.8% agreed, 34.4% agreed while 14.8% were not sure. The average response was

3.1 with a standard deviation of 1.3. The respondents moderately agree that the matter of

according different retention periods for different categories of medical records affects

service quality and medical records management.

This is in agreement with (Ismail and Jamaludin, 2009) who argues that organization should

have their own “documented records disposal program” to secure that records with fiscal,

legal and business continuity (vital records) value are preserved.”

On the destruction of records after being kept for a maximum of five years, 80.3% disagreed,

8.2% agreed while 11.5% were not sure. The average response was 2.0 with a standard

deviation of 0.9. The respondents disagreed implying that the destruction of records after

being kept for a maximum of five years affects service quality and medical records

management.

In agreement the informant argues that, “he had never heard of the act and that records are

not destroyed according to the act much as they are kept in the archive room.” In agreement

on the other hand (Marutha, 2016) argues that records disposal is keeping or retaining of

medical records for a certain period according to its value in a records maintenance medium

until such time that it reaches its disposal period. They are either destroyed or transferred to

an archival repository for permanent preservation.”

On the careful registration and sorting of records before disposal, 50.8% agreed, 51.0%

disagreed while 8.2% were not sure. The average response was 3.0 with a standard deviation

61
of 1.3. The respondents moderately agree implying that the careful registration and sorting of

records before disposal affects service quality and medical records management.

In agreement “(Sichalwe et al., 2011) argues that proper disposal rules must be applied only

after the national archivist issued a written disposal authority, although there were always

some delays or lack of support for disposal approval from the NARSSA.”

On the issue of seeking for disposal permission application is sought from the Archivist

records manager, 47.5% disagreed, 37.7% agreed while 14.8% were not sure. The average

response was 2.7 with a standard deviation of 1.2. The respondents disagreed that the issue of

seeking for disposal permission application is sought from the Archivist records manager

affects service quality and medical records management.

In disagreement “Moreq2 (2008) argues that an organization needs to develop a disposal

schedule that guides them “to govern the eventual fate of records from on-going operation.

Chinyemba and Ngulube (2005) confirm that a records disposition is essential to the records

management of the organization.”

On the matter of records disposal, once authority is granted, 42.6% disagreed, 41.0% agreed

while 16.4% were not sure. The average response was 2.8 with a standard deviation of 1.4.

The respondents disagreed that records are not disposed off, which affects service quality and

medical records management.

The informant also asserted that, “There is need for medical research, thus records should not

be destroyed especially the electronic records.”

On the matter that a disposal certificate is issued by the records manager before records are

disposed off, 55.7% disagreed, 29.5% agreed while 14.8% were not sure. The average

response was 2.5 with a standard deviation of 1.2. The key respondents disagreed on the

62
matter that a disposal certificate is issued by the records manager before records are disposed

off which affects records management and therefore service quality is affected.

On the matter of creation of a disposal register for safe keeping and for future reference and

accountability, 45.9% disagreed, 36.1% agreed while 18.0% were not sure. The average

response was 2.7 with a standard deviation of 1.3. The respondents disagreed that the matter

of creation of a disposal register for safe keeping and for future reference and accountability

affects service quality and medical records management.

However, in agreement (Decman and Vintar, 2013) argue that different institutions or

hospitals should have their own Electronic Document and Records Management Systems

(EDRMS) or Health Management Information System (HMIS) connected to the government

cloud system. This is to ensure records maintenance and sharing of all categories of records

(active, semi-active and inactive) through the central repository system is possible.

About the occurrence of effective disaster preventive measure, 60.7% agreed, 34.4%

disagreed while 4.9% were not sure. The average response was 3.2 with a standard deviation

of 1.3. The respondents agreed that the occurrence of effective disaster preventive measure

affects service quality and medical records management.

On the routine mechanism for record disposal, 45.9% disagreed, 42.6% agreed while 11.5%

were not sure. The average response was 2.8 with a standard deviation of 1.3. The

respondents agreed that the routine mechanism for record disposal affects service quality and

medical records management.

In agreement the informant argues that, “records of the dead can be disposed off.” In

agreement ISO 15489-1 (2001) argues that in the initial system design, records disposal

process should be taken into consideration. An Electronic Record Management System

(ERMS) in design should facilitate enforcement of records disposal through activated

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automatic alerts for disposal with an audit trail identifying records disposed-off and records

outstanding for disposal.”

On the capture of the disposal date by the records officer, 44.3% agreed, 42.3% disagreed

while 13.1% were not sure. The average response was 2.9 with a standard deviation of 1.3.

The respondents disagreed that the capture of the disposal date by the records officer affects

service quality and medical records management.

According to an informant, “records should not be disposed of so that they can be assessed at

a later time for a given demand.”

On the description of disposed records, 44.3% agreed, 42.6% disagreed while 13.1% were not

sure. The average response was 2.9 with a standard deviation of 1.3. The respondents

disagreed that the description of disposed records affects service quality and medical records

management.

