UNIVERSITY OF GHANA THE ROLE OF RECORDS MANAGEMENT PRACTICES IN IMPROVING DECISION MAKING IN PUBLIC HOSPITALS: THE CASE OF ASHANTI BEKWAI MUNICIPAL HOSPITAL BY AMO JUSTICE (10305044) THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF MPHIL HEALTH SERVICES MANAGEMENT DEGREE JULY, 2016 University of Ghana http://ugspace.ug.edu.gh i DECLARATION I, Justice Amo hereby declare that except for references to other people’s work, which have been duly acknowledged, this thesis titled “The Role of Records Management Practices in Improving Decision Making in Public Hospitals: The Case of Ashanti Bekwai Municipal Hospital” is the product of my own research work in University of Ghana Business School, University of Ghana, Legon, from August 2015 to July 2016. This thesis has neither in part nor in whole been published nor submitted elsewhere for another degree. .………………….. ……………………... Amo Justice Date (10305044) University of Ghana http://ugspace.ug.edu.gh ii CERTIFICATION I hereby certify that this Thesis was supervised in accordance with procedures laid down by the University. ……………………. ………………………. Dr. Gordon Abekah-Nkrumah Date (Supervisor) University of Ghana http://ugspace.ug.edu.gh iii DEDICATION This work is dedicated to my parents, Nana Kwabena Amo and Grace Twum, who knew very well the difference between consumption and savings and sacrificed their previous consumption for my education which they know to be an investment. Also, to my sisters, Rita Amo, Ophelia Amo and Juliet Amo who showed unflinching support during the entire period of the research. Finally, I dedicate this work to my wife, Jackline Ofori and uncle, Charles K. Opoku for their best wishes and encouragements. University of Ghana http://ugspace.ug.edu.gh iv ACKNOWLEDGEMENTS To God be the glory, great things He has done and greater things He will do. I am indebted to my supervisor, Dr. Gordon Abekah-Nkrumah, whose honest criticism, guidance and request for diligence ensured that this work was successfully done. For financial support, I express my profound gratitude to my parents, Nana Kwabena Amo and Grace Twum, my uncle, Charles K. Opoku and my wife, Jackline Ofori. Special appreciation also goes to the management and staff of Ashanti Bekwai Municipal Hospital and the head of records unit for providing me with information that constituted both primary and secondary data. Finally, I thank my wife, Jackline Ofori who doubled as a field assistant during the data collection stage. University of Ghana http://ugspace.ug.edu.gh v TABLE OF CONTENTS DECLARATION …………………………………..……………………………………………...i CERTIFICATION ………………………………………………………………………………..ii DEDICATION …………………………………………………….……………………………..iii ACKNOWLEDGEMENTS …………………..……………………………………………….…iv TABLE OF CONTENTS ………………………..………………………………………….…….v LIST OF TABLES ………………………………...…………………………………………….xv LIST OF FIGURES ……………………………………...…………………………………….xvii LIST OF ABBREVIATIONS ……………………………………..……………………...….…xix ABSTRACT ………………………………………………………………………………....... xxi CHAPTER ONE: INTRODUCTION 1.0 Introduction ………………………………………………………………………………...1 1.1 Background of the Study …………………………………………..……………………….1 1.2 Problem Statement …………………………………………………………………………4 1.3 Research Objectives ……………………………………………………………………..…7 1.4 Research Questions …………………………………………………………………..….…8 1.5 Significance of the Study …...………………………………………………………...........9 1.6 Organization of the Study…..……………………………………………………………..10 University of Ghana http://ugspace.ug.edu.gh vi 1.7 Summary ...…………...……...……………………………………………………………11 1.8 Definition of key terms ...…….……………..…………………………………………….13 CHAPTER TWO: LITERATURE REVIEW 2.0 Introduction …………………………….…………………………………………………14 2.1 Review of Theoretical Literature ....………………………………………………………14 2.2 Hybrid Records Life Cycle Model ...….….…………..……………………….…………..15 2.2.1 Pre-Natal Phase ...……………….………………...………………….……………….18 2.2.2 Active Phase ...……………….………………………………………..……………....18 2.2.3 Semi-Active Phase …...………….…………..……………………………………..…19 2.2.4 Non-Active Phase …....………...………………………..............................................19 2.3 Linking the Hybrid Records Life Cycle Model to the Study ...…………….......................20 2.4 Records and Records Management ...……………………………………………………..21 2.5 Decision Making…….…………………...……………………….……………………….23 2.5.1 Decision Accuracy …...……………………………………………………………….26 2.5.2 Decision Timeliness …...……………………………………………………………...26 2.5.3 Decision Commitment …...…………………………………………………………...26 2.5.4 Decision Understanding …...………………………………………………………….27 2.6 Records Management and Decision Making ...….………………………………………..27 University of Ghana http://ugspace.ug.edu.gh vii 2.7 Conceptual Framework for the Study …...………....……………………………………..30 2.8 Review of Empirical Literature …………………………………...……………………...31 2.8.1 Pre-Natal Phase …..……………………………………….…………………….…….32 2.8.1.1 Participation in System Design ……...…………………………………….……32 2.8.2 Active Phase …..……………………….………………………………………….…..33 2.8.2.1 Records Creation and Capturing …………………...…...………………...…….33 2.8.2.2 Use and Maintenance …………………...……………………...……………….35 2.8.3 Semi-Active Phase ……………...…………………………………………………….36 2.8.3.1 Use and Storage …………………………......…………………………….……36 2.8.4 Non-Active Phase ……………………………...……………………………………..38 2.8.4.1 Disposal and Destruction ……...….…………………...…………………….….38 2.8.4.2 Archival and Preservation ………………………………………………...…….39 2.8.5 Good Practices …………………………………...……………………………...……41 2.8.5.1 Security and Access Controls ………………………...……………..……….…41 2.8.5.2 Disaster Management Plan ………………………...…………………………...42 2.8.5.3 Staff Capacity Building……………………...…………………………………..43 2.8.6 Compliances ………………………………………………...………………………...45 University of Ghana http://ugspace.ug.edu.gh viii 2.8.6.1 Legal and Regulatory Framework …………………………………...…………45 2.8.6.2 Policies and Standards ………………………………...……….……………….46 2.8.7 Decision Making …………………………………...…………………………………47 2.8.7.1 Decision Accuracy ………...……………………………………………………47 2.8.7.2 Decision Timeliness ………...…………………………………...…….………..48 2.8.7.3 Decision Commitment ………...……………………………...…………...……49 2.8.7.4 Decision Understanding ….….………………………………………...…….….50 2.9 Implications of the Reviewed Studies ………….…..……………………………………...51 2.10 Summary ……...…………………………………...…….………………………….........53 CHAPTER THREE: METHODOLOGY 3.0 Introduction………………………………………………….……………………….…….54 3.1 Profile of Study Area …………………………………………………………...................54 3.1.1 Vision of the Hospital ………………………………………………………………....55 3.1.2 Mission Statement of the Hospital ………………………………………………….....56 3.1.3 Core Values of the Hospital …………………………………………………………...56 3.1.4 Morbidity Trend ………………………………………………………………….……56 3.2 Research Approach ………………………………………………………………………..57 University of Ghana http://ugspace.ug.edu.gh ix 3.3 Research Design …………………………………………………………………..…….…58 3.4 Target Population ……………………………………………………………………….…59 3.5 Sampling Technique ………………………………………………………………………60 3.6 Determination of Sample Size …………………………………………………………….62 3.7 Types and Sources of Data ………………………………………………………………..63 3.8 Data Collection Instruments ………………………………………………………………64 3.8.1 Questionnaire …………………………………………………………………….……64 3.8.2 Interview Guide …...………………………………………………………………..…64 3.8.3 Observation .………………………..…………………………………………….……65 3.9 Data Collection Procedure ……………………….……………………………..…………66 3.10 Pre-testing ………………………………………………………………………………..67 3.11 Reliability and Validity …………………………………………………………………..68 3.12 Data Management and Analyzes…………………………………………………………68 3.13 Ethical Consideration ……………………………………………….……………………69 3.14 Summary ……...………………………………………………….……..………………..70 CHAPTER FOUR: PRESENTATION OF FINDINGS 4.0 Introduction …………………………………………………………………………….….71 4.1 Questionnaire Response Rate ……………………………………………………………..71 University of Ghana http://ugspace.ug.edu.gh x 4.2 Demographic Characteristics of Respondents ……………………………………….……72 4.2.1 Age, Gender and Educational Level …………………………………………………..72 4.2.2 Unit, Length of Work and Rank in Hospital …………………………………………..73 4.3 Awareness and Knowledge of Records Management …………………………………….74 4.3.1 Understanding of Manual Records, Electronic Record and Records Management …...74 4.3.2 Is Records Management Your Responsibility? ………………………………………..75 4.3.3 Roles in Records Management ………………………………………………………..76 4.4 Records Creation and Capturing …………………………………………………………..77 4.4.1 Records Creation ………………………………………………………………………77 4.4.2 Accurate Capturing and Retrieval ……………………………………………………..78 4.4.3 Security and Access Controls …………………………………………………………79 4.4.4 Filing System ………………………………………………………………………….79 4.5 Records Use and Maintenance …………………………………………………………….80 4.5.1 Daily Records Keeping ………………………………………………………………..80 4.5.2 Records Keeping Formats ……………………………………………………………..81 4.5.3 Retrieval Methods, Timeliness and Challenges ……………………………………….81 4.5.4 The State of Records Management …………………….……………………………...83 University of Ghana http://ugspace.ug.edu.gh xi 4.5.5 Justifications for the State of Records Management ………………………………..…83 4.6 Disposal and Destruction ………………………………………………………………….84 4.6.1 Records Disposal, Guidelines and Sanctions …………………………….……………84 4.7 Storage, Archival and Preservation ………………………………………………………..85 4.7.1 Storage Capacity ………………………………………………………………………85 4.7.2 Records Storage Security and Archival ……………………………………………….86 4.8 Legal and Regulatory Framework ………………………………………………………...88 4.8.1 Awareness of Legislations …………………………………………………………….88 4.8.2 Guidelines and Sanctions ……………………………………………………………...88 4.8.3 Punitive Measures ……………………………………………………………………..89 4.9 Records Management Programme and Practices ……………..…………...………………89 4.9.1 Existence and Awareness of Records Management Programme ……………………...90 4.9.2 Medium of Records Management Programme ………………………………………..90 4.9.3 Records Management Programme Consistent with Practices ………….……………..91 4.10 Staff Capacity Building …………………………………………………….…………….92 4.10.1 Staff Capacity Building and Training Programmes …………………….……………92 4.11 Security and Access Controls ……………………………………………………………93 University of Ghana http://ugspace.ug.edu.gh xii 4.11.1 Security Mechanisms ………………………………………………………………...93 4.11.2 Access to Records ……………………………………………………………………94 4.12 Disaster Management Plan ………………………………………………………………95 4.12.1 Existence of Disaster Management Plan ……………………………………………..95 4.12.2 Disaster Management Equipment and Backup Plan ……………………..…………..96 4.13 Challenges and Recommendations ……………………………..………………………..97 4.13.1 Challenges and Recommendations ………………………………..…………………97 4.14 Records Management and Decision Making ………………..…………….……………..98 4.14.1 Decision Commitment ………………………………………………………..……...98 4.14.2 Decision Accuracy ………………………………..………………………………...100 4.14.3.1 Understanding of Records Created ……………………..…………………………101 4.14.3.2 Decision Understanding ………………………………………..…………………101 4.14.4 Decision Timeliness ……………………………………………………..………….102 4.15 Challenges in Making Decisions from Records …………………………………...……104 4.16 Bio Data of Head of Records Unit and Records Unit …………………………..………104 4.17 Records Management Practices, Policies and Standards …………………………….....105 4.18 Involvement of Records Unit and Management in System Design ………….…………106 4.19 Challenges and Recommendations ………………………………………………..……107 University of Ghana http://ugspace.ug.edu.gh xiii 4.20 Summary …………………………………………………………………………….….107 CHAPTER FIVE: DISCUSSION OF FINDINGS 5.0 Introduction ……………………………..………………………………………….……108 5.1 Records Management Practices, Programmes, Policies and Standards ………...…….…108 5.2 Awareness, Knowledge and Skills of Staffs on Records Management ……..……..........110 5.3 Records Officers involvement in Records Management Systems …………..……..……111 5.4 Records Management and Decision Making …………..………..…………..…………..112 5.5 Challenges in Managing Records and Making Decisions ……...……………..……...…115 5.6 Summary ...……….……………………….…………………………………..