Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa

Abstract

BackgroundA performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers’ to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development.MethodsThree focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions.ResultsParticipants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system.ConclusionFindings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented.

Providers’ perceptions of the implementation of a performance measurement system for substance abuse treatment: A process evaluation of the Service Quality Measures initiative

“…This is a concern, as findings from earlier work suggest that excessive burden to providers will threaten the sustainability of any performance measurement system. [10] An electronic system that allows for audio-computer-assisted personal interviewing could help with this difficulty by enabling even functionally illiterate patients to complete the SAATSA. Apart from reducing the workload of treatment providers, such a system would have the added benefit of reducing social desirability bias.…”

“…Despite the benefits of an electronic system, we are challenged by the fact that many treatment sites do not have a sufficient number of computers to implement an electronic version of the SQM system. [10] While finding the resources to move the SQM system onto an electronic platform is an important goal for this initiative; in the short term we are trying to identify ways of assisting treatment providers to remember to implement the system. These include helping treatment sites to develop their own systems for tracking patients through the care pathway and also providing treatment sites with more regular on-site support.…”

“…In developing these protocols, we were guided by providers' requests for simplicity and congruence with existing administrative practices as much as possible. [10] In 2014, we conducted a pilot implementation of the system at six treatment facilities to identify ways in which the protocols could be improved prior to implementing the system on a larger scale. This article describes providers' perceptions of the feasibility and acceptability of implementing the SQM system, including barriers and facilitators to implementation.…”

“…This developmental process has been described in detail elsewhere. [10][11][12] The finalised system comprises three tools: the SA Community Epidemiology Network on Drug Use (SACENDU)'s admission form that collects sociodemographic and substance use history information and is completed on enrolment into treatment, the SA Addiction Treatment Services Assessment (SAATSA) that accumulates patientreported data on perceived outcomes and quality of services, and a discharge form that gathers data on the type of services received and the patient's response to treatment. To support implementation we developed a toolkit for providers, specifying in detail the protocols to be followed when implementing this system.…”

Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative

“…This information collects administrative data on the type of services received and the patient's response to treatment. [7] The developmental process [6,7] and the process evaluation of this system's initial implementation have been reported elsewhere. [8] Despite a robust developmental phase, questions remain about the extent to which treatment facilities will adopt the SQM system.…”