On the matter of capturing the signatures of individuals supervising and witnessing the

destruction of records, 52.5% disagreed, 31.1% agreed while 16.4% were not sure. The

average response was 2.6 with a standard deviation of 1.2. The respondents disagreed that the

matter of capturing the signatures of individuals supervising and witnessing the destruction of

records affects service quality and medical records management.

On the availing of a statement that records were destroyed within the agreed terms, 54.1%

disagreed, 26.2% agreed while 19.7% were not sure. The average response was 2.5 with a

standard deviation of 1.2. The respondents disagreed that the availing of a statement that

records were destroyed within the agreed terms affects service quality and medical records

management.

64
On the matter of putting a records retention schedule in place, 52.5 agreed, 31.1% agreed

while 16.4% were not sure. The average response was 3.1 with a standard deviation of 1.2.

The respondents agreed that the matter of putting a records retention schedule in place affects

service quality and medical records management affects service quality and medical records

management.

On the classification of records inventory, 59.0% disagreed, 18.0% agreed while 23.0% were

not sure. The average response was 3.4 with a standard deviation of 1.0. The respondents

agreed that the classification of records inventory affects service quality and medical records

management.

On the matter of having a legislation on how long records should be kept, 47.5% agreed,

39.3% disagreed while 13.1% were not sure. The average response was 2.9 with a standard

deviation of 1.3. The respondents disagreed that the matter of having legislation on how long

records should be kept affects service quality and medical records management.

On the keeping of archived records private and confidential, 98.4% agreed, 0.0% disagreed

while 1.6% were not sure. The average response was 4.4 with a standard deviation of 0.5.

The respondents agreed that the keeping of archived records private and confidential affects

service quality and medical records management.

The respondents replied that they heard of the act but records are not destroyed according to

the act much as they are kept in the archive room. Furthermore, Decman and Vintar (2013) in

agreement elaborates that, cloud as an ERMS records appraisal method is a decent approach

for free records management and records archival. This is also pertinent for hospitals to ably

centralize, evaluate, share and archive medical records leveraging on technology.

65
4.4.10 Relationship between Records disposal and Service quality

Table 4. 15: Correlation of Records disposal and Service quality

Correlations
I.V.3 mean D.V. mean
Pearson Correlation 1 .103
Records
Sig. (2-tailed) .429
disposal
N 61 61

Pearson Correlation .103 1

Service quality
Sig. (2-tailed) .429
N 61 61
**. Correlation is significant at the 0.01 level (2-tailed).
Source: Primary Data (2020).

A Pearson Correlation was run to determine the relationship between Records Appraisal

process and Service quality. To that effect, table 4.15 provides a P-value of 0.429 which was

above 0.01 level of significance statistically implying that the Null hypothesis that medical

record disposal does not significantly influence the quality of service delivered at Reach Out

Mbuya (ROM) was accepted. Conclusively therefore, table 4.16 of correlations suggests that

medical record disposal does not significantly influence the quality of service delivered at

Reach Out Mbuya (ROM) { P-value = 0.429 >0 0.01 level of significance}.

4.4.11 Regression of Medical records disposal and service quality in healthcare

Table 4. 16: for regression on Medical records disposal and Service quality
Variables Regressed R-square F-value Sig-value Interpretation
Medical records disposal Vs. Insignificant influence
Service quality .011 0.634 0.429
Coefficients Beta t-value Sig.
(Constant) 0.395 31.297 0.000 Significant influence
Medical records disposal .034 0.796 0.429 Insignificant influence

Source: Primary Data (2020)

Table 4.15 above provides a R-square value of 0.011, this statistically indicates that theModel

Medical records disposal collectively contributes to only 1.1% (0.011* 100) variability on the

quality of service delivered at Reach Out Mbuya (ROM). Further still, the same table also

presents a 0.634 F-value that was below 1 and a Sig-value of 0.429 that was above the level

66
of significance of 0.01 indicating that the influence of Medical records disposal

insignificantly influence the quality of services delivered. Also to note, the same table also

presents a Beta –value of 0.395 and a P-value of 0.000 < 0.01 both statistically revealing that

other factors rather than records disposal in the model produce a 39.55 ( 0.395* 100)

influence on quality of service. No wonder the same table also presented a Beta – value of

0.034, a t-value of 0.796 which was below 2 and lastly a corresponding P-value of 0.429

that was above 0.01 level of significance statistically indicating that the Model Medical

records disposal produce only a 3.4% which was insignificant. This therefore stand to mean

that almost 96.6% of change in service quality is explained other factors rather than Medical

records disposal since the said factor only produced 3.4% causality on service delivery.