…………115 CHAPTER SIX: SUMMARY, CONCLUSION AND RECOMMENDATIONS 6.0 Introduction ………………………………………………………………………………117 6.1 Summary of Findings ……………………………...……………………………………..117 6.1.1 Records Management Practices, Programmes, Policies and Standards …..………….118 6.1.2 Awareness, Knowledge and Skills of Staff on Records Management ……………….120 6.1.3 Records Officers involvement in Records Management Systems ……………….…..121 6.1.4 Records Management and Decision Making ………………..……………………….121 6.1.5 Challenges in Managing Records and Making Decisions ……….…………………..122 University of Ghana http://ugspace.ug.edu.gh xiv 6.2 Contributions of the Study …………………………………………………………….....122 6.2.1 Implications for Theory ……………………………………..……………………….122 6.2.2 Implications for Policy ……...……………………………………..…………………123 6.2.3 Implications for Research ………………………………………………..…………..124 6.3 Recommendations ………………………………………………………………….….…125 6.4 Suggestions for future Research ………………………………………………………....126 6.5 Limitations of the Study ……………….………………………………………...……….127 6.6 Conclusion ……………………………………………………………………………….128 REFERENCES …………………………………………………………...……………………130 APPENDIX QUESTIONNAIRE …………………………..……………………………………………....149 INTERVIEW GUIDE ………………………………………...………………………..……..157 LETTER OF INTRODUCTION ……………………………………...…………………...…158 University of Ghana http://ugspace.ug.edu.gh xv LIST OF TABLES Table 3.1 2015 Top Ten (10) Out Patient Department (0PD) Cases ………..…..….……..…..57 Table 3.2 Target Population and Sample Size ………………………………….…..…………61 Table 4.1 Gender and Educational Level ………………………………………………….......72 Table 4.2 Unit, Length of Work and Rank in Hospital ………………….…………………….73 Table 4.3 Understanding of Manual, Electronic Records and Records Management …………75 Table 4.4 Roles in Records Management …………………………………………..……….…76 Table 4.5 Records Creation ………………………………………………………………….…77 Table 4.6 Filing System ………………………………………...………………………………79 Table 4.7 Retrieval Methods, Timeliness and Challenges …………..….………………………82 Table 4.8 Justifications for the State of Records Management …………………………………84 Table 4.9 Records Disposal, Guidelines and Sanctions …………………………………………85 Table 4.10 Storage Capacity …………….…………………………………………..………......86 Table 4.11 Records Storage Security and Archival …………………………………………..…87 Table 4.12 Awareness of Legislations …………………………………………………………..88 Table 4.13 Existence and Awareness of Records Management Programme …………………....90 Table 4.14 Records Management Consistent with Practices ……………………………………92 Table 4.15 Staff Capacity Building and Training Programmes ………...…….…………………93 University of Ghana http://ugspace.ug.edu.gh xvi Table 4.16 Security Mechanisms ……………………………………………..………..………..94 Table 4.17 Existence of Disaster Management Plan ……………………………..………….….95 Table 4.18 Disaster Management Equipment and Backup Plan ………….…………...………...96 Table 4.19 Challenges and Recommendations ……………………………………………..…...98 Table 4.20 Decision Commitment ……………………………………….…..……………....….99 Table 4.21 Decision Accuracy …………………………………………………..……………..100 Table 4.22 Decision Timeliness ……………………………………………………………..…103 University of Ghana http://ugspace.ug.edu.gh xvii LIST OF FIGURES Figure 2.1 Conceptual Framework showing Hybrid Records Life Cycle Model ………...........17 Figure 2.2 Conceptual Framework depicting Decision Making variables …………….….…....25 Figure 2.3 Conceptual Framework depicting Records Management Leading to Decision Making ………………………………………….………….....31 Figure 4.1 Is Records Management Your Responsibility? ………………………….………......76 Figure 4.2 Accurate Capturing and Retrieval …………………………………………….……..78 Figure 4.3 Security and Access Controls ……….………………….……………………………79 Figure 4.4 Daily Records Keeping ……………………………………..……………………..…80 Figure 4.5 Records Keeping Formats ………………………………………………………...…81 Figure 4.6 The State of Records Management ……………………………………….…………83 Figure 4.7 Guidelines and Sanctions ………………………………………………..………..…89 Figure 4.8 Punitive Measures ………………………………………………………..……….…89 Figure 4.9 Medium of Records Management Programme ………………………………………91 Figure 4.10 Access to Records …………………………………………………………………..95 Figure 4.11 Understanding of Records Created …………………………………………..……101 Figure 4.12 Decision Understanding ………………………………………………………..….102 University of Ghana http://ugspace.ug.edu.gh xviii Figure 4.13 Challenges in Making Decisions from Records ………………………………..…104 University of Ghana http://ugspace.ug.edu.gh xix LIST OF ABBREVIATIONS ANC – Anti Natal Care ART – Anti Retroviral Therapy CCTV – Closed Circuit Television CESPAM – Centre of Specialization in Public Administration and Management DHIMS – District Health Information Management Systems ENT – Ear Nose and Throat ERMS – Electronic Records Management System ESARBICA – Eastern and Southern Africa Regional Branch of the International Council on Archives GHS – Ghana Health Service HIO – Health Information Officer IRMT – International Records Management Trust ISO – International Standards Organizations IT – Information Technology ITS – Information Technology System MDA – Ministries, Departments and Agencies MMDA – Metropolitan, Municipal and District Assemblies University of Ghana http://ugspace.ug.edu.gh xx MoH – Ministry of Health NHIA – National Health Insurance Authority NHIS – National Health Insurance Scheme OPD – Out-Patient Department PNC – Pre Natal Care PRISM – Professional Records and Information Services Management RCH – Reproductive and Child Health SSA – Sub-Saharan Africa URTI – Upper Respiratory Tract Infection University of Ghana http://ugspace.ug.edu.gh xxi ABSTRACT The role of healthcare institutions in providing quality health care and making decisions strive on the effective management of hospital records which are made up of clinical/medical and non- clinical records. The study therefore sought to inquire into the role of records management practices in improving clinical and administrative decisions at Ashanti Bekwai Municipal Hospital. In view of that, the study used the Hybrid Records Life Cycle Model which encompassed the pre-natal phase of the Records Continuum Model and the conceptual stages of the Records Life Cycle Model as its underpinning model for the study. The model extended to decision making variables such as decision accuracy, decision commitment, decision timeliness and decision understanding. The study employed a mixed method approach where an exploratory survey was used. A cluster sampling technique was used to classify the whole hospital into 16 units (clusters). The researcher purposively selected 160 health workers and a records manager to participate in the study. A semi-structured questionnaire, interview guide and direct observation were employed to elicit information from 160 health workers and the records manager. The findings show that the hospital has a records management programme, a disaster management plan, security and access control measures and an electronic records management system to manage patients’ records and to keep reports on morbidity and mortality. However, the hospital does not organize training programmes on records management to its staff. The study further reveals that records officers are always engaged in the design of records management systems of the hospital. Furthermore, the kind of records management system at the hospital improves decision timeliness, decision accuracy and decision commitment. Unfortunately, the hospital is plagued by challenges such as inadequate storage location (filing space), misfiling, missing files, damaged records, poor staff knowledge, lack of records management training programmes and inadequate hardware. In that University of Ghana http://ugspace.ug.edu.gh xxii regards, the study recommends that healthcare facilities should train and educate their employees in the management of records. Also, healthcare facilities should adopt an integrated electronic records management system (automation) as a solution to minimize records keeping challenges caused by paper records keeping. Key words: Records, Records Management, Decision Making, Records Life Cycle Model, Records Continuum Model and Hybrid Records Life Cycle Model. University of Ghana http://ugspace.ug.edu.gh 1 CHAPTER ONE INTRODUCTION 1.0 Introduction The purpose of this study is to discuss the importance and problems arising out of effective and ineffective records management practices in organizations and how records management practices affect clinical and administrative decisions in organizations. Specifically, this study focuses on records management in health institutions and uses Ashanti Bekwai Municipal Hospital as a case to examine the role of effective records management practices in improving clinical and administrative decisions. In this chapter, we discuss the background of the study, problem statement, research objectives and questions, significance of the study and definition of key terms. Lastly, the outline of the study is discussed. 1.1 Background of the Study Like most organizations, health institutions on daily basis create, receive and maintain records on patients, human resource, assets, finances, drug and non-drug consumables, making hospital records a critical factor in providing capacity for hospitals that strive to achieve information security, service delivery and decision making (Mensah & Adams, 2014). Hospital records can also be obtained from patient folders and registers, consultation notes, hospital admission notes, hospital discharge records, diagnosis, prescriptions, X-ray and laboratory test results. Hospital records are used to validate statistical reports, medical reviews and research and address medico- legal issues among others. In the end, the reports and statistics are used to make clinical and University of Ghana http://ugspace.ug.edu.gh 2 administrative decisions to improve service delivery in hospitals (Nabimara, 2007). Moreover, comprehensive and detailed records kept by healthcare institutions ensure that health practitioners have access both to administrative and clinical information on a wide range of issues; including policies and decisions, legal and financial obligations, human resource, physical resource, capital resource and quality services to patients (International Records Management Trust [IRMT], 1999a; Kemoni, Ngulube & Stilwell, 2007). Effective management of hospital records controls the rate at which accumulated papers gain momentum in health institutions. This is as a result of large volume of records that have been created and piled up in different offices and shelves without any organized plan for their preservation and maintenance, thereby making it difficult to locate and retrieve the needed information (Iwhiwhu, 2005). An efficient management of hospital records also expedite decision making, inform future decisions, increase accountability of decision makers, produce evidence in medico-legal issues, support perpetuity of the facility and improve service delivery (Akor & Udensi, 2013; Mampe & Kalusopa, 2012). Consequently, the kinds of records kept by health institutions represent the only reliable and verifiable source of information that serves as evidence for decisions and service delivery (Wamukoya, 2000). Efficient records keeping practices in public hospitals are likely to eliminate the problem of missing files, misfiling, shortage of physical filing space, lengthy turnaround time in retrieving files and lengthy patient waiting time (Ojo, 2009). Ohsfeldt, Ward, Schneider, Jaana, Miller and Lei (2005), Shekelle, Morton and Keeler (2006) and Thompson and Brailer (2004) concur that accurate and comprehensive hospital records leads to quality patient care, increase in efficiency of care, reduce medical errors, improve access to patient data, confidentiality of patients and quality decision making. This is due to the fact that without hospital records, no assessment can be made University of Ghana