Abstract
Quality Improvement Plans (QIPs) are essential for strengthening healthcare service delivery
and ensuring compliance with regulated norms and standards in public health establishments.
Environmental Health Practitioners (EHPs) are critical to implementing and monitoring QIPs
within healthcare facilities. However, there is limited evidence regarding EHPs' knowledge,
attitudes, and practices related to QIP implementation in South African provincial hospitals.
This study aimed to assess the knowledge, attitudes, and practices of EHPs regarding the
implementation of QIP norms and standards in Gauteng Provincial Hospitals.
A quantitative, cross-sectional study was conducted, using a structured, self-administered
questionnaire distributed electronically to EHPs working in Gauteng Provincial Hospitals. The
questionnaire assessed socio-demographic characteristics, knowledge of regulated norms and
standards, attitudes toward quality improvement, and practices related to QIP implementation.
Descriptive and inferential statistical analyses were used to determine levels of knowledge,
attitudes, and practices, as well as factors influencing QIP implementation.
The findings revealed that respondents demonstrated a high level of knowledge regarding
quality improvement norms and standards, with a mean knowledge score of 12.84 out of 15
(85.6%). Attitudes toward quality improvement were moderately positive (mean = 5.79 out of
8; 72.4%), and practices related to QIP implementation were moderately high (mean = 10.60
out of 14; 75.7%). Practice was positively associated with gender and knowledge, but
negatively associated with age, experience, and attitude. Despite widespread engagement in
QIP activities, implementation was often compliance-driven, with limited ownership and
inconsistent adherence to norms and standards. Key factors influencing practice included
training gaps, role ambiguity, resource constraints, and insufficient organisational support.
In conclusion, while EHPs possess adequate foundational knowledge and participate in QIP
activities, systemic and organisational challenges limit the effective and sustainable
implementation of QIPs. Strengthening targeted capacity-building initiatives, clarifying roles
and responsibilities, and enhancing institutional support are essential to improve the impact of
QIPs and promote a culture of continuous quality improvement within Gauteng Provincial
Hospitals.