4.4.12 Multiple Regression Analysis

Model summary of records management practices and service quality in health care
Table 4. 17: Regression model summary

Mode R R Square Adjusted R Std. Error of Change Statistics

l Square the Estimate R Square F df1 df2 Sig. F
Change Change Change
1 .558a .311 .275 .24834 .311 8.576 3 57 .000
a. Predictors: (Constant), Records Maintenance, Records Appraisal Process, Records disposal
Coefficients
Model Unstandardized Coefficients Standardized t Sig. 95.0% Confidence Interval for B
Coefficients
B Std. Error Beta Lower Bound Upper Bound
(Constant) 2.564 .300 8.551 .000 1.964 3.164
Records
.261 .086 .411 3.029 .004 .088 .433
Maintenance
1 Records
Appraisal .098 .068 .194 1.428 .159 -.039 .235
Process
Records
.035 .036 .106 .967 .338 -.037 .107
disposal
a. Dependent Variable: Service quality in Health Care

67
Analysis and interpretation

The results from table 4.16 above, indicate that medical records maintenance with beta

coefficient (B) of 0.261 and p=0.004) is statistically significant, records appraisal process

with beta coefficient (B) of 0.98 and p=0.159) is not statistically significant in influencing

service quality in health care facilities at a multivariate level. Medical records disposal (B) of

0.35 and p=0.338 is not statistically significant factor in influencing service quality of

healthcare at ROM.

From the table 19, the R value represents multiple correlation coefficients between all the

independent variables in the model and the dependent variable. In this study the results show

the multiple correlation coefficients (R) of 0.558 with p value of 0.000, which is less than the

level of significance set at 0.05 as shown in table 19 above. This shows that there is a

moderate positive statistically significant relationship between the independent variables

(medical records maintenance, records appraisal, and disposal) and dependent variable

(service quality in health care facilities) hence implying that an increase in medical records

management practices influences moderately improves service quality of healthcare facilities

at ROM.

The table also shows the R square value for the model at 0.311, which means that 31.1% of

the total variations in service quality are explained by the medical records management

practices. Conversely, 68.9% of the variation in service quality in healthcare facilities could

be explained by other factors other than records management practices.

68
 CHAPTER FIVE

SUMMARY, DISCUSSIONS, CONCLUSIONS AND RECOMMENDATIONS

5.0 Introduction

This chapter presents the summary, discussion, conclusion and recommendations of the

study which are presented according to the research objectives of the study.

5.1 Summary of results

This study set out to examine the influence of medical records management practices on the

quality of service delivered at Reach Out Mbuya (ROM). It was based on three specific

objectives which included establishing the influence of medical records maintenance,

Records appraisal and Medical records disposal on the quality of service delivered at Reach

Out Mbuya (ROM).

5.1.1 Medical Records Maintenance & Service Quality.

The first objective of this study was to establish the influence of medical records maintenance

on the quality of service delivered at Reach Out Mbuya (ROM). To that effect, the study

results revealed that Medical records maintenance produce a statistically significant positive

influence the quality of service delivered at Reach Out Mbuya (P-value = 0.000 & R-value =

.525** ).

5.1.2 Medical Records Maintenance & Service Quality.

The second objective of this study was to establish the influence of medical records appraisal

on the quality of service delivered at Reach Out Mbuya (ROM). To that effect, the study

results revealed that medical records appraisal produce a statistically significant positive

influence the quality of service delivered at Reach Out Mbuya (P-value = 0.000 & R-value =

.434** ).

69
5.1.3 Medical Records Maintenance & Service Quality.

The third objective of this study was to establish the influence of medical records appraisal

on the quality of service delivered at Reach Out Mbuya (ROM). To that effect, the study

results revealed that influence of medical record disposal on the quality of service delivered

at Reach Out Mbuya (P-value = 0.429 & R-value = .103** ).

5.2 Discussion of results

The study findings are discussed under each objective below.

5.2.1 Records maintenance and Service Quality

The correlation analysis results (r = 0.550, p < 0.001) show that medical records maintenance

has a moderate positive effect on service quality and hence the hypothesis of the study was

accepted. This means that categorical arrangement of medical records, putting guidelines on

how to create a new record, to update existing records and to regulate the records file

movement better service quality in health care. (Chinyemba and Ngulube, 2005) argues that

maintenance of records is very vital to certify that records are safe and protected against any

treacherous perils within the maintenance atmosphere, and they must be accessible always, as

required by the organization. Proper management of records is mostly about “establishing

physical and intellectual control over records that are entering the records system.”

5.2.2 Records Appraisal Process and Service quality

The correlation analysis results (r = 0.429, p < 0.001) show that records appraisal process has

a moderate positive correlation on healthcare service quality and therefore the hypothesis of

the study was supported. This implies that the identification and separation of short term and

long-term value, keeping of records separately as active and inactive is likely to cause an

increase in service quality in healthcare. On average, respondents felt that training staff on

how to effectively separate active and inactive records and teaching them how to reassess

records regularly would eventually improve the quality of healthcare services.

70
Ngoepe and Nkwe (2018) observes that appraisal as like a way or process of separating chaff

from the wheat, which means separating records with long-term value from records with only

short-term value. They use wheat to refer to long-term value records as they are permanently

important and chaff used to refer to short-term value records as they are only used for short

period before they are destroyed. Records appraisal brings about a lot of benefits if properly

planned and implemented, such as compliance to legislations, easy destruction of ephemeral

records to keep only enduring value records, and the smooth running of an organization (The

National Archives of UK, 2013).