http://ugspace.ug.edu.gh 3 of whether hospitals have actually provided health cares to individuals or not (Thomassen, 2001). The significance of records to healthcare facilities made Rampfumedzi (2006), a midwife to recommend that decisions about women’s care need to be recorded and properly preserved for future reference and assessment. This is because poor records keeping affect the health of a woman especially during pregnancy, delivery and child care. Globally, organizations spend an average of 4 weeks a year searching for or waiting on misfiled, mislabeled and lost information. Many organizations typically misfile 2% to 7% of their paper and electronic records. Specifically, paper records users waste up to 2 hours a day looking for misplaced documents whiles electronic records users spend 7.5% of their time on electronic systems looking for files (Professional Records and Information Services Management [PRISM] International, 2004). This situation occurs because at any given time, between 3 and 5 percent of organizations’ files are lost or misplaced. Moreover, 90% of records, once filed, are hardly or never referred to again or immediately (PRISM International, 2004). Studies into records keeping systems in Sub-Saharan Africa (SSA) have also shown that a little over half (52.2%) of records are retrieved within 1 hour (Aziz & Rao, 2002). The haphazard arrangement and poor recovery of records in health institutions informed the United States Department of Health and Human Services (2006) to report that in most cases, 80% of the problems that affect health institutions in the delivery of quality health care to individuals are caused by inaccurate information in medical records, inaccessible records, missing files, misfiling and damaged records. The organization further indicates that in healthcare institutions, the ratio for missing medical records is 1:7. This means that for every seven patient’s visits, consultations and reviews at a healthcare facility, one medical file would be missing. There is more to this as a report by Chauke (2008, p. 7) revealed that the “Doctors at Nkhesani Hospital in the Limpopo University of Ghana http://ugspace.ug.edu.gh 4 Province, South Africa, could not operate on a patient because of a missing file”. This situation occurred in South Africa because without accurate, detailed and accessible patient history, healthcare providers may not offer the best of medical care or may misdiagnose a condition (IRMT, 1999a). The emergence and growing importance of an effective records management system as a means of preserving hospital’s information poses new challenges to records professionals and unless the challenges are addressed adequately, health institutions stand to lose valuable information (Mnjama & Wamukoya, 2007). Other challenges that affect the adoption of effective records management systems in Sub-Saharan Africa include limited staff knowledge, low priority of records keeping, lack of clear policies and records management programmes and inadequate standard operating procedures for managing records (Nengomasha, 2009; Sejane, 2005; Tafor, 2006; Wamukoya & Mutula, 2005b). Notwithstanding, for developing countries like Ghana to have effective records management systems, there is the need to strike a balance between conflicting goals, healthcare quality, readiness and willingness of healthcare providers in terms of their skill and knowledge and its related challenges (Walker, Bieber & Richards, 2005). 1.2 Problem Statement Records keeping problems are more pronounced in healthcare institutions because accurate, comprehensive and trustworthy records that provide information about individuals’ health and well-being are often created but are not properly managed. This is due to the haphazard arrangement and poor recovery of records in healthcare facilities which has a detrimental effect on University of Ghana http://ugspace.ug.edu.gh 5 service delivery and decision making (IRMT, 1999a). Although effective records management systems are crucial for quality decisions and service delivery (Dikopoulou & Mihiotis, 2012; Lorato & Mnjama, 2007), some healthcare institutions in Ghana do not recognize an effective records management system as a key mechanism for attaining their desired goals (Acheampong, 2012; Tanko, 2009). In the absence of a well-functioning records management system, decisions are made without detailed information (Ngoepe, 2004; Thurston, 2005; Wamukoya & Mutula, 2005b). Moreover, documents are likely to be disorganized, lost, destroyed or tampered with which ultimately results in poor planning and defective scheduling of activities (Pfeffer & Sutton, 2006). In the end, management is handicapped in its decision making processes and organizations are unable to fulfill their statutory obligations (Iwhiwhu, 2005; Mjnama, 2004). Studies have shown that records management in healthcare institutions in Sub-Sahara Africa is yet to attain the level of attention and support as compared to what is found in the developed world (Mnjama & Wamukoya, 2007; Ngoepe, 2004). Particularly in Sub-Saharan Africa, the act of keeping records has often been perceived as a less significant administrative task that can be handled by any member of staff within health institutions (Tale & Alefaio, 2011). These challenges are predominant in developing countries. For example, surveys conducted in Nigeria revealed that records keeping in health institutions in Nigeria had been plagued by factors such as poor staff skills, incompetent records personnel and low prioritization of records management in relation to other functions (Afolabi, 2004; Egwuyenga, 2009). Similarly, the findings from Tanko’s (2009) study into Ghanaian healthcare facilities revealed that there were problems of poor staff knowledge and incompetent records professionals which made the practice of an effective records management system a major challenge. University of Ghana http://ugspace.ug.edu.gh 6 The repercussions of poorly managed records in healthcare facilities made Stanberry (2011) to suggest that in order to minimize a variety of medico-legal issues and improve administrative functions, hospital records must be properly created, maintained, and the confidential information in them secured against unauthorized access and disclosure. In a situation where the organization does not value the benefits of sound record keeping practices, the ramifications are poor healthcare delivery, long patient waiting time, poor decisions and weak corporate memory. In the end, healthcare providers end up not rendering certain services because the patient’s history is not contained or captured in medical files (Hitler, 2013; Marutha, 2011). For instance, a survey by Marutha (2011) in South Africa revealed that healthcare providers in public healthcare institutions are usually not able or are struggling to render timely health care to individuals due to lack of effective records management systems. Widespread studies into records management have been at the national and organizational levels with little emphasis on the knowledge and competence of employees in public hospitals (Makhura, 2005; Ngulube, 2003; Sejane, 2005). However, the knowledge and competence of healthcare providers and their contributions to the creation, use, maintenance and preservation of records cannot be underestimated if health care and decisions are to improve (Abioye, 2007; Adams, 2010; Egwuyenga, 2009; Mensah, 2011). This was evident in Mensah’s (2011) study in Ghana that for effective and efficient management of hospital records to exist; there is the need for healthcare institutions to have records officers that have the requisite competence to manage the records in their design, creation, preservation and disposition stages. Previous studies on records management have encompassed themes such as Corporate Governance (Dikopoulou and Mihiotis, 2012; Mensah and Adams, 2014), Service Delivery (Mampe and Kalusopa, 2012; Marutha, 2011), Risk Management (Erima and Wamukoya, 2012) and University of Ghana http://ugspace.ug.edu.gh 7 Organizational Performance (Tagbotor, Adzido and Agbanu, 2015) with limited attention to Decision Making. However, decision making is vital for every organization that strives to mitigate risk, achieve organizational performance and improve service delivery. Other studies carried out on records management have used either the Records Life Cycle Model (Makhura, 2005; Marutha, 2011) or the Records Continuum Model (Mensah and Adams, 2014) and sometimes both (Coetzer, 2012; Ngoepe, 2008) without considering the Hybrid Records Life Cycle Model. Nonetheless, the involvement of records officers in the design of records management systems cannot be overlooked if an effective records management system is to be designed and practiced successfully in health institutions (Chachage & Ngulube, 2006). It is against this background that this study examines the role of records management practices in improving decision making in Ashanti Bekwai Municipal hospital. 1.3 Research Objectives Based on the research problem, the main objective of the study is to find out the role of records management practices in improving decision making at Ashanti Bekwai Municipal hospital. The specific objectives are to: a. Examine the practices, policies and programmes put in place to manage records at Ashanti Bekwai Municipal Hospital. b. Assess the awareness, knowledge and skills of healthcare providers in managing records at Ashanti Bekwai Municipal Hospital. University of Ghana http://ugspace.ug.edu.gh 8 c. Ascertain the role of records officers in designing records management systems at Ashanti Bekwai Municipal Hospital. d. Examine the effect of proper records management on decision making at Ashanti Bekwai Municipal Hospital. e. Identify problems associated with managing records at Ashanti Bekwai Municipal Hospital. 1.4 Research Questions To achieve the objectives outlined above, the study seeks to answer the following questions: a. What are the practices, policies and programmes put in place to manage records at Ashanti Bekwai Municipal Hospital? b. Do employees of Ashanti Bekwai Municipal Hospital have the right level of competence, skills and knowledge to manage records appropriately? c. What are the roles of records officers in designing records management systems at Ashanti Bekwai Municipal Hospital? d. What effect does proper records management have on decision making at Ashanti Bekwai Municipal Hospital? e. What problems are associated with managing records at Ashanti Bekwai Municipal Hospital? University of Ghana http://ugspace.ug.edu.gh 9 1.5 Significance of the Study This study is important for government, policy makers, health institutions, records professionals and researchers. This is because the study provides insight into the role of records management practices in improving both clinical and administrative decision making in public hospitals. The findings from the study provides useful information to governments and policy makers for the formulation of records management legislations, regulations and policies both at the national and corporate levels to help ameliorate the challenges that health institutions encounter when creating and managing records throughout its life cycle. Moreover, this study provides an analysis of records management practices and decision making in Sub-Saharan Africa and demonstrates the shortcomings of current records keeping trends and practices in healthcare facilities. This assertion is dependent on Ngulube’s (2003) declaration that, research into records management practices can lead to a better understanding of records keeping problems, as well as providing guidelines in respect of what is to be done, and how resources should be utilized. This would motivate healthcare institutions to adopt