Identification of systemic barriers, facilitators and adaptations to effective record-keeping: a South African primary healthcare clinic case study

Inadequate patient record completion and storage present challenges to patient safety. Understanding record-keeping tasks and how they are impacted by both barriers and facilitators through Human Factors and Ergonomics (HFE) tools is crucial to improving record-keeping systems. This study applied HFE tools to characterise the tasks associated with the record-keeping system in a primary healthcare clinic in South Africa and to understand the barriers and facilitators influencing this process. Through semi-structured interviews, observations and informal discussions with clinic staff, nine tasks were identified using a Hierarchical Task Analysis. Selected Systems Engineering Initiative for Patient Safety (SEIPS) 101 tools revealed a range of systemic barriers, facilitators and adaptations impacting the record-keeping process. The results emphasise the importance of understanding the tasks being performed, offering an opportunity to reflect on how to overcome identified barriers, while leveraging facilitators and adaptations to improve the record-keeping systems and, ultimately, the care being provided.Practitioner Summary The paper maps record-keeping systems and processes in a South African primary healthcare clinic, using Hierarchical Task Analysis and SEIPS 101 to reveal barriers, facilitators, and adaptations. It highlights the need to understand challenges while leveraging facilitators and adaptations to improve patient safety and care in Global South healthcare settings.