COHSASA is pleased to announce that its Quality Improvement Manager, Dr Leonard Londa, has been awarded an International Society for Quality in Health Care (ISQua) Fellowship Certificate.
ISQua is a driver of improvement and implementation of change in the healthcare systems across the globe.
The Fellowship, which takes a year to complete, is a continuing education programme for healthcare professionals and affords an opportunity to share global knowledge on topics such as:
- Leading for Quality and Safety
- Person-centred Care
- Patient Safety
- Health Information Technology
- External Evaluation Systems
- Quality and Safety in Resource Challenge Countries.
- Patient excess readmission in the hospital.
The Fellowship offers the healthcare professional a chance to be part of a vibrant global community continuing to learn about quality improvement and patient safety, sharing such learning with peers and be empowered by the knowledge.
Says Dr Londa of the benefits of the Fellowship: “The followship programme provided me with deeper clarity about the impact that I would like to make in healthcare industry and the legacy that I would like to leave.”
“It has made me set goals to expand my interactions and get involved in the quality improvement and patient safety network space. I would like to apply the methods and tools I have learnt in my daily work in my organisation and in the public domain. This would involve assisting healthcare facilities and systems with capacity building in quality improvement processes to actively prepare them for the future and changing demographics.”
Continuing the good news, Dr Londa has been informed that the abstract he submitted on behalf of a team of authors from COHSASA, Kamuzu Central Hospital and the Ministry of Health, and Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) in Malawi has been accepted as an oral presentation at the ISQua Conference in Florence in July.
The abstract is entitled: “A case study on the impact of a risk management programme implemented at a tertiary hospital in Malawi over a period of six years (2013 – 2019)”.
The abstract was described by one member of the scientific programme committee as being “a very relevant abstract inspiring improvement in low- and middle-income countries that are facing huge constraints to patient safety initiatives.”
In a significant step forward for South Africa’s palliative healthcare sector, late last year saw the fourth edition of the Standards for Palliative Healthcare Services being recognised internationally and accredited for four years by the global authority on standards development and assessment. This is the International Society for Quality in Health Care’s External Evaluation Association (IEEA). read more…
The accreditation celebration ceremony of King Faisal Hospital Kigali was held at the Marriott Hotel in Kigali. From left, COHSASA Quality Advisor and Surveyor, Riël Le Roux, Dr Edgar Kalimba, Deputy CEO of King Faisal Hospital Kigali; Dr Pierre Dongier (Board member); Marcel Mukeshimana (Board member); Prof Jacob Souopgui (Chairperson Board of Directors); Hon. Dr Ngamije M Daniel, Rwandan Minister of Health; Prof Miliard Derbew CEO KFH and Dr Giel Van Schalkwyk, Chief Surveyor of COHSASA.
KING FAISAL HOSPITAL KIGALI has become the first hospital in Rwanda to receive a four-year accreditation award from The Council for Health Service Accreditation of Southern Africa (COHSASA). The occasion was celebrated at a ceremony on October 29, 2020 held at the Marriott Hotel in Kigali.
Speaking at the ceremony, the Minister of Health in Rwanda, Dr Ngamije M Daniel, commended the facility on its determination and intent to meet the needs of its patients and exceed their expectations while maintaining a good attitude, empathy, professionalism, accountability and teamwork.
The Minister of Health said the government of Rwanda holds King Faisal Hospital Kigali in high esteem, but that consistency should be observed.
Dr David Nzanira, CEO of HQS Consulting who leads the facilitation of the quality improvement process at several hospitals in Rwanda.
Professor Miliard Derbew, newly appointed CEO of King Faisal Hospital Kigali, gave that assurance. He attributed the success of the hospital to constant collaboration with the COHSASA team. “We will keep the momentum and we are confident our standards will remain outstanding. Our first priority is the patient, and we will ensure standards remain constant.”
The accreditation journey of King Faisal Hospital Kigali in Rwanda began in 2006 when COHSASA conducted a baseline survey to assess the hospital’s level of compliance with accreditation standards. The hospital did not do well, scoring a mere 41 out of a possible 100.
However, from this low baseline emerged, over time, a hospital that has just been awarded the four-year accreditation against internationally accredited standards, making King Faisal Hospital Kigali the first healthcare facility in Rwanda to achieve this distinction.
The award means that King Faisal Hospital Kigali shares this position with an elite group of 56 facilities in Africa to have achieved a four-year accreditation to date, of which 30 are hospitals.
Four years after the first ever survey conducted and after much work by hospital staff, King Faisal Hospital Kigali scored an impressive 86 out of 100 at an external survey in February 2010 and received an Intermedial Level Graded Recognition Award. A mere nine months later, the hospital received its first two-year full accreditation award (conferred on 18th February 2011), scoring 99 out of 100.
The surveyors report at the time read: “It is evident that the culture of quality improvement and management has become well entrenched in the organisation, and quality management processes, which include clinical audit programmes, are now well-established throughout the facility. Physical facility requirements are not yet being met in all areas, but these improvements are being planned as part of the hospital’s upgrading plans.”
In 2013, the hospital once again excelled, scoring 99 out of a possible 100 points and was awarded a three-year accreditation in May 2013. Then there was a setback.
After a traumatic re-structuring process in the hospital which left many staff reeling, the hospital again delivered a triumphant result: 98 out of a possible 100 and they were awarded a three year-accreditation in September 2016. This three-year award was extended from September 2019 to March 2020 due to special circumstances surrounding changes in the governance and contractual arrangements for the management of the facility.
One week before South Africa was placed into lockdown during the 2020 COVID19 pandemic, an external survey was conducted at King Faisal Hospital Kigali. The hospital achieved a score of 98 out of a possible 100 and was accredited for four years.
Dr Edgar Kalimba, Former Acting Chief Executive Officer and present Deputy CEO of King Faisal Hospital Kigali who led the most recent accreditation process, said that over the many years of the facility’s involvement with COHSASA, the culture of quality improvement has become an entrenched part of everyday hospital routine.
“Accreditation has given us a structure within we can work. Staff know what they must do, how they must do it and how they can measure whether they have done it effectively. This makes governing and managing a hospital so much easier.”
He said the standards spelt out clearly and unambiguously what needed to be done. “The standards create a structure which sets the tone for everything we do.”
He believes that formal training in quality improvement and patient safety should be available more readily and that key leaders in hospitals should receive formal training in quality improvement (QI).
He said that COHSASA’s standards relating to infection prevention and control has assisted the hospital in the treatment and isolation of COVID19 patients who, although they are not actually treated there, are referred onwards to treatment centres established by the Ministry of Health in collaboration with Rwanda Biomedical Centre.
In a message sent to King Faisal Hospital Kigali, the CEO of COHSASA on the occasion of the accreditation ceremony, Ms Jacqui Stewart, said: “The four-year accreditation award recognises the healthcare facility teams that have demonstrated a real commitment to continuous quality improvement. The recognition is for all of you – the King Faisal team that has demonstrated over the years that you really care about providing your patients with a high-quality, safe service that meets the best international standards.
“We know that it has not always been an easy journey, there have been major organisational changes over the years – but the spirit and the commitment of the multidisciplinary team has always shone through.
“You have shown that it is not about ticking boxes and getting a high score. It is about real dedication to do the right thing every time – however busy you are. In the current situation in