and practice effective records management systems as a solution to improve healthcare delivery and achieve better clinical and administrative decisions. Finally, the findings would serve as a source of reference for future researchers who wish to conduct studies on records management. University of Ghana http://ugspace.ug.edu.gh 10 1.6 Organization of the Study The entire study is categorized into six (6) chapters with each chapter addressing specific issues of the study. Chapter one discusses the background of the study, problem statement, research objectives and questions, significance of the study and definition of key terms. In view of that, we discuss issues of records management practices and decision making in health institutions. Chapter two covers the necessary theoretical and empirical literatures on records management and decision making in public hospitals. The chapter further uses the Hybrid Records Life Cycle Model which encompasses the pre-natal phase of the Records Continuum Model and the conceptual stages of the Records Life Cycle as its underpinning model to inquire into the role of records management practices in improving decision making at Bekwai Municipal Hospital. The Hybrid Records Life Cycle Model functions effectively in organizations that deal with both paper and paperless records. Chapter three presents the methodology which outlines the processes and procedures used in obtaining data and literature for the entire study. The study employs a mixed method approach where an exploratory survey is adopted for the study. The location for the study is Ashanti Bekwai Municipal Hospital. A cluster sampling technique is used to select 16 units but the selection of respondents is purposively done base on the size of each unit to arrive at the sample size of 160. The study uses survey questionnaires, interview guide and direct observations to elicit information from the respondents. University of Ghana http://ugspace.ug.edu.gh 11 Chapter four presents the findings collected from the respondents to provide answers to the research objectives and the extant literature. The chapter further uses pie charts, bar graphs, tables, frequencies and percentages in the presentation of findings. Chapter five discusses the findings by situating it in the context of the research objectives and extant literature to ascertain if the findings confirm or contradict previous related studies and the extant literature. Chapter six provides a summary of key findings, implications of the study, conclusions and recommendations based on the findings, limitations and suggestions for future research. 1.7 Summary This chapter provided an overview of records management practices and decision making in organizations. In view of that, we discussed the importance and problems that arise out of effective and ineffective records keeping practices in organizations. The discussions revealed that the adoption of efficient records keeping practices in Sub-Saharan Africa would expedite decision making, produce evidence in medico-legal issues, reduce patient waiting time, reduce lengthy turnaround in retrieving files, support perpetuity of the organization and improve service delivery. On the other hand, the discussions showed that misfiling, missing files, poor staff knowledge and incompetent records professionals are the major records keeping problems that affect most organizations in Sub-Saharan Africa. The haphazard arrangement and poor recovery of records in Sub-Saharan Africa guided the researcher to investigate the role of records management practices in improving clinical and administrative decisions at Ashanti Bekwai Municipal Hospital. University of Ghana http://ugspace.ug.edu.gh 12 1.8 Definition of key terms Records: Records are defined as “information created, received, and maintained as evidence by an organization or person, in pursuance of legal obligations or in transaction of business” (International Standards Organization [ISO] 15489-1, 2001, p. 3). Electronic Records: Electronic Records refer to “records that are dependable on the relevant machines for access or reading that is computer hardware and software such as database” (Tafor, 2003, p. 72). Records Management: Records Management is the “field of management responsible for the efficient and systematic control of the creation, capture, receipt, maintenance, use and destruction or preservation of records, as well as maintaining evidence of information about business daily activities and transactions in the form of records” (ISO 15489-1, 2001, p. 3). Decision Making: Decision Making is “identifying and selecting a course of action among alternatives to solve a specific problem” (Vander Waldt, 2001, p. 193). Disaster Management Plan: Disaster Management Plan is a formal written plan, on the basis of identified potential accidents together with their consequences, describes how such accidents and their consequences should be handled either on site or off site (Ministry of Health [MoH] & Ghana Health Service [GHS], 2010). Records Creation and Capturing: Records Creation and Capturing is “developing consistent rules to ensure integrity and accessibility, deciding on systems to log and track records, and procedures for registering, classifying and indexing” (Yusof & Chell, 1999, p. 10). University of Ghana http://ugspace.ug.edu.gh 13 Records Retention: Records Retention is the length of time set for retaining records before disposal by the government body. Records retention is the records disposal (destruction or transfer to archive custody) time frame set by the organization (National Archives and Records Service of South Africa, 2006). Records Appraisal: Records Appraisal is a process whereby certain relevant criteria are used to evaluate records on whether their value or use can be considered permanent or temporary in nature (The United States National Archives and Records Administration, 2007). Records Disposal: Records Disposal is the process whereby the “organization, through its records manager destroys or erases ephemeral records or transfers archival valued records to an archival institution for permanent safe keeping” (Adelaide University Records and Archives Management, 2004, p. 30). Archival Records: Archival Records are records that are kept permanently because of its administrative, legal, fiscal, or research value (Norris, 2002, p. 13). University of Ghana http://ugspace.ug.edu.gh 14 CHAPTER TWO LITERATURE REVIEW 2.0 Introduction This chapter presents the relevant theoretical and empirical literature on the role of records management practices in improving decision making in public hospitals. The chapter is categorized into three (3) main sections. The first section introduces the Hybrid Records Life Cycle Model which incorporates the pre-natal phase of the Records Continuum Model and the conceptual stages of the Records Life Cycle Model in the management of both paper and paperless records in public hospitals. The second section looks at decision making and the various decision making dimensions such as decision accuracy, decision commitment, decision timeliness and decision understanding. Finally, the framework shows the nexus between records management practices and decision making where various empirical studies are reviewed. 2.1 Review of Theoretical Literature A good theoretical literature needs to produce a conceptual framework, including philosophical stances and theoretical assumptions; key assumptions and theoretical problems or contradictions (Mugenda & Mugenda, 2003). There is a tendency amongst organizations not to base their records management practices on existing theories or principles of records management (Ngulube, 2003). However, in records management, the rules that guide the investigation of researchers into issues, problems or concepts are determined by records management theories and methods. Cox (2001) therefore argues that records management has revolved around a specific body of knowledge and University of Ghana http://ugspace.ug.edu.gh 15 is strongly supported by its own theory. This development informs this study to adopt the Hybrid Records Life Cycle Model proposed by Chachage and Ngulube (2006) for records management which functions in both paper and electronic environments. 2.2 Hybrid/Modified Records Life Cycle Model The evolvement of records management models from the Records Life Cycle Model to the Records Continuum Model has recently led to the development of the Hybrid Records Life Cycle Model. The Hybrid Records Life Cycle Model blends the pre-natal phase of the Records Continuum Model and the conceptual phases of the Records Life Cycle Model (Chachage & Ngulube, 2006). The Records Life Cycle Model developed by the American, R.T. Schellenberg (Shepherd and Yeo, 2003) has guided the management of paper records in many organizations. The Records Life Cycle Model perceives records as an analogy of a biological organism, which is born, lives and dies, and a record, which is created, maintained and used for as long as it has continuing value and is then disposed of either by destruction or by archival (Northwest Territories, 2012; Shepherd & Yeo, 2003). The features of the Records Life Cycle Model imply that the model is more applicable and suitable for organizations dealing with the management of paper records (Yusof & Chell, 2000). Nonetheless the goodness of the Records Life Cycle Model, Yusof and Chell (2002) point out that the Records Life Cycle Model is not suitable for organizations or studies investigating the management of electronic records and calls for the need to replace it with a model that appropriately reflects the special characteristics of electronic records. The perceived weaknesses University of Ghana http://ugspace.ug.edu.gh 16 of the Records Life Cycle Model conspicuously led to the development of the Records Continuum Model. The Records Continuum Model originated in Canada but was developed and adopted in Australia in the 1980s and 1990s by Australian archival theorist, Frank Upward (Bantin, 2002). The Records Continuum Model refers to the consistent and systematic way of managing records from the development of record keeping systems to the final disposition stage that is either by destruction or preservation or use as archives (IRMT, 2009). Jackson (2008) justifies that the Records Continuum Model works effectively in an organization that operates in an electronic environment. Dikopoulou and Mihiotis (2012) and Kemoni et al. (2007) state that the adoption of the Records Continuum Model is very useful as it facilitates policy making, constitutes organizational memory, enhances compliance and enhances security. The most significant feature of the Records Continuum Model is its participatory nature of the design phase whereby records professionals and systems designers participate in the designing of the system. The design phase of the Records Continuum Model is normally referred to as the pre-natal phase (Flynn, 2001). Chachage and Ngulube (2006) give a simplified explanation of the Hybrid Records Life Cycle as the fusion of the pre-natal stage of the Records Continuum Model with the conceptual stages of the Records Life Cycle Model. At the design stage, Records Managers and Archivists appraise records and decide on what records would support the functions of the organization during the records continuum. The collaboration between these stakeholders in the system design enables the creation of the right records containing the right information in the right formats; organizing the records to facilitate their use; systematically disposing of records that are no longer required; and protecting and preserving records. Yusof and Chell (2002) assert that management in organizations should merge both the pre-natal phase of the Hybrid Records Life Cycle Model and that of the University of Ghana http://ugspace.ug.edu.gh 17 conceptual phases of the Records Life Cycle Model in the management of records as they do not exist independently of each other. The relevance of the Hybrid Records Life Cycle Model informed the study to adopt it as its underpinning model for this study. The Hybrid Records Life Cycle Model is shown in figure 2.1. Figure 2.1: Conceptual Framework showing Hybrid Records Life Cycle Model Source: Author's Construct, 2016 2.2.1 Pre-Natal Phase Pre-Natal Phase -Participation in System Design Active Phase -Creation & Capturing -Use & Maintenance Semi-Active Phase -Use & Storage Non-Active Phase -Disposal & Destruction -Archival & Preservation Records Management University of Ghana http://ugspace.ug.edu.gh 18 At the pre-natal stage, a participatory design approach is considered. Here, records professionals (Records Managers, Archivists and Health Information Officers) and Management collaborate in the records keeping system design. Shepherd and Yeo (2003) and Myburgh (2005) emphasize that Archivists, Records Managers and systems designers should collaborate in the designing of record keeping systems. The engagement of records professionals is essential because in the absence of engaging the records professionals in the system design, the ramifications are that some records are likely to disappear in the sub-systems due to a lack of records management and archival knowledge on the part of system designers (Chachage & Ngulube, 2006). Moreover, the creation and preservation of reliable and authentic records require a shared purposive activity among the system designers and users of records in organizations (Lyytinen & Ngwenyama, 1992). 