Background Gauteng province, with 26.3% of South Africa’s population, is the commercial and industrial powerhouse of the country. During the first epidemic wave in 2020, Gauteng accounted for 32.0% of South Africa’s reported COVID-19 cases. Aim The aim of this study was to describe the health system response to the COVID-19 pandemic during the first epidemic wave in Gauteng province and to explore the perspectives of key informants on the provincial response. Material and methods Using an adapted Pandemic Emergency Response Conceptual Framework, this was a qualitative case study design consisting of 36 key informant interviews and a document analysis. We used thematic analysis to identify themes and sub-themes from the qualitative data. Results Our case study found that Gauteng developed an innovative, multi-sectoral and comprehensive provincial COVID-19 response that aimed to address the dual challenge of saving lives and the economy. However, the interviews revealed multiple perspectives, experiences, contestations and contradictions in the pandemic response. The COVID-19 pandemic exposed and amplified the fragilities of existing systems, reflected in the corruption on personal protective equipment, poor data quality and inappropriate decisions on self-standing field hospitals. Rooted in a chronic under-investment and insufficient focus on the health workforce, the response failed to take into account or deal with their fears, and to incorporate strategies for psychosocial support, and safe working environments. The single-minded focus on COVID-19 exacerbated these fragilities, resulting in a de facto health system lockdown and reported collateral damage. The key informants identified missed opportunities to invest in primary health care, partner with communities and to include the private health sector in the pandemic response. Conclusion Gauteng province should build on the innovations of the multi-sectoral response to the COVID-19 pandemic, while addressing the contested areas and health system fragilities.

Background Electronic Health Records (EHR) has been espoused to be an innovation from the paper-based system, with benefits such as fast access to patient information thereby facilitating healthcare provider communication, healthcare continuity and improved quality of care. However, it is the extent of the quality of the electronic health records that determines the access to these stated benefits. The quality of health care records indirectly contributes to patient safety because inaccurate patient data can lead to improper diagnosis and consequently wrong treatment of patients. Most hospitals in Ghana, have recently transitioned into the EHR system, hence, there is a need to assess its accuracy, impact on workflow, staff training on usage, support from the EHR team, and the overall satisfaction of the EHR system. As health leaders are at the frontline of its implementation, their views on the challenges and successes of the EHR system are imperative. Method This qualitative study sought to explore the views of the health leaders on the implemented electronic health records system in nine (9) hospitals within three (3) regions in Ghana. Following ethical approval, GHS-ERC:007/04/21, focus group discussions were conducted with a minimum of 10 hospital leaders in each facility. These included quasi, government and private hospitals. Data was collected between September and November 2021. Results The study found poor quality of records, lack of involvement of frontline clinicians in the development of the EHR system, inadequate training of staff and limited workstations as some of the challenges associated with the use of EHR in hospitals. Health leaders were generally not satisfied with the EHR system. Conclusion It is recommended that addressing inputs from end-users as well as circulating more computers will motivate EHR usage and acceptance. Provision of additional workstations for the various units and involvement of staff in the system development would be most prudent to enable health workers to accept the EHR system in improving the quality of care.

Background The International Council of Nurses’ 2021 code of ethics mandates nurses to provide evidence-informed care to patients. Globally, using research evidence has led to improvement in nursing and midwifery practice, according to the World Health Organization. A study in Ghana found that 25.3% (n=40) of nurses and midwives use research in clinical care. Research utilization (RU) increases therapeutic effectiveness, improves health outcomes, and enhances the personal and professional development of clinicians. However, it is uncertain the extent to which nurses and midwives are prepared, skilled, and supported to utilize research in clinical care in Ghana. Objective This study aims to develop a conceptual framework that can facilitate RU among clinical nurses and midwives in Ghanaian health facilities. Methods This will be a cross-sectional study with a concurrent mixed methods approach. It will be conducted in 6 hospitals and 4 nursing educational institutions in Kumasi, Ghana. The study has 4 objectives which will be executed in 3 phases. Phase 1 follows a quantitative approach to describe the knowledge, attitudes, and practices of clinical nurses and midwives on the use of research in their practice. Using a web-based survey, 400 nurses and midwives working in 6 health facilities will be recruited. Data analysis will be conducted using SPSS, with statistical significance set at .05. Qualitative methodology, using focus group discussions with clinical nurses and midwives, will be conducted to identify the factors influencing their RU. In phase 2, focus group discussions will be used to examine and describe how nurse educators in 4 nursing and midwifery educational institutions prepare nurses and midwives for RU during their education. Views of nurse managers on the RU in Ghanaian health care facilities will be explored in the second section of this phase through one-on-one interviews. Inductive thematic analysis will be used to analyze the qualitative data, and Lincoln and Guba’s principles of trustworthiness will be applied. In phase 3, the stages of model development proposed by Chinn and Kramer; and Walker and Avant will be used to triangulate findings from all objectives and formulate a conceptual framework. Results Data collection started in December 2022. Publication of the results will begin in April 2023. Conclusions RU in clinical practice has become an acceptable practice in nursing and midwifery. It is critical that nursing and midwifery professionals in sub-Saharan Africa shift their practice to embrace the global movement. This proposed conceptual framework will empower nurses and midwives to improve their practice of RU. International Registered Report Identifier (IRRID) DERR1-10.2196/45067

Background Improving patient safety culture in healthcare organisations contributes positively to the quality of care and patients’ attitudes toward care. While hospital managers undoubtedly play critical roles in creating a patient safety culture, in Ghana, qualitative studies focussing on hospital managers’ views on the state of patient safety culture in their hospitals remain scanty. Objective This study aimed to explore the views of hospital managers regarding compliance to patient safety culture dimensions in the selected hospitals in the Bono, Greater Accra, and Upper East regions of Ghana. Methodology This was a qualitative exploratory study. A purposive sampling of all hospital managers involved in patient safety practices was conducted. The sampled managers were then invited to a focus group discussion. Twelve focus group discussions with each consisting of a maximum of twelve participants were conducted. The ten patient safety culture dimensions adapted from the Agency for Healthcare Research and Quality’s patient safety culture composite measures framed the interview guide. Deductive thematic content analysis was done. Lincoln and Guba’s methods of trustworthiness were applied to ensure that the findings are valid and reliable. Findings Positive patient safety culture behaviours such as open communication, organisational learning, and strong teamwork within units, were an established practice in the selected facilities across Ghana. Lack of teamwork across units, fear of reporting adverse events, the existence of a blame culture, inconsistent response to errors, extreme shortage of staff, sub-standard handover, lack of management support with resources constrained the patient safety culture. The lack of standardised policies on reporting adverse events and response to errors encouraged managers to use various approaches, some resulting in a blame culture. Staff shortage contributed to poor quality of safety practices including poor handover which was also influenced by lateness to duty. Conclusion Prompt and appropriate responses by managers to medical errors require improvements in staffing and material resources as well as the enactment of standard policies across health facilities in the country. By so doing, hospital managers would contribute significantly to patient safety, and help build a patient safety culture in the selected hospitals.