5.2.3 Records disposal and service quality

The regression analysis results (r =0.097, p = 0.455) show that there is a no correlation

between records disposal quality and healthcare service quality and thus in disagreement with

the study hypothesis. This indicates that an improvement in records disposal does not affect

the healthcare service quality. Over all, respondents felt that classification of records

inventory, destruction of short-lived records and effecting a routine mechanism for disposal

of records have less significance on the healthcare quality.

(Marutha, 2016) agrees that medical records retention and disposal is the custody or medical

records up to a defined period based on its value in a records management approach till when

it gets to its disposal period for destruction or archival in the repository for reference.

5.3 Conclusions

This section is the conclusion of the study objectives and they are as follows.

5.3.1 Records maintenance and service quality

The study examined the influence of records maintenance and healthcare service on quality.

The results indicate that there was a moderate positive correlation between records

maintenance and healthcare service quality. This signals that a simple but comprehensive

record maintenance effort is essential in the improvement of healthcare services quality. It is

71
therefore vital that the staff file client medical records separately, explaining the importance

of records management guidelines and giving them guidelines on how to create new records

as well as updating records.

5.3.2 Records appraisal process and service quality

The study assessed the influence of the records appraisal process dimension on healthcare

service quality. The findings show that there was a moderate positive correlation between the

two variables. This implies that record appraisal processes play a critical role in healthcare

service quality. It is therefore important that management pays more attention to the

identification and separation of short term and long-term value, keeping of records separately

as active and inactive so as to improve service quality in healthcare.

5.3.3 Records disposal and service quality

The study established the influence of records disposal on healthcare service quality. This

dimension as a whole statistically proven under this concept does not currently affect the

quality of services in healthcare quality in ROM.

5.4 Recommendations of the study

The researcher of this study arrived at the following recommendations:

5.4.1 Records maintenance and service quality

Medical records maintenance practices like orderly storage, regular updating of files and

ensuring an adequate storage capacity for medical records should be highly considered to

improve service quality in healthcare. The study results show a moderate positive relationship

between records maintenance and service quality in health care hence records maintenance

affects service quality in healthcare.

Lafond (2015) notes proper documenting of patient's medical records guarantees simple

recovery and adds to decreased patient waiting time, guaranteeing continuity of care. It is

72
thusly, basic, that medical records are constantly kept in light of a legitimate concern for both

the clinician and the patient.

Marutha (2011) notes that an absence of a documenting space was the significant reason for

misfiling, missing records and harm to records.

5.4.2 Records appraisal process and service quality

Regular reassessment of record statuses should be practiced and the labeling of records as

active, semi active and inactive should be done to the medical records. The findings show

that there is moderate positive relationship between Records appraisal process and service

quality in health care which implies that records appraisal process affects the service quality

in healthcare.

The National Archives of UK (2013) underscore those proper records appraisal requires

consideration of five key principles, which are timing, methodology, engagement,

documentations and guidelines. This means appraisal needs to be done in time so that the

records may also be disposed of in line with the set retention period. In the process of

appraisal, several things need to be considered.

(Decman and Vintar, 2013) notes that various institutes or hospitals ought to have an

independent Electronic Document and Records Management Systems (EDRMS) or Health

Management Information System (HMIS) linked to the government cloud framework for a

standardized and smooth records review, and feedback for all various record classifications

(active, semi-active and inactive) centrally.

5.4.3 Records disposal and service quality

The medical records should be kept privately and confidential and putting of disaster

preventive measures should be highly considered. From the findings, no significant

relationship was found between the records disposal and service quality in healthcare.

73
ISO 15489-1 (2001) highlights that the records disposal process ought to be considered

during the structural design. An Electronic Record Management System (ERMS) should be

formulated to facilitate implementation of records disposal through activated automatic alerts

for disposal with an audit trail showing disposed-off records and existing records outstanding

for disposal.

(Marutha, 2016) notes that medical records retention and disposal is keeping of medical

records for a defined period based to its value in the records management guidelines up to

that moment when it gets its disposal period to be done away with or archived and separated

for reference.

Policy formulation & enforcement targeting improvement of record management practices of

maintenance, appraisal & disposal. These practices should be disseminated in all public

health facilities. This will add to the existing knowledge & stimulate further research in

practices for improving service quality in healthcare.

The organization of Reach Out Mbuya should use these research findings identified during

the study to address record management gaps which have affected responsiveness, accuracy,

timeliness and empathy in their service delivery thereby improving the quality of health care

provided to patients.

5.5 Limitations of the study

The research had the following limitations among others:

During the document review process of data collection, some organization documents were

inaccessible to the researcher such as the financial budgets to capture the budget lines for

records and information management in comparison to the entire budget.

2 of the 63 sampled respondents declined to participate in the study interview at the time.

The corona virus (Covid19) lockdown delayed data management and documentation process.

74
5.6 Areas for future research

Future researchers can draw attention to examine the influence of medical records

maintenance and medical records appraisal towards service quality in healthcare facilities.