2.2.2 Active Phase This phase synthesizes records creation, storage and maintenance for both administrative and clinical uses. The activities of organizations involve the creation and maintenance of records and most importantly, render services and make decisions in the interest of the public. For instance, in healthcare facilities, once a record is created, it could be classified as confidential or non- confidential and current or non-current depending on the type of information they contain (Iwhiwhu, 2005). In most instances, organizations’ records created are classified based on dates, numbers and alphabets. These records keeping classifications are meant to facilitate easy retrieval and security of records especially patients’ folders and also, to reduce patient waiting time. For organizations that use electronic records management systems, records are created automatically by the system. On the other hand, organizations that deals with manual records, individuals are required to create records manually (Tucker, 2012). University of Ghana http://ugspace.ug.edu.gh 19 2.2.3 Semi-Active Phase At this phase, some records are rarely used for day-to-day activities. After some time the record becomes less frequently used and enters the in-active period. At this stage, records must be stored in easily accessible, conducive and a good room temperature prior to being destroyed according to the country’s or organization’s records retention and destruction policy. Records are often stored at a lower cost in an archive pending ultimate disposal. The essence of proper storage relates to privacy issues, security issues, access controls and unauthorized destruction of records. Organizations such as healthcare institutions maintain and preserve records for reference, medico- legal issues and financial reasons (Northwest Territories, 2012). 2.2.4 Non-Active Phase Here, records are considered to have finished their active life and are not needed for immediate use in the current records systems and have no more value to organizations. The majority of the records are destroyed and a limited number are transferred to archival repositories for preservation (Northwest Territories, 2012). Organizational policy on the disposal of records should be communicated to employees to ensure that confidential information is not leaked out to external parties. Generally, records must be accessible for a certain number of years to comply with state laws before being disposed or destroyed (Tucker, 2012). 2.3 Linking the Hybrid Records Life Cycle Model to the Study University of Ghana http://ugspace.ug.edu.gh 20 Archival and records management theories and principles are increasingly becoming relevant in organizations such as public hospitals (Bilotto & Guercio, 2003). This is due to the fact that health institutions on daily basis create, use, maintain, preserve and dispose of records. For organizations to go through the life cycle of records successfully, organizations must be guided by set of principles in order to fulfill its legal and financial obligations. In view of that, the Hybrid Records Life Cycle Model is chosen as its underpinning theory to guide this study. The use of the Hybrid Records Life Cycle Model is situated in the context of the research problem and objectives of the study to investigate the role of records management practices in improving decision making in organizations. Organizations in Sub-Saharan Africa continue to practice both paper and paperless records and this necessitates the adoption of the Hybrid Life Cycle Model which blends the pre-natal phase of the Records Continuum Model and the conceptual stages of the Records Life Cycle Model. Moreover, the adoption of records management systems in organizations are likely to create records management challenges if records professionals are not involved at the design stage of records management systems. However, the engagement of records professionals in system design ensure that records management systems are successfully implemented and practiced. This is because the creation and preservation of reliable and authentic records require a shared purposive activity between system designers, records professionals and management (Lyytinen & Ngwenyama, 1992). It is based on this that the Hybrid Life Cycle Model is adopted to investigate the role of records management practices in improving clinical and administrative decisions at Ashanti Bekwai Municipal Hospital. 2.4 Records and Records Management University of Ghana http://ugspace.ug.edu.gh 21 The International Standards Organization 15489-1 (2001, p. 3) defines records as “information created, received, and maintained as evidence by an organization or person, in pursuance of legal obligations or in transaction of business”. The Public Records and Archives Administration Act 535 of Ghana also defines records as “any recorded information regardless of form or medium created, received and maintained by any institution or individual in the pursuance of its or his legal obligations or in the transaction of its or his business” (Ghana Legal, 2015). These two definitions have some similarities as both view records as information that are created and maintained in pursuance of business activities. Thomassen (2001) posits that a record is more than just information: it is supposed to be trustworthy; reliable and authentic and be able to serve as evidence and to support accountability. For a record to be trustworthy; the record must be guided by some level of confidentiality, proper maintenance, security, preservation of the content and context (Iwhiwhu, 2005). MacNeil (2000) also views trustworthy of a record as the one that is both an accurate statement of facts and a genuine manifestation of those facts. Record trustworthiness thus has two qualitative dimensions: reliability and authenticity. Reliability means that the record is capable of standing for the facts to which it attests, while authenticity means that the record is what it claims to be. Shepherd and Yeo (2003) point out three main qualities of good records: First and foremost, organizations use records in the conduct of business transactions and to enhance decision making. Secondly, organizations use records to support accountability and legal and financial obligations. Lastly, records may be used for cultural purposes and research, to promote awareness and understanding of corporate history. Cox (2001) states that the evidential value of a record can only exist if the content, structure and context are preserved, meaning that without preservation, there won‘t be any record. University of Ghana http://ugspace.ug.edu.gh 22 The essence of records in organizations are for formulating and implementing policies, keeping track of day-to-day activities, achieving consistency in decision making, providing quality service to individuals and achieving greater efficiency (Kemoni et al., 2007). The International Records Management Trust (2003a) and the World Bank (2006) concur that records are essential for the effective functioning of private and public organizations. They assert that records validate decisions and activities of organizations and also, serve as benchmarks against which they can measure their future decisions and activities. Shekelle et al. (2006) opine that accurate and reliable records lead to improvement in patient care, increase in efficiency of care, communication between caregivers, reduce medical errors and costs, security and quality decision making. Healthcare institutions on daily basis create, receive, maintain and dispose or preserve records on patients, human resource, assets, finances, clinical programmes, drug and non-drug consumables and procurement (Saint Michael hospital, 2012). For healthcare institutions to manage its records effectively, they must develop the capacity to manage records and information. The rationale is that, the challenges of conceiving, initiating, implementing, monitoring and evaluating organizational activities will always require reliable, pertinent and timely records (Kalusopa, 2011). This makes effective records management system an essential part for organizations that strive to fulfill its objectives. Records Management is therefore the “field of management responsible for the efficient and systematic control of the creation, capture, receipt, maintenance, use and destruction or preservation of records, as well as maintaining evidence of information about business transactions in the form of records” (International Standards Organization 15489-1, 2001, p. 3). Records management seeks to efficiently and systematically control the lifecycle (creation, capture, use, maintenance, archive or disposal) of records that are daily generated as a result of business daily activities and transactions. University of Ghana http://ugspace.ug.edu.gh 23 This signifies that records management is based on the principles of daily review and controlled retention or destruction of records with the general aim of ensuring legal and regulatory compliance and corporate accountability (Chinyemba & Ngulube, 2005). Simon Fraser University (2007) argues that records management does not only allow an organization to function on a daily basis, but also to fulfill its legal and financial requirements since up-to-date information of activities is available as reference point. Records that are managed effectively facilitate timely and efficient decision making, inform future decisions, produce evidence in litigation cases, increase accountability of decision makers and fast track an efficient service delivery (Akor & Udensi, 2013; Kemoni & Wamukoya, 2005; Mampe & Kalusopa, 2012). With effective records management, organizations such as hospitals benefit from reduced risks from medico-legal or regulatory challenges by finding and producing the relevant evidence contained in records. In effect, the hospital can be assured that there is a full disclosure of information for decision-makers to rely on in the course of carrying out their duties, thus improving the quality of decision making, long term planning and delivering efficient health care to the public (Ojo, 2009). 