The primary role of quality assurance is to monitor the quality of patient care. Improvements to the quality are dependent on issues such as sufficient financial, structural and personnel resources. While the quality assurance programme makes recommendations and offers guidance the implementation of improvements must be effected at institutional level.
The Department will prioritise quality of patient care in 2009-14 in line with point 3 of the NDOH 10-Point Plan: Improving the Quality of Health Services. Activities envisaged by NDOH include:
- Establishment of a National Quality Management and Accreditation Body
- Empowering Sub-district teams to coordinate with ward councillors
- Integrated communication strategy for internal and external customers.
- Reinforcing Batho Pele principles and patient rights and responsibilities.
- Identification of quality problems in health care establishments and implementing plans to address the inefficiencies and inequities.
- Regular monitoring of quality of clinical care and implementation of specific recommendations to resolve problems.
- Autonomy for CEOs with accountability, and minimal third parties.
- Strengthening the Customer Care Programme at facility level.
The national programme requires all institutions to have their quality monitored and accredited and also that all institutions have a quality improvement plan in all five priority areas:
- Patient safety
- Staff attitudes
- Infection prevention and control
- Waiting times.
In 2009 and 2010 all hospitals will be required to develop a Quality Improvement Plan, followed by all Community Health Centres (CHCs). All hospitals and CHCs will be inspected for compliance to the quality standards – one per month, in order to complete monitoring of all facilities within 3-year cycle, as required by the Health Act.
To support the NDOH plan on the improvement of Quality of services and, Gauteng is adopting the revised quality framework for quality health care institutions and directing its immediate implementation.
A task team has been established to specifically address the issue of waiting times at the pharmacy and best practices in this regard are being rolled out to hospitals in a phased manner. Queue management will be improved at all institutions including through queue marshals. A comprehensive waiting times project has been commenced at 6 community health centres.
Reporting of serious adverse events is gradually improving and the process of investigating has been largely decentralized resulting in a more equitable workload and therefore faster turnaround times. Due to the improved reporting trend analysis is now more accurate and has resulted in the identification of common issues which can be addressed. The work on improving compliance to partogram monitoring introduced by the maternal and Child Directorate has resulted in a noticeable decrease in serious adverse events in the maternity units. Much work is still required in this regard however.
A “Cleanest Hospital” campaign has commenced and will result in support staff being better trained to provide a quality cleaning service thus improving patient satisfaction and decreasing infections. A new approach to improving staff attitudes is being developed which depends on the concepts of emotional intelligence and will be piloted in 4 institutions to start with. The departmental psychologists are assisting with this project.
Another new initiative is the “Best care Always” project conducted in cooperation and with assistance from the private sector where hospitals are required to choose one of four targeted campaigns which should result in a reduction of hospital acquired infections. The areas they may choose from are infections relating to surgical wounds, those resulting from urinary catheter use, those resulting from central lines and ventilator acquired pneumonias.
Case managers will assist to improve bed management and cost containment. This will control the expenditure by patients on medical aids, and also reduce costs for the department.
The annual Patient Satisfaction survey using the national tool has been done for a second year with slight improvement over last year. This tool will continue to be used in order to provide reliable comparable data. It is hoped to have the tool modified for use in the community health centres next year. All institutions are required to include the areas of concern emanating from the patient satisfaction results into their quality improvement plans for the year.
The revitalization grant currently contains an amount for quality assurance. This programme needs to be carefully aligned to the quality assurance programme which includes the revitalization sites.