Furthermore, the same study can also be carried out on a larger scale to include all public

health facilities delivering services in public healthcare facilities.

In addition, further studies can be done to assess how the new electronic-health system;

Uganda Electronic Medical Records (Uganda EMR 3.0) Point of Care version contributes to

the quality of services offered in healthcare as a practice of records management.

75
 REFERENCES

Adeleke, I. E. (2014). Health Information Technology in Nigeria: Stakeholders' perpectives

of Nationwide implementions and meaningful use of the emerging technology in the
most populous black nation. American Journal of health research.
Ahmed, U. J. (2010). Documentary Research Method: New Dimensions. Journal of
Management & Social Sciences, 1-14.
Alemayehu, M. (2009). Antiretroviral treatment adherence and its correlates in Addis Ababa,
Ethiopia. Ethiop Med J. 44, 237-244.
Amin, E. M. (2005). Social science research, conception, methodologyand analysis.
Kampala: Makerere University.
Asogwa, E. M. (2012). The challenge of managing electronic records in developing
countries: Implications for records managers in sub-saharan Africa. Records
Management Journal, (22)3, 198-211.
Bayiga, J. (2018). Records Storage and Retrieval Systems. Kampala: Makerere University.
Bhawna and Gobind. (2015). Research Methods and Approaches. IOSR Journal of Research
and Method in Education (IOSR-JRME), 48-51.
Boonstra, A., & Broekhuis, M. (2010). Barriers to acceptance of electronic medical records
by physicians from systematic review to taxonomy and interventions. BMC Health
Service Research, 1-17.
Bordoloi, P., & Islam, N. (2012). Knowledge management practices and healthcare delivery:
A contigency framework. The Electronic Journal of Knowledge Management (10)2,
110-120.
Bradsher, J. G., & Ambacher, B. I. (1992). Archival sampling: A method of Appraisal and a
Means of retention. Mid-Atlantic regional archival conference.
CFI Education Inc. (2015). Quantitative Analysis. Retrieved from Corporate Financial
Institute: https://corporatefinanceinstitute.com/resources/knowledge/finance/
quantitative-analysis/
Cheterera, F., Ngulube, P., & Rodrigues, A. (2014). Records surveys in support of a
framework for managing public records in Zimbabwe. Information development
(30)4, 366-377.
Chiyemba, A., & Ngulube, P. (2005). Managing records at a higher education institution: A
case study of the University of KwaZulu-Natal, Pietermaritzburg campus. South
African Journal of information management, 7(1), 241-250.
Cooper, D. R., & Schindler, P. S. (2005). Business research methods (9th edition). Tata
McGraw.
Creswell, J. W. (2017). Qualitative, Quantitative and Mixed methods Approaches. In J. W.
Creswell, Research Design (pp. 203-224). Califonia: SAGE Publications Inc.

