1. EMERGING MOBILE HEALTH (mHealth) IN KATH ED: ASSESSING ITS STRENGTHS, WEAKNESSES,OPPORTUNITIES AND THREATS (SWOTANALYSIS) AMONG HEALTHCARE WORKERS.
Presented by Ms Joycelyn Sarfo-Frimpong
Research and Development Unit
Komfo Anokye Teaching Hospital

2. outline Introduction Methods Data Collection Data Analysis Results
Conclusion

3. Definition of terms
mHealth: The World Health Organization has defined mHealth as the use of mobile and wireless technologies to support the achievement of health objectives.(1)
mHealth is most appropriately understood as a tool for promoting healthy behaviors and strengthening health systems through the use of  mobile phones, tablets and other mobile devices. (1)
eHealth: is the application of ICTs for health, including laptop and desktop computers and servers, television and radio, teleconferencing systems, and all of the devices used in mHealth (1)

5. Definition of terms
SWOT Analysis: is an effective and simple planning technique which addresses one aspect of many strategic planning processes.
It is used to evaluate the Strengths, Weakness, Opportunities and Threats involved in a project, or any other situation requiring a decision.(2)

6. Definition of terms
Strengths: internal attributes of the organization that are helpful to the achievement of the objective.
Weaknesses: internal attributes of the organization that are harmful to the achievement of the objective.
Opportunities: external conditions that are helpful to the achievement of the objective.
Threats: external conditions that are harmful to the achievement of the objective.

7. INTRODUCTION
ED overcrowding affects quality of care received by the patient
Overcrowding causes
Increased stress to health workers
Dissatisfaction to both patients and workers(3)
Increases in morbidity and mortality

8. INTRODUCTION
KATH ED receives an average of 84 patients per day and 28,000 patients in a year
Overcrowding and long boarding hours has been a challenge in the ED
A number of initiatives have been taken to deal with long boarding hours in the ED and to increase patient flow.
Staff in KATH perceive overcrowding to influence poor attitudes to work, turning patient away (4)

9. INTRODUCTION
KATH ED has challenges of overcrowding due to long boarding hours of patients. mHealth tools could be useful in addressing them.
Round-the-clock patient transfers to admitting wards using mHealth tools have been found to address the challenge of
overcrowding and
improve quality care given by physicians to patients in some EDs.

10. mHealth solutions have the potential to help
INTRODUCTION
mHealth is relatively a new concept in developing countries and questions arise regarding reliability of technology used for health outcomes
mHealth solutions have the potential to help
improve access to health information and services for underserved populations,
generate cost efficiencies and
improve the capacity of health systems to provide quality health services.

11. INTRODUCTION
Many countries are embracing mHealth as a complementary strategy for strengthening health systems and achieving their Millennium Development Goals for health.

12. OBJECTIVE
To assess the behavioral attitudes of healthcare workers at KATH towards the use of mobile phone app for monitoring bed occupancy.

13. METHODOLOGY
We adopted an observational study to critically observe healthcare workers attitudes towards the use of mobile phone app to send bed states.
23 mobile phones were dispatched to the various wards that receive patient transfers from KATH ED.
Nurses on these wards were trained on how to use mobile app to send bed state two hourly; nine times a day.

14. METHODOLOGY
SWOT analysis model was adopted for the purpose of planning early in the life cycle of this research with the intent that described here can be used to strengthen and guide this emerging discipline.

15. ETHICAL CLERANCE
Ethical approval was obtained from the Committee on Human Research, Publications and Ethics. This was necessary to ensure that ethics of this research was designed to protect the study participants against any risks that study might pose.

16. showing snapshot of the bed state application

17. showing snapshot of the bed state application

18. showing snapshot of the bed state application

19. showing snapshot of the bed state application

20. RESULTS

21. Using SWOT analysis model,
STRENGHTS
Using SWOT analysis model,
mHealth facilitated a strong teamwork among staff.
Ward Nurses, doctors and the patient flow team worked hand in hand to address challenges that arouse during the study
Compilation of weekly and monthly reports to the wards and nursing director to show progress and challenges of work

22. Free calls to admitting wards in KATH
STRENGHTS
Development of user friendly mobile phone app for simple data entry to improve patient flow and reduce stress of nurses in the hospital
Improved communication between the ED and admitting wards, encouraging patient flow in the ED.
Nurses on the admitting wards would communicate better with bed managers
Free calls to admitting wards in KATH
Two desk phones (ED Triage and KATH Polyclinic) aided nurses and doctors to communicate better with referral hospitals

23. Improved bed management with the use of mHealth app
STRENGHTS
Improved bed management with the use of mHealth app
Readiness of Bed managers to support and encourage nurses on the ward to send bed states
Bed managers willingly reported any problems with the phones on the wards to the patient flow project team for rectification

24. Success in the request of funds from management early in the month
STRENGHTS
Monitoring on a day to day bases by the patient flow team helped the team to touch base with reality.
Success in the request of funds from management early in the month
to ensure phones were recharged with credits to avoid a break in connection

25. Better supervision by some ward in charges.
STRENGHTS
User friendly mobile phone devices selected by the team were well embraced by the ward nurses
Better supervision by some ward in charges.
Some wards worth mentioning would be D2c, D2B and D4ICU. Ward in charges monitored keenly when, who and how bed states are sent two hourly 9 times everyday.

26. NETWORK: GOOD INTERENT BUDLES AND FREE CALL ACROSS ALL THE PHONES ON THE WARD

27. weaknesses
There was apathy among some ward nurses because they perceived this technology as extra responsibility
Attitudinal Change
The data from the phones were not entered at the specified times; every ward were to send at least 9 bed states daily.
But this was not usually the case as some wards sent as low of 1 per day. Sometimes the phones are even off the entire day due to a low battery.

28. weaknesses
And sometimes took the patient flow team to ensure mobile phones are charged and bed state data is sent by ward nurses almost daily.
Some of these wards were marked for sending less bed state data during the study period
Misuse of Data by ward nurses
Some of the wards misuse the data on the phones and they run out of data before the month ends and increases the cost of running the project.

30. weaknesses
Durability of the mobile phones were not in question until almost at the end of the study some of the wards reported faulty chargers, fast running of the batteries of the mobile phones.
Credibility of bed state data sent in by ward nurses.
Occasional staff shortages during the time project was implemented and staff overwhelmed with sending of bed state data and calls

32. opportunities Consistent hospital administrative support
The patient flow team received immense support from the hospital administration
Nursing director visited wards from time to time to monitor and have meetings with ward nurses and also address any outstanding concerns
Sponsorships from other organizations to run this project on a larger scale

33. Occasional Poor Network connectivity
threats
Phone Thefts
We had four incidences of missing phones on wards B1, C2A,C2B and D4icu.
Ward B1 replaced their phone but was not comfortable using the new phone again with the fear of the phone getting lost a second time so no bed states are sent from ward B1.
Occasional Poor Network connectivity
Delay of funds from hospital management

34. WAY FORWARD
To keep the mobile phones safe on the wards, ward in charges could monitor the mobile phone device and charger
there should be a book to notify who the phone has been handed over to just as they do with other valuables on the wards.
and keep phone safe from water, food and visitors to avoid destruction and theft.

35. WAY FORWARD Sensitize nurses on the importance of mHealth.
The integration of mHealth in the emergency department at a low cost will give real-time monitoring of patient flow could help improve quality care and reduce stress of healthcare workers.
Moreover, monthly phone credit could be provided by hospital management for ward nurses to send bed state data with their own mobile phones
This would make them feel they own and are part of the process the project seeks to set out.

37. CONCLUSION
The mHealth reechoes the importance of an institutionalized and functioning Electronic Medical Records (EMR) in KATH
……….but it will be important to consider a behavioral model that will encourage acceptance and compliance among staff of KATH.
An mHealth project is bound to fail if we do not consider the human behavioral factors of the healthcare workers

38. CONCLUSION
Given the complex nature of modern health care systems, the ability to use this type of technique can enable health professionals to participate more fully in the use and implementation of mHealth to reduce overcrowding in KATH ED.
Without a behavioral model that embraces the concerns (SWOT) of healthcare workers on the use of mHealth tools, it would be impossible to evolve as a society to provide quality healthcare delivery in KATH and Ghana at large.

39. Contributing Authors Dr. George Oduro Dr. Paa Kobina Forson
Dr. Joseph Bonney

40. REFERANCES
who2011The Boston Consulting Group, 2012https:// introduction-mobile-technology-health
2. G.J. Hay a, *, G. Castilla, Object-based Image Analysis: Strengths, Weaknesses, Opportunities And Threats (Swot), a Foothills Facility for Remote Sensing and GIScience, Department of Geography, University of Calgary, Earth Sciences 454, 2500 University Dr. N.W. Calgary, AB, Canada, T2N 1N4 - (gjhay,
Ashish K. Jha, M.D., M.P.H., Catherine M. DesRoches, Dr.Ph., Eric G. Campbell, Ph.D., Karen Donelan, Sc.D., Sowmya R. Rao, Ph.D., Timothy G. Ferris, M.D., M.P.H., (2009). Use of Electronic Health Records in U.S. Hospitals New England Journal of Medicine; 360: April 16, 2009DOI: /NEJMsa
Forson PK (2011). An audit of emergency care at the Accident and Emergency Unit of KATH, Kumasi, Ghana. Masters Thesis Community Health Department, KNUST, Kumasi. (Unpublished)