2.5 Decision Making The concept of decision making is defined by Vander Waldt (2001, p. 193) as “identifying and selecting a course of action among alternatives to solve a specific problem”. One of the most important factors in making decisions is the information or records. This is due to the fact that having detailed, accurate and timely information hasten decision making likewise scanty, inaccurate and poor timing result in making wrong decisions (Darwish, Saki, Sahraei, Zakrifar & University of Ghana http://ugspace.ug.edu.gh 24 Talebi, 2014). Decision making in organizations occurs in different conditions that are sometimes challenging to its process. These conditions are uncertainty (each alternative lead to one or more consequence with an unknown probability), risk (each alternative has one or more consequence and the probability of each are known) and certainty (each alternative lead to a goal or consequence) (Ahmed & Omotunde, 2012). In order to overcome these turbulent processes, a competent decision making should comprise of the ability to understand the information, integrate information in an internally consistent manner, identify the relevance of information in a decision process, and inhibit impulsive responding. The demonstration of these skills is expected to have an impact on the degree of congruence between characteristics of the decision maker and the demands of the task and context (Finucane, Mertz, Slovic & Schmidt, 2005). Extant literature has revealed that making rational decisions by following prescriptive decision making rules yield the most successful outcomes (Nutt, 2007; 2008). Unfortunately, rational decision making is often not a practical proposition due to limitations of time, cost and visibility of all potential solutions. In a situation where all factors necessary for rational decision making exist; about 45% of managers simply use their instinct to make decisions (Hall, 2007). How and what types or kinds of decisions are made, when and by whom doesn’t matter as long as the outcome of those decisions are directed towards an accomplishment of goal that affects people or organization or both, the need to measuring those decisions for efficiency and effectiveness is not only necessary but also, inevitable (Weddle, 2011). Notwithstanding, current thinking on decision making is wide and varied but there is no general consensus of rating a decision as good or bad and how to go about making good decisions (Heavey, Simsek, Roche & Kelly, 2009; Miller, 2008; Rausch, 2007). Indeed, Rausch (2007) believes that outcomes are not a true measure of the quality of the decision. Unfortunately, there is no proven University of Ghana http://ugspace.ug.edu.gh 25 criterion for sound decision making that has been validated by empirical research currently exists. Conversely, Michel (2007, p. 33) believes that the “best decisions are those that are aligned with the strategic intent of the organization and developments in the market and that support the organization’s ability to perform”. Bain and Company’s as cited by Rogers and Blenko (2006) assert that making good decisions means being clear about which decisions really matter followed by prompt effective action. This implies that having good decision choices guarantees viable decision in organizations (Jawadekar, 2006; Vital & Shivraj, 2008). In view of this, decision commitment, decision accuracy, decision timeliness and decision understanding have been adopted as a measure of decision making in public hospitals. These dimensions are shown in the figure 2.2 Figure 2.2: Conceptual Framework for Decision Making variables Source: Author's Construct, 2016 2.5.1 Decision Accuracy This shows the extent to which data are correct, genuine, reliable and certified. This implies that there is no inherent limitation, free from errors and mistakes. Inaccurate information is likely to Decision Making Decision Understanding Decision Accuracy Decision Timeliness TTimTtTimeliness Decision Commitment University of Ghana http://ugspace.ug.edu.gh 26 result in poor decisions likewise accurate information can also result in good decisions (Ge & Helfert, 2006). 2.5.2 Decision Timeliness This refers to the timing in which decisions are made or making decisions at the right time. Decisions made at the right or opportune time leads to achieving organizational goals such as high productivity, profitability and competitive advantage whiles wrong timing of decisions sometimes waste organizational resources (Darwish et al., 2014). 2.5.3 Decision Commitment This is a reflection of an individual’s identification with organizational goals and his/her willingness to work towards them (Reichers, 1985). This involves the willingness of people to contribute or participate in decision making. Reluctance or willingness of an individual impacts negatively or positively on decisions that are made or to be taken in organizations. 2.5.4 Decision Understanding University of Ghana http://ugspace.ug.edu.gh 27 This involves making sense of data or information; explain the meaning of information. In hospitals, for a decision to be made on records generated, there is the need to interpret such information in order to inform the decision. This implies the ability to interpret available information influences the decision to make (Darwish et al., 2014). 2.6 Records Management and Decision Making Decision making in public hospitals is an administrative function and invariably requires information in the form of records. In effect, records and archives provide the information that is required by those who make the decisions. The question is whether these records and efficient records management systems are available to the management of public organizations and whether the management of public organizations are aware of their existence and thus make use of them when making decisions (Akor & Udensi, 2013). Therefore, in trying to indicate the role of records management systems in decision making, Gill (1993) indicates that records are facts supporting decisions and facts upon which to base future decisions, facts to communicate to employees, customers, potential customers, government stakeholders and facts to document the history of a company. Records represent major sources of information and are almost the only reliable and legally verifiable source of data that can serve as evidence of decisions, actions and transactions in organizations (Wamukoya, 2000). By managing records effectively and adopting efficient records management systems, hospitals can be assured that there is a full disclosure of information for managers of hospitals to rely on in the course of carrying out their duties, thus improving the quality of decision making, long term planning and delivering efficient health care to the public (Ojo, 2009). University of Ghana http://ugspace.ug.edu.gh 28 On the other hand, Iwhiwhu (2005) believes that in the absence of records or information and sound records management systems, the management of organizations are incapacitated in its decision making process. The consequences of poorly supported decisions are choices that waste company resources and even risk the future of the organization. Many managers simply need effective records management systems and guidance to make quality decisions based on reliable evidence. However, there is no systematic guarantee that the evidence available to managers of organizations is reliable and genuine to make such decisions (Pfeffer & Sutton, 2006). This signifies that the quality of information and records management systems at the disposal of organizations are significant for organizations in the formulation and implementation of varied policies and programmes that guide the organization to achieve its set targets. Records management systems if adopted and practiced effectively, it is likely to improve decision making thereby helping management (Richmond, 2010). As revealed by Odinioha and Chukwuma (2013), the effectiveness or otherwise of any organization is dependent on the quality of decisions that informs its operation. If decisions are right, it translates into positive organizational outcomes such as competitive advantage, increase in profit margins, high morale of employees and good corporate image in the eyes of the public but where insufficient or inaccurate information exists, then the organization’s growth is likely to be retarded hence making it difficult to break even or cover its operational cost. This is why records or information available to organizations are major determinants of organizations’ success or failure. Taking into cognizance the level of risk involved in making decisions under high uncertainty, and the scholarly convergence that effective records management ensures good decisions (Jawadeker, 2006; Rhodes, 2010), one will think that any organization that hungers for effectiveness and efficiency would seek to make relevant decisions at every point of its operations; University of Ghana http://ugspace.ug.edu.gh 29 and making good decisions is a by-product of effective records management. Majority of operations in an organization revolve around decisions made by the management and other key stakeholders in the organization. However, for decisions to be made adequately, it is imperative for an existence of sound records management systems that support management decisions in that particular organization (Nowduri, 2011). In reference to the preceding claim, Jahangir (2005) states that based on the significant role that records and sound records management systems play in decision making, organizations must ensure that they have adequate and quality information in addition to effective records management systems. According to Shepherd (2006), comprehensive records management programmes in organizations are clear indications of organizations attempt to deliver efficient services and aids management decision making, policy execution and the general administration of organizations. Jawadeker (2006), UStudy (2010) and Vital and Shivraj (2008) agree that the quality of management decision making depends directly on the quality of available information and sound records management systems such as simple and functional filing system hence; managers should cultivate an environment that encourages the growth and viable sprouting of quality information. This was evident in the findings of Jawadeker’s (2006) study that having reliable, error free records and better records management systems guarantee an organization to have viable and better decisions. A survey conducted by Akor and Udensi (2013) and Mampe and Kalusopa (2012) revealed that effective records management systems facilitate timely and quality decision making, inform future decisions and fast track service delivery. As recommended in a study carried out by the Institute of Medicine (2001), organizations such as health institutions should move away from manual records management to electronic records management as the latter is likely to facilitate clinical University of Ghana http://ugspace.ug.edu.gh 30 decision making and minimize the potential for mistakes that arise out of inaccurate and incomplete of paper records. This point to the direction that public hospitals’ adoption and practice of sound records management system is likely to reduce patients waiting time, reduce medical errors caused by paper records, improve service delivery and fast track administrative and clinical decision making. 