76
Dang, V. M., Batailler, P., Seigneurin, A., Vittoz, J. P., Sellier, E., & Labarere, J. (2014).
Medical record keeping and patient perception of hospital care quality. International
Journal of health care quality assurance, 531-543.
Decman, M., & Vintar, M. (n.d.). A possible solution for digital preservation of e-
government: A centralised repository with in a cloud computing framework. New
information perspectives, (pp. 406-424).
Etikan, E., Musa, S. A., & Rukayya, S. A. (2017). Comparison of convinience sampling and
purposive sampling. American Journal of Theoretical and Applied Statistics.
Gilliland, A., & McKemmish, S. (2004). Building an infrastracture of archival research.
Journal of archival science.
Green, M. A. (2011). Essentials of health information managment: Principles and practices.
Cengage learning. New York.
Huffman, K. E. (2001). Medical records management (9th edition). New york: Clare don
press.
International standards organization. (2001). Information and documentation and records
management part 1. In International standards organization. Geneva: International
standards organization.
International standards organization, . (2001). Managing public sector records:A study
progromme automating records services. London: International records management
trust.
Ismail, A., & Jamaludin, A. (2009). Towards establishing a framework for managing trusted
records in the electronic environment. Records management journal.
Kemoni, H. N., Ngulube, P., & Stilwell, C. (2007). Public records and archives as tools for
good governance: Refelections within the record keeping scholarly and practioner
communities. ESARBICA Journal.
Kothari, C. (2009). Research methodology. Methods and techniques. New Delhi: New age
international limited publishers.
Krejcie, C., & Morgan, . (1970). Determining sample size for research activities. Retrieved
from www.opa.uprrp.edu.
Kyayise, A., Kyeyagalire, R., Livesley, N., Kirunda, I., & Tumwesigye, B. (2008). Private
for profit HIV/AIDS care in Uganda: An assessment. Kampala.
Lafond, A. (2015). Improving the quality of investment in health: Lessons for sustainability.
Lott, L. A. (1997). The conundrum of patient records. International journal of health care
quality assurance incorporating leadership in health services, iv-vi.
Mampe, G., & Kalusopa, T. (2012). Records management and service delivery: The case of
department of corporate services in the ministry of health in Botswana. Journal of
South African society od archivist, vol.45, 1-23.
Marutha, S. N. (2011). Records management in support of service delivery in the public
health sector of Limpopo province in South Africa. University of South Africa.
77
Maryland State Archives. (2015). Retention schedule preparation: record inventory.
Retrieved from https://msa.maryland.gov/msa/intromsa
Mathebeni, B. P. (2015). Management of medical records for healthcare service delivery at
the Victoria public hospital in the eastern cape province . Eastern cape.
McKemmish, S. (1997). Today, today and tomorrow: A continuum of responsibility.
Preceedings of the records management association of Australia 14th national
convention.
McKemmish, S. (2001). Placing records continuum theory and practice. In Archival science
(pp. 333-359).
Ministry of health, . (2016). Strategy for improving health service delivery 2016-2021.
Kampala: Ministry of health.
MoReq2, . (2008). Model requirements for the management of electronic records.
Naidain, M. (2006). The case of kenya paper presented at the international seminar of
strategic management and democratic use of government information in Africa. In
Strategic management and use of government information in Africa: (pp. 27-30).
Addis Abba.
National archives records service of South Africa (2006). Managing electronic records in
governmental bodies: meta requirements.
Ngoepe, M. (2014). Strategies for preservation of electronic records in South Africa:
Implications on access to information. 2nd annual knowledge, archives and records
management conference.
Ngoepe, M., & Nkwe, M. (2014). Separating the wheat from the chaff with the winnowing
fork. The eeny meeny miny mo appraisal approach of digital records in South Africa.
Records management journal, 130-142.
Ogden, J., & Nyblade, L. (2005). Common as its core: HIV related stigma across contexts.
Internationa centre of research on women.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1985). A conceptual model of service
quality and its implications for future research.
Peterson, T. H. (1991). The archival bestiary. In A. archivist, The archval bestiary (pp. 192-
205).
Polit, D. F., Beck, C. T., & Hungler, B. P. (2001). Essentials of nursing research methods,
appraisal and utilization (5ht edition). Philadelphia.
Reach Out Mbuya (2018). Annual report. Kampala: Reach Out Mbuya.
Reed, B. (2000). Reading the records continuum: Interpretations and exploration. Retrieved
from www.records.com.au
Roberts, K. (2012). Physician patients relationship, patient satisfaction, and antiretrovial
medication adherence among HIV infected adults attending a public health clinic. In
AIDS patients care and STDs.

78
Sacred Heart University Library. (2019). Types of research designs. Retrieved from Sacred
Heart University Library: https://library.sacredheart.edu/c.php?g=29803&p=185902
Schneider, A., Hommel, G., & Blettner, M. (2010). Linear regression Analysis. Evaluation of
scientific publications, 776-782.
Schoonenboom, J., & Johnson, R. (2017). How to construct mixed methods research design.
107-131.
Shan, A. (2005). Public service delivery: Public sector governance and accountability series.
Washington DC: World bank.
Sharyl, J. N., Levit, A. L., Lawrence, O., & Gostin, O. L. (2009). Beyond the health
insurance profitability and accountability Act. Enhancing privacy, improving health
research. Institute of medicine (US) committee on health research and the privacy of
health.
Shepherd, E., & Yeo, G. (2003). Managing records: A hand book of principles and practice.
Shortliffe, E. H., & Barnett, G. O. (2011). Medical data: The medical records: How health
care providers are managing. The challenges of managing medical records.
Sichalwe, E., Ngulube, B. & Stilwell, C. (2011). Managing records as a strategic resource in
the government ministries of Tanzania. Information Development journal, 264-279.
Sinha, R. K. & Shenoy, N. (n.d.). Assessment of oncology medical records as per NABH
standards. Journal of health management, 329-343.
The national archive of UK. (2013). Retrieved from www.nationalarchives.gov.uk
UNCST. (2014). National guidelines for research involving humans research participants.
Retrieved from The Uganda National Council of Science and Technology:
www.uncst.go.ug
Upward, F. (1998a). Post custodial principles and properties. Retrieved from Structuring the
records continuum: www.sims.monash.edu.au
Upward, F. (1998b). Structuration theory and record keeping . Retrieved from Structuring
records continuum.
Upward, F. (2000). Modeling the continuum as a paradigm shift in recordkeeping and
archiving processes and beyond; a personal reflection. Retrieved from
www.infotech.monash.edu.au
Wayne, F. A. (2011). Sampling Statistics. New Jersey: John Wileys& Sons Inc.
Weeks, R. V. (2013). Electronic health records:Managing the transformation from a paper-
based to an electronic system. Journal of contemporary managment, 135-155.
Were, M. C. (2010). Evaluating a scalable model for implementing electronic health records
in resource limited settings. JAMIA.
Wisniewski, M. (n.d.). Using SERVQUAL to assess customer satisfaction with public sector
services. Managing service quality: An international journal vol. 11 N0. 6, 380-388.

