Derrick Report
Derrick Report
Derrick Report
BY
DERECK MUSOOKA
18/MMS/BA/KLA/MAR/021
April, 2021
i
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.
i
APPROVAL
This work has been submitted for examination with the approval of both my academic
supervisors.
ii
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.
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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
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
To my beloved mother, Ms. Mugerwa Gloria, I am very grateful for the profound research
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TABLE OF CONTENTS
DECLARATION...........................................................................................................................i
APPROVAL.................................................................................................................................ii
DEDICATION.............................................................................................................................iii
ACKNOWLEDGEMENTS........................................................................................................iv
TABLE OF CONTENTS.............................................................................................................v
ABSTRACT................................................................................................................................xii
CHAPTER ONE...........................................................................................................................1
INTRODUCTION........................................................................................................................1
1.1 Introduction..............................................................................................................................1
v
1.8.2 Time scope..........................................................................................................................11
CHAPTER TWO........................................................................................................................14
LITERATURE REVIEW..........................................................................................................14
2.1 Introduction............................................................................................................................14
CHAPTER THREE...................................................................................................................24
METHODOLOGY.....................................................................................................................24
3.1 Introduction............................................................................................................................24
vi
3.5.1 Quantitative data collection method....................................................................................27
3.6.1 Questionnaire......................................................................................................................29
3.7.1 Validity................................................................................................................................30
3.7.2 Reliability............................................................................................................................31
CHAPTER FOUR......................................................................................................................35
4.0 Introduction............................................................................................................................35
vii
4.3.8 Frequency of filing client medical records..........................................................................39
CHAPTER FIVE........................................................................................................................69
5.0 Introduction............................................................................................................................69
5.3 Conclusions............................................................................................................................71
viii
5.4.3 Records disposal and service quality...................................................................................73
REFERENCES...........................................................................................................................76
APPENDICES...............................................................................................................................i
ix
LIST OF TABLES
Table 4.12: For regression on Medical Records Appraisal and Service quality..........................58
Table 4. 16: for regression on Medical records disposal and Service quality..............................66
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LIST OF FIGURES
Figure 1. 1: Conceptual Framework showing the relationship of medical records management
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ABBREVIATIONS AND ACRONYMS
xii
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
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
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.
The background section comprises of the historical, theoretical, conceptual and the contextual
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
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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
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).
medical records back to the seventeenth century, when he portrayed that, in 1752 A.D.
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
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
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
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
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 continuous value of records likewise suggests persistent care inferring that organizations
(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
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
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
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
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
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
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
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identifiers to follow treatment of a person after some time, connect different sources of
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
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
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
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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
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,
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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
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,
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
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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
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
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
This section introduces the purpose and the specific objectives of the study.
The purpose of this study examines the influence of medical records management practices
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2. To establish the influence of medical records appraisal on the quality of service delivered
3. To find out the influence of medical record disposal on the quality of service delivered at
1. What is the influence of medical records maintenance on the quality of service delivered
2. What is the influence of medical records appraisal on the quality of service delivered at
3. What is the influence of medical records disposal on the quality of service delivered at
Ho: Medical records maintenance do not significantly influence the quality of service
Ho: Medical records appraisal do not significantly influence the quality of service delivered
Ho: Medical record disposal does not significantly influence the quality of service delivered
management program enables the organization to render better patient care, provides
legitimate faultlessness and prompts improved benefit. In the conceptual framework, figure 1,
dimensions; medical records maintenance, records appraisal, and records disposal and while
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
The scope identified the boundaries of the study in terms of the geography, time and content
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
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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.
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
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
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
management practices and service quality of healthcare in ROM and the health sector.
Record: It’s a document irrespective of form created, received, maintained, and used by an
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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
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
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.
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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
The study reviews the Records Life Cycle Theory and The Records Continuum Model which
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
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
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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.
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
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
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
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.
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,
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
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).
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
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
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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
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
records to keep only enduring value records, and the smooth running of an organization (The
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
The National Archives of UK (2013) underscore those proper records appraisal requires
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
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
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
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formats, records must likewise be appraised at an initial phase (National Archives and
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,
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
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
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
Additionally, Decman and Vintar (2013) stress that, cloud as an ERMS records preservation
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
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
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
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
Effective hospital records management requires, among others, policy, models, lawful
practices may either negatively or positively influence on the healthcare service quality
Nonetheless, the healthcare quality improvement process also depends on better medical
records management practice that brings about accessibility of reliable medical records. For
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).
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
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
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
adapted to because the study considered a sample size of above 30 respondents and that the
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
bias in the study because each approach was used to check and fill the gaps of the other
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
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,
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
This section introduces the aspects of determining the sample size of the respondents and the
The sample size for this study was selected from the population size using a table by Krejcie
25
3.4.2 Sampling strategies
The researcher used both Simple random sampling and purposive sampling for quantitative
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
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
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
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.
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
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.
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
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).
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.
relating to medical records management practices and service quality of health care facilities.
These included; reports, journals, magazines, minutes of meetings, newspapers, the internet
28
3.6 Data collection instruments
The data collection instruments used for this study were; the questionnaire, the key informant
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
health facility to ensure data collection runs smoothly and is saved to the online destination
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-
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.
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
management practices. These included strategic plans, policies and procedures in various
Other documents included Reach Out Mbuya evaluations, reviews, or assessments (external
or internal) about the organization’s health care quality performance achieved were also
medical records and health care quality with references to the systems, practices and
effectiveness. These studies were found in the journals, organization’s websites and other
publications
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
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
3.7.2 Reliability
Reliability Statistics
Cronbach's N of Items
Alpha
.911 64
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
After the approval of the research proposal, the researcher got an introductory letter from the
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
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
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.
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
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
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.
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
34
CHAPTER FOUR
4.0 Introduction
This chapter presents the analysis and interpretation of the study that seeks to examine the
using a case of Reach Out Mbuya. The researcher applied descriptive, correlation and
This section shows in detail the proportion of respondents interviewed to those sampled in the
study.
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
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.
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
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
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
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
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
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
the least were from Banda, a distance away from the health facility who seemingly did not
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.
that they participate in management of records. This implies that all the staff sampled
quality.
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
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
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.
40
4.4. Service Quality in health care
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
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
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
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,
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
records may either negatively or positively influence on the quality of healthcare in facilities.
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
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
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
In agreement the informant argues that, “recording precisely and accurate.” is a key
management procedure
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
44
accessibility of true information about previous encounter visits also used for steady
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
In agreement the informant argues that, “There is need to stick to one system, either the
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
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
“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”
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
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
“In agreement another informant argues that According to another informant, reduce on the
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
In agreement the informant argues that, “A database should be maintained to track clients’
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
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
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
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
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,
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
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
“(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
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
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
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
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,
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
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
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
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
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
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
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
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
In agreement the informant argues that, “records should be kept manually and computerized
in folders.”
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
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
significant positive influence the quality of service delivered at Reach Out Mbuya (P-value =
Results in table 4.8 provides a 0.276 R-square indicating that the Model Medical records
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
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
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
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
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
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
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
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
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
57
4.4.6 Relationship between Records Appraisal and Service quality
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
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
significant positive influence the quality of service delivered at Reach Out Mbuya (ROM).
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
58
Results in table 4.11 provides a 0.188 R-square indicating that the Model Medical Records
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.
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
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
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
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
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,
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
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
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
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
The informant also asserted that, “There is need for medical research, thus records should not
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
However, in agreement (Decman and Vintar, 2013) argue that different institutions or
hospitals should have their own Electronic Document and Records Management Systems
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
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
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
63
automatic alerts for disposal with an audit trail identifying records disposed-off and records
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
According to an informant, “records should not be disposed of so that they can be assessed at
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
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
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
65
4.4.10 Relationship between Records disposal and Service quality
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}.
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.
Model summary of records management practices and service quality in health care
Table 4. 17: Regression model summary
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
(medical records maintenance, records appraisal, and disposal) and dependent variable
(service quality in health care facilities) hence implying that an increase in medical records
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
68
CHAPTER FIVE
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.
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
Records appraisal and Medical records disposal on the quality of service delivered at Reach
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** ).
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
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
physical and intellectual control over records that are entering the records system.”
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
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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
records to keep only enduring value records, and the smooth running of an organization (The
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
(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.
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
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
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
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
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
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
Marutha (2011) notes that an absence of a documenting space was the significant reason for
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
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
(Decman and Vintar, 2013) notes that various institutes or hospitals ought to have an
Management Information System (HMIS) linked to the government cloud framework for a
standardized and smooth records review, and feedback for all various record classifications
The medical records should be kept privately and confidential and putting of disaster
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
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.
maintenance, appraisal & disposal. These practices should be disseminated in all public
health facilities. This will add to the existing knowledge & stimulate further research in
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.
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
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
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
75
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APPENDICES
Appendix I: Survey Questionnaire For Healthcare Service Staff
Dear Respondent,
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.
Yours sincerely,
DERECK MUSOOKA
i
Section A: Biographical information
1. Please indicate your gender
1) Male 2) Female
ii
10. What kind of records management system do you practice at Reach-Out Mbuya?
1) Centralized 2) De-centralized 3) Other specify …….....
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
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
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)
vi
Appendix II: Key Informant Interview Guide For Managers
Dear Respondent,
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
ii
Appendix III: Sample Size Determination Table
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