2.7 Conceptual Framework for the Study The framework shows how the various stages of records management, compliance and good practices lead to clinical and administrative decisions in public hospitals. The stages of the records management start from pre-natal phase through active and semi-active phases and finally end at the non-active phase. In order for public organizations to have a successful records management system, there must be compliance with legal and regulatory framework and standards, implementation of records management policies. Moreover, good practices such as staff capacity building, adherence to security and access controls’ measures and an implementation of a disaster management plan. The presence of these constructs is likely to influence clinical and administrative decisions in public hospitals. However, the clinical and administrative decisions are measured using decision accuracy, decision timeliness, decision commitment and decision understanding. These are shown in figure 2.3 Figure 2.3: Conceptual Framework depicting Records Management leading to Decision Making Pre Natal Phase -Participation in System Design University of Ghana http://ugspace.ug.edu.gh 31 Source: Author’s Construct, 2016 2.8 Review of Empirical Literature A good review of an empirical literature needs to indicate the different views, agreements, disagreements and trends of thoughts on the topic of research and be accurately portrayed and acknowledged in the text. In view of that, the empirical literature presented related studies in the area of records management conducted in other developing countries especially, Sub-Saharan Africa. Active Phase -Creation & Capturing - Use & Maintenance Semi-Active Phase - Use & Storage Non-Active Phase - Disposal & Destruction -Archival & Preservation Records Management Decision Making Decision Understanding Decision Accuracy Decision Timelines s Decision Commitment Compliance -Legal & Regulatory Framework -Policies & Standards Good Practices -Security & Access Controls -Disaster Management Plan -Staff Capacity Building University of Ghana http://ugspace.ug.edu.gh 32 2.8.1 Pre-Natal Phase 2.8.1.1 Participation in System Design Participation in system design simply means the involvements of records professionals (Records Managers and Archivists), management and system designers in the designing of records management systems (Shepherd & Yeo, 2003). Studies conducted by Myburgh (2005) and Shepherd and Yeo (2003) revealed that records professionals and system designers need to participate in the designing of the records keeping systems as their engagements are likely to improve the management of records in organizations. A study by Kemoni et al. (2007) buttressed the point that an effective collaboration of records professionals and system designers enable the creation of the right records containing the right information in the right formats and organization of records to facilitate their use. Moreover, the Life Cycle Model employed by Iwhiwhu (2005) to conduct a survey into some Nigerian Universities indicated that the cooperation of records professionals in the system design provide evidence of a particular activity, the systems and procedures needed to ensure that the records are captured and maintained, records retention and disposal schedules to fulfill their legal and financial obligations, storage procedures and security and access controls. Conversely, the Life Cycle and the Records Continuum Models adopted by Chachage and Ngulube (2006) to carry out a survey into some companies in the Iringa region in Tanzania disclosed that without the engagements of records professionals in the system design, some records may disappear in the sub-systems due to a lack of records management and archival knowledge on the part of corporate information systems designers whereas some records are likely not to be captured in the system. This is due to the fact that the adoption and practice of a sound records management University of Ghana http://ugspace.ug.edu.gh 33 system requires a shared purposive activity among records officers, management and system designers, which can only be achieved through cooperative action (Lyytinen & Ngwenyama, 1992). A survey by Dearstyne (2002) into Indiana University Electronic Records Project revealed that successful records and archives management systems require concerted efforts to eliminate traditional boundaries, collaborate with others, improvise when solutions are not clear because the issues and problems are relatively new, and occasionally compromise archival and records management principles. Notwithstanding the cooperation, Dearstyne (2002) recommended that records management programmes need to be designed to capture the organizational culture of the institution because what transpires in organizations is likely to have an impact on the implementation and practice of records keeping programmes and records management systems. This therefore calls for concerted efforts to re-assign the responsibility between the organization and the records management programmes. 2.8.2 Active Phase 2.8.2.1 Records Creation and Capturing Records creation and capturing involves “developing consistent rules to ensure integrity and accessibility, deciding on systems to log and track records, and procedures for registering, classifying and indexing” (Yusof & Chell, 1999, p. 10). The thrust of records creation is to ensure that only records needed by the system and the organization are created (Shepherd & Yeo, 2003). Yusof and Chell (2000) are of the view that if the meaning assigned to creation is to be relied upon, then it means organizations are functioning in a paper environment. Unfortunately, this is not University of Ghana http://ugspace.ug.edu.gh 34 always true because in an electronic environment, records are created automatically by the system. However, the major challenge for any electronic management system is the inability to document the origination of new records in a logical and consistent manner while some records require an individual to create a record manually and this normally occurs in paper environment (Tucker, 2012). A comparative study by Norris (2002) into some institutions and departments in New York found out that records management is often not effective during the time that records are created. The outcomes of these inefficiencies are redundancy of records, lack of clearly identified official copies and insufficient records for clinical audits and medico-legal issues. Mrwebi (2000), in his survey, put forward that as records are created in different formats, it is imperative that some standards for records retention are established and complied with in the organization to ensure that the same information is not duplicated. The National Archives of Canada (2003, p. 1) asserted that the most important aspect of the creation and capturing of records is to “recognize records as the main source of information that have been generated and to empower employees to assess the value and role of the information contained at the moment of creation within a recognized framework, thereby making it easy to support the organization’s activities and policies”. Similarly, in healthcare facilities, patients’ medical records (patient history) are created during patient consultations and prescriptions given by medical officers. Eventually, records are received by the hospital’s records management unit for proper records keeping (IRMT, 2009). In support of the above study, the findings from a study by Nchise (2011, as cited in Maal-Ire, 2013) into healthcare facilities in Ghana indicated that almost every patient visit, medical documents and drug prescriptions are produced and handwritten in paper formats. This signifies that most records about patients are still created and maintained in paper formats. University of Ghana http://ugspace.ug.edu.gh 35 2.8.2.2 Use and Maintenance Records usage is when records are actively accessed and shared by all employees of an organization and it is at this point that ensures easy access to timely, accurate and available information. Irrespective of the format, records need to be managed and maintained well to ensure that they are kept current and secure, and not accidentally disposed of (National Archives of Canada, 2003). It is prudent for health institutions to establish policy manuals regarding the classification of documents into records and security concerns as both form part of records maintenance. This can be achieved by instituting security measures and access controls to deny unauthorized access into the system. The Stakeholders Theory and the Records Continuum Model used by Mensah and Adams (2014) to conduct a survey into both private and public hospitals in Ghana claimed that an effective management of hospitals’ records are critical factors in providing capacity for hospitals’ efficiency, information security and confidentiality, quality of care and decision making. However, a comparative survey done by Wamukoya (2000) into the Eastern and Southern Africa Regional Branch of the International Council on Archives (ESARBICA) region disclosed that in many African countries, records have been created and maintained in paper formats. This revelation was due to the fact that most records professionals were accustomed to working with paper records so much that they perceived the act of keeping records in the context of a paper based environment. The International Records Management Trust (2005) in their survey posited that, over the last decades, there had been a decline in the management of records in developing countries such as Sub-Saharan Africa, which has had detrimental effects on efficiency, accountability, security, confidentiality, service delivery and decision making in organizations. In University of Ghana http://ugspace.ug.edu.gh 36 the same vein, Tale and Alefaio (2011) found out that managing records in Sub-Saharan Africa was receiving little attention and support as compared to countries of the developed world. The authors further put forward that although the need to have a good filing system was understood, records management practices were not given the necessary credence as it is required in organizations, and invariably records were controlled by staff that had very limited experience or skills in managing records. In contrast, a study by Ojo (2009) indicated that records that are managed effectively eliminate missing files, increase physical filing space, reduce lengthy turnaround time in retrieving files and lengthy patient waiting time. It also assists in tracking the movement of paper records in public health institutions. In the opinion of Chimezie (2005, as cited in Maal-Ire, 2013), the maintenance system which is essential to the use of records should be included as an additional strategy for managing hospital records. To the author, record may be in place but if they are not well maintained, they lose their credibility and authenticity. 2.8.3 Semi-Active Phase 2.8.3.1 Use and Storage At this point, records that have been used and are no longer needed regularly by the organization are used for reference and to fulfill legal and financial obligations. At this stage, organizations must formulate policies that guide the procedures and manners in which records are to be stored. The essence of this is to ensure proper storage relating to privacy and security issues since any disclosure of sensitive and confidential information could amount to legal suits especially, medico- legal issues in the health sector (Tucker, 2012). The findings from Dhabi’s (2009) study indicated that the storage systems (offsite and onsite) are to be equipped with environmental control, University of Ghana http://ugspace.ug.edu.gh 37 applicable safety and security measures to ensure better storage and preservation of in-active records. Thus, the records must be stored in larger and conducive storage places pending ultimate disposal. The Stakeholders Theory and the Records Continuum Model used by Mensah and Adams (2014) to carry out a survey into both private and public hospitals in Ghana revealed that the most common storage equipment used by public health institutions were steel cabinets and wooden shelves. To the authors, there were problems of inadequate storage equipment and inadequate filing space. Wema (2003) in his study showed that expensive office space was wasted on storing records which could have been moved to less expensive space, such as archives. The inappropriateness of storing records on floors has repercussions on the ultimate disposition of the records when their retention time had expired. The author suggested that keeping active and in-active records together poses serious storage and retrieval problems and also, increases the deterioration of records. This means that active records should be separated from inactive records to facilitate easy retrieval to expedite decision making. A study carried out by Nchise (2011, as cited in Maal-Ire, 2013) into Ghanaian hospitals revealed that almost every patient visit, medical documents and drug prescriptions were stored in folders. The ramifications of storing patients’ records in folders to some extent make such folders susceptible to the violation of privacy and confidentiality issues and other challenges such as missing files, misfiling and damaged files. Therefore, records should be stored in such a manner so as to facilitate user access and ensure that they are protected from unauthorized access, use, disclosure, removal, deterioration, and loss or destruction. 2.8.4 Non-Active Phase University of Ghana http://ugspace.ug.edu.gh 38 2.8.4.1 Disposal and Destruction Records disposal is the process whereby the “organization, through its records manager destroys or erases ephemeral records or transfers archival valued records to an archival institution for permanent safe keeping” (Adelaide University Records and Archives Management, 2004, p. 30). The purpose of disposal or destruction is to permanently remove records from active use, with no possibility of reconstructing the information (Dhabi, 2009; Nye, 2010). The issue of inappropriate records destruction in South Africa informed the National Archives and Records Service of South Africa (2006) to suggest that, organizations should determine the length of time for retaining records before disposal. To the organization, records officers should set the period for keeping different types of records, based on different records values or use such as clinical, administrative, legal, research and financial values. However, the systematic disposal of hospital records that have been maintained for the prescribed retention period is the overall responsibility of concern to healthcare facilities. Hospital record that is scheduled for destruction must be placed in a secure location to guard against unauthorized access until the destruction takes place (Dhabi, 2009). The International Records Management Trust (2003a) pointed out that among other challenges identified in most African countries; there were no records retention and disposition policies in the ESARBICA region. This was evident in a study by Balasu (2009) that there was no public sector organization in Ghana that applied records retention and disposition schedule as they are not in existence. The author further expatiated that the absence of records retention and disposition schedule is a serious weakness in the governments’ disposition infrastructure. A later argument was that once records are no longer needed by their creating agencies, archivists must make a final decision about the disposition of records; that is, whether records merit continued maintenance University of Ghana http://ugspace.ug.edu.gh 39 and preservation in archives or destroyed or disposed of (Marshall, 2006). Consequently, the delay in authorizing the disposal of records may result in unnecessary accumulation of records (Mnjama, 2006). According to Atuloma (2011), information can be maintained in a manner that effectively serves the need of the organization and any information that are no longer necessary can be efficiently disposed of. 2.8.4.2 Archival and Preservation Archival and preservation of records are records that are kept permanently because of its administrative, legal, fiscal, or research value (Norris, 2002, p. 13). Preserving records effectively means that the records must be stored in a safe and secure location and displayed under appropriate preservation conditions. Preservation of records facilitates perpetuation in decision making while providing substantiation of precedent activities and historical superiority for future generations (Kasetsart University Archives, 2010). A study by Ngulube (2003) stated that records and archives help to establish communication between the past and future generations. To the author, without records and archives, it would be difficult, if not impossible, for records users to learn from past successes or failures and also, limits the society‘s ability to act based on sound information. The author further opined that without records and archives, we cannot fully explain the ever changing present and inform the future with certainty. Moreover, proper accounts must be kept at all times of the precise location, including those temporarily withdrawn or undergoing administrative uses (Ngulube, 2003). A survey by Cox (2000) in the United States of America revealed that there was no coherent system of archives and records management existed. To the author, this was a major barrier to the successful protection of the nation's documentary heritage and the scheme between records officers University of Ghana http://ugspace.ug.edu.gh 40 and other information professionals. A study into the European Union framework of the Information Society also disclosed that a lot of public organizations had chosen to preserve parts of their archives by digitization (Dikopoulou & Mihiotis, 2010). According to Ngulube and Tafor (2006), the overwhelming challenge of Archivists and Records Managers in Sub-Saharan Africa is a long-term preservation and management of electronic records especially converting paper records to electronic records form by means of scanning and other technological devices. Not excluding Ghana, a study by Akussah (2002) showed that there were inadequacies in preserving awareness among the staff and users of public records in the registries of Government Ministries, Departments and Agencies (MDAs) in Ghana. This was attributed to inadequate professional training of staff and the lack of preservation education in the form of seminars and workshops. This was not different from subsequent surveys conducted by Adams (2010) and Mensah (2011) into the MMDA’s and public hospitals respectively. In their studies, they found out that most common preservation equipment used in the public sector were steel cabinets and wooden shelves and that there were problems of inadequate storage equipment. This implies that preservation of records for a longer time still poses serious threats to many organizations in Sub-Saharan African countries such as Ghana. 2.8.5 Good Practices 2.8.5.1 Security and Access Controls Security issues in most public organizations like public hospitals follow traditional norms. Safety measures such as locking cabinets, employing security personnel, cameras, Closed Circuit Television (CCTVs), alarm systems, fire warnings and protection systems are mostly taken for the University of Ghana http://ugspace.ug.edu.gh 41 physical security of records. On the other hand, electronic security measures such as firewalls, passwords, encryption, security copies and access rights for each user category are some of the tools used for securing electronic records integrity, accuracy and trustworthiness. In healthcare facilities, medical records are filed in a secure location that is locked during non-clinic hours to safeguard against loss, tampering, or use by unauthorized personnel. Hospital staff must take reasonable steps to protect the personal and confidential information it holds from misuse and loss and from unauthorized access and modification or disclosure (Professional Practice Group, 2008). This is very essential in institutions like hospitals where on daily basis, confidential records in the form of medical history of patients are created and maintained. Access rights in organizations are stipulated by the management that prescribes who is authorized or mandated to access confidential and non-confidential records (Dikopoulou & Mihiotis, 2010). To the authors, the lack of security controls in organizations exposes the organization to lose private and confidential records about the individuals and the organization as a whole. 2.8.5.2 Disaster Management Plan Disaster management plan is a formal written plan, on the basis of identified potential accidents together with their consequences, describes how such accidents and their consequences should be handled either on site or off site (MoH & GHS, 2010). Disaster management also known as disaster preparedness is regarded as an essential part of any records management programme. Disaster University of Ghana http://ugspace.ug.edu.gh 42 management ensures that organizations are prepared to respond quickly to emergencies. Disaster mitigation, or the ability to identify risks and prevent some emergencies from happening, should always play a key role in an institution's emergency preparedness and planning efforts. A survey by Ngulube (2007) revealed that despite the fact that disaster preparedness plans allow organizations to plan and make decisions about emergency response and recovery, archival institutions in South Africa did not adequately plan for emergencies. To the author, the absence of disaster management plan is obvious in South Africa as a study into Iringa region also showed that most companies had not made disaster preparedness as part of their records management strategy. Ngulube (2007) later disclosed that there were four archival institutions that had written disaster preparedness plans. Out of these four archival institutions, only one institution had a disaster management plan covering natural disasters such as floods. Similarly, Akussah’s (2002) study into government registries in Ghana pointed out that most of the government registries did not have any idea about disaster preparedness. The repercussions of lack of a disaster management plan in organizations leads to missing or lost records and damaged files which ultimately affect decisions and service delivery (Rodriguez, 2005, as cited in Bundotich, 2013). An organization that is well prepared for disaster is able to efficiently and quickly face any emergency that might be dangerous to staff, documents and building. Moreover, it protects records against theft, deliberate or accidental and unauthorized damage and destruction (Ngulube, 2003). The negative effect of lack of a disaster management plan requires organizations to back-up electronic records on a regular basis to safeguard against loss of information due to equipment malfunctions, human error, or other natural disasters. On the other hand, institutions that have not complied with their retention policy should not dispose of their record University of Ghana http://ugspace.ug.edu.gh 43 notwithstanding the existence of back-up plans (Florida Department of State Division of Library and Information Services, 2010). 2.8.5.3 Staff Capacity Building Records management has been described as a profession that is constantly evolving. This has implications on the skills and competencies needed to manage records. Training should be an ongoing activity for all staff involved in the management of records from the inception to their destruction or preservation. Whilst records management requires that records designers and creators be imparted with some levels of skills in the management of