79
Wisniewski, W. & Donnelly, M. (1996). Measuring service quality in the public sector, the
potential for SERVQUAL. Total quality management vol. 7, 357-365.
Yin, R. K. (1984). Case study research: Design and methods. Newbury park.

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 APPENDICES
Appendix I: Survey Questionnaire For Healthcare Service Staff

Dear Respondent,

I am a student at Uganda Management Institute conducting a study entitled “Medical records

management practices and service quality in healthcare facilities: A case of Reach Out
Mbuya (ROM)”. The study is a partial fulfillment of the requirements for the award of “a
Master’s Degree in Management Studies”. You have been selected because of your position
and capacity as you have useful information to contribute to the success of this study. The
information in this questionnaire shall not be used for any other purposes other than for this
study and will treated with maximum confidentiality.

You are not required to provide your name, and you will therefore remain anonymous. It is
on this basis that the researcher is kindly requesting you as the study participant to give
consent through this form for your participation in this study by sincerely and accurately
answering the following questions. Should you have any question or seek any clarity, feel
free to ask the researcher at any time of your participation.

Thanks for your cooperation.

Yours sincerely,

DERECK MUSOOKA

i
Section A: Biographical information
1. Please indicate your gender
1) Male 2) Female

2. Please indicate your age group

1) 18 – 22yrs 2) 23 – 27yrs 3) 28 – 32yrs 4) 33-37yrs 5) 38-42yrs
6) 43yrs and above

3. In which ROM site do you work?

1) Mbuya 2) Banda 3) Kinawataka 4) Luweero

4. In which department do you work?

1) Registry and M&E 2) Medical 3) Laboratory 4) Pharmacy
5) Counseling 6) Community 7) Finance 8) Administration and logistics
9) Other specify………………………

5. What is your highest acquired academic qualification?

1) ‘O’ level 2) ‘A’ level 3) Certificate 4) Diploma 5) Undergraduate
6) Post graduate Diploma 7) Masters 8) Others
specify………………

6. How long have you been employed in this health facility?

1) 0-1yr 2) 2-3yrs 3) 4-5yrs 4) 6yrs and above

7. Do you participate in the ROM records management process?

1) Yes 2) No

8. How do you store medical documents?

1) Manually 2) Electronically 3) Both

9. How often do you file the medical records/ documents?

1) Daily 2) Weekly 3) Monthly 4) Quarterly 5) Semi-
annual 6) Annual

ii
 10. What kind of records management system do you practice at Reach-Out Mbuya?
1) Centralized 2) De-centralized 3) Other specify …….....

Section B: Medical Records Maintenance practice

1. Rate of medical records maintenance
Activity Strongly Disagree Not Agree Strongly
disagree sure agree
Rom has records management guidelines/
manual/ procedures
ROM goes by the records management
guidelines
Guidelines describe staff responsibilities in
records management
Guidelines describe how to creating a new
record
Guidelines describe how to update existing
records
Guidelines regulate records file movement
Medical records security and safety measures
are adequate
Client medical records are filed individually
Medical records are categorically and
sequentially arranged
The organization has a records maintenance
schedule to mitigate file misplacement or loss
The organization restricts sharing medical
records
Medical records are kept undisturbed
There is a regular backup of medical records
The institution has a File tracking register
The institution has File tracking card
The institution uses barcodes to track files
Physical check of files/records in the storage
areas is frequently carried out
The medical records storage capacity is
adequate
Shelving equipment and facilities are adequate
Records administration resources are adequate
Records are easily accessible when needed by
staff
The institution restricts access to sensitive
records
There is ease of retrieval of records from the
shelves
Medical records supplies are well managed

iii
Section C: Medical Records Appraisal practice
14. Medical records appraisal practice
Rate the medical records appraisal practice at Strongly Disagree Not Agree Strongly
Reach Out Mbuya disagree sure agree
The institution identifies and separates records
of short-term value and long-term value
The archival value of records is assessed to
categorize them as active, semi-active and
inactive
Archival records value is managed through the
records management system
The institution labels medical records as active,
semi-active and inactive records
Records are kept separately as active, semi-
active records and inactive
Records status is reassessed on a regular basis

Section D: Medical Records Disposal practice

15. Do you have a records retentions schedule for paper records?

1) Yes 2) No

16. Do you have a records retentions schedule for electronic documents?

1) Yes 2) No

17. Do you have a standardized naming convention for medical records?

1) Yes 2) No
18. Medical records disposal practice
Rate the medical records disposal practices at Strongly Disagree Not Agree Strongly
Reach Out Mbuya disagree sure agree
Short lived records are destroyed quickly
Records retention period are determined for
category of medical records
Records are kept for a maximum of 5 years
then are destroyed
Records sorting and registration is carefully
carried out before disposal
Disposal permission application is sought from
the archivist/records manager
If disposal authority is granted, records are
disposed off
Disposal certificate is issued by the records
manager before disposal is carried out
Disposal register is created for safe keeping for
future reference and accountability

iv
Disaster preventive measures are in place and
effective
There is a routine mechanism for record
disposal
The date of destruction is captured by the
records officer
There is description of disposed records
Signatures of individuals supervising and
witnessing the destruction are captured
There is a statement that records were
destroyed with in the agreed terms.
There is a records retention schedule in place
There is an classification of records inventory
There is legislation which affects how long
records should be kept
Archived records are private and kept
confidential

Section E: Healthcare Service quality

19. Health care service quality practices
Strongly Disagree Not Agree Strongly
disagree sure agree
Ineffective and unreliable records management
guidelines affect service quality of health care
Medical records are always available as and when
needed by the staff in service delivery (Service
reliability)
The stored medical records are trusted/ not
doubted when providing a service (Service
Assurance)
Medical staff confide in the stored medical
records to provide a service to clients (Service
Assurance)
Medical records management approach helps
save time during service delivery (Service
Responsiveness)
Stored medical records are comprehensive
enough in enabling medical staff understand the
client’s condition (Service Assurance)
Medical records management procedures enable
ROM perform the promised service accurately
Medical records management approaches
influence the willingness of ROM staff to help
clients
Medical records management practices affect the
provision of a prompt service by ROM staff to
clients
Medical records management procedures inform
the knowledge of ROM staff about their clients to
serve them better
ROM staff help clients receive services in a
timely (service assurance)

v
A client file is quickly prepared upon registering
at ROM (reliability)
A client’s medical record is always updated on a
regular basis. (reliability)
A client’s medication is always captured in the
medical records for ease of follow up
(responsiveness)
Clients medical records are handled with care
(responsiveness)
A client has ever been delayed a service due a
missing or misplaced file
A client has ever missed a service provision due
to a lost record
Clients are always notified on the return date to
pick drugs basing on their individual medical
record (responsiveness)

Thank you for your Time

vi
 Appendix II: Key Informant Interview Guide For Managers

Dear Respondent,

I am a student at Uganda Management Institute conducting a study entitled “Medical records

management practices and service quality in healthcare facilities: A case of Reach Out
Mbuya (ROM)”. The study is a partial fulfillment of the requirements for the award of
“Master’s degree in Management Studies”. You have been selected because of your position
and capacity as you have useful information to contribute to the success of this study. The
information in this questionnaire shall not be used for any other purposes other than for this
study and will treated with maximum confidentiality.
You are not required to provide your name, and you will therefore remain anonymous. It is
on this basis that the researcher is kindly requesting you as the study participant to give
consent through this form for your participation in this study by sincerely and accurately
answering the following questions. Should you have any question or seek any clarity, feel
free to ask the researcher at any time of your participation.

Thanks for your cooperation.

Yours sincerely,

DERECK MUSOOKA

i
Key Informant Interview (KII) guide
Medical records management practices and service quality in healthcare
1. Gender of key informant
2. Job title of key informant
3. Which medical records do you interface with?
Key informant interviews
Medical records maintenance
In your opinion, how are medical records currently organized here in ROM and how can they
be organized better?
In your opinion, how are medical records preserved and how can they be preserved better?
Medical records appraisal
In your opinion, are medical records with archival values appraised as active, semi-active and
in-active?
In your opinion, are records categorized and separated accordingly?
In your opinion, how can records be appraised better?
Medical records disposal
In your opinion, are inactive medical records destroyed according to the national records and
archives act?
In your opinion, how should the active records with enduring archiving values be retained
and maintained?
Service quality in health care
In your opinion, does records management influence service quality in health care?
In your opinion, how can the approaches of records management be improved for a timely
service?
In your opinion, how can the practices of medical records managements be improved to
enable the health worker provide an assured service to the clients’ expectation?
In your opinion, how can the practices of medical records management be improved to enable
a good client-service provider relationship
Any comments on improving health service quality through approaches of medical records
management

Thank you for your Time.

ii
 Appendix III: Sample Size Determination Table

TABLE FOR DETERMINING SAMPLE SIZE FROM A GIVEN POPULATION

N S N S
N S
10 10 220 140 1200 291
15 14 230 144 1300 297
20 19 240 148 1400 302
25 24 250 152 1500 306
30 28 260 155 1600 310
35 32 270 159 1700 313
40 36 280 162 1800 317
45 40 290 165 1900 320
50 44 300 169 2000 322
55 48 320 175 2200 327
60 52 340 181 2400 331
65 56 360 186 2600 335
70 59 380 191 2800 338
75 63 400 196 3000 341
80 66 420 201 3500 346
85 70 440 205 4000 351
90 73 460 210 4500 354
95 76 480 214 5000 357
100 80 500 217 6000 361
110 86 550 226 7000 364
120 92 600 234 8000 367
130 97 650 242 9000 368
140 103 700 248 10000 370
150 108 750 254 15000 375
160 113 800 260 20000 377
170 118 850 265 30000 379
180 123 900 269 40000 380
190 127 950 274 50000 381
200 132 1000 278 75000 382
210 136 1100 285 1000000 384
Source: Krejcie & Morgan (1970)
Note. N is population size. S is sample size.

i
Appendix IV: Introductory Letter

Appendix V: Anti-Plagiarism Report