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Feb 18
Cleaning up: Strengthening the filing system at Phoenix Community Health Centre in eThekwini

By: Judith King  (Copy and Content Editor: SA SURE )

Tidying the contents of a filing room might not strike one as being a task that could enhance patients' experience of service delivery and health outcomes − but the work done by HST's SA SURE team at Phoenix ​Community Health Centre​​ (CHC) in eThekwini proves otherwise.

Prior to October 2020, Phoenix CHC faced the challenge of a disorganised filing system, with congested shelves, torn folders, and high numbers of missing files that resulted in the creation of duplicates.

To support technical analysis of the problem, Health Systems Trust's (HST's) Sr Noluvuyo Sibisi (Facility Team Lead) conducted a file retrieval efficiency assessment using a CDC scorecard. For this test, 20 patients' names were identified from an appointment list generated by Data Capturers. Two Filing Clerks were each given 10 patient names whose files were to be retrieved, each within five minutes. Any file that was not found within this time failed the assessment, and the percentage of files found was calculated against the 20 names on the list. Because of the disarray in the filing room making retrieval difficult, the facility scored 40%.

This situation contributed not only to poor data availability, quality and management, but also to longer queues and waiting times for patients, and a negative effect on their continuum of clinical care through delays in service delivery.

With the supportive engagement of Mr BT Zwane (the facility's Assistant Director of Systems), the SA SURE team − led by Sr Sibisi, Area Co-ordinator Philani Bhengu, and Area M&E Co-ordinator Bonginkosi Ndlovu − devised an intervention plan to strengthen the CHC's filing system. ​

From left: Mr BT Zwane (DoH); Mr B Ndlovu (HST); Sr N Sibisi (HST) and Mr P Bhengu (HST).

This entailed the deployment of a Filing Clerk Team Lead and an Assistant Filing Clerk Team Lead with eight temporary Filing Clerks to rationalise and re-archive approximately 16 800 files – covering HIV/AIDS, STI and TB patients, as well as general patients.  

Sr Sibisi, Mr Bhengu and Mr Ndlovu designed a set of tools to monitor implementation of the intervention, comprising Daily Tally Sheets, a Daily Reporting Tool, a Missing Files Register, and a list of identified dormant and duplicate files.

From 28 December 2020 to 15 January 2021, each member of the Filing Clerk squad worked through the holiday season and on weekends to sort 150 files in sequence per day, and to: ​

  • identify dormant files and prepare them for archiving;
  • identify duplicate files and merge them with original files;
  • identify files without Unique Identifiers/Folder numbers and update them accordingly;
  • identify torn files and repair them or change the file covers;
  • identify and locate missing files; and
  • correct the misfiling of records, such as blood test results.​​​

The team's unwavering commitment ensured that each member sorted 200 files per day. By close-out of the intervention, they had sequenced a total of 82 938​ files, de-duplicated 2 461 files, repaired 11 859 files, and transformed the filing room into a haven of order. The CHC scored 90% in a post-intervention retrieval efficiency assessment.

HAST patient files before and after the intervention. 

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General patient files before and after the intervention.

Commenting on the revamped filing room, Mr Zwane noted that an accomplishment of this nature could not have been completed without the assistance of the HST team. "I am grateful for their wonderful work and continued guidance and support, as well as mentorship throughout the project."

In turn, Sr Sibisi paid tribute to Mr Zwane and the Filing Clerk team: "It always seems impossible until it is done with good team spirit. Consistent hard work ensured the success of the project. The Systems Manager was very supportive and provided the resources required to materialise the intervention."

Our partner's ownership of a project of this calibre is paramount to ensure sustainability of the gains," said Mr Bhengu. "Hopefully, this collaboration will also be cascaded to the lower levels where the actual work is done."  Mr Ndlovu agreed: "Continuous collaboration between the DoH and HST teams can envision a health fraternity that serves our community at its best. The filing project was a success because of the dedicated team and commitment they have shown."

Mr S Chuma, HST Filing Clerk Team Lead, noted that “with togetherness, everyone achieves more. We worked very hard as a team and managed to overcome all the challenges encountered.” 

"Team work is a vehicle for success," said HST Filing Clerk, Mr Nhlakanipho Parkies. We thank the HST and Phoenix CHC management for affording us as temporary staff an opportunity to work in this facility. We have learnt a lot. The experience and skills we gained from this project will help us to implement the same intervention in other facilities where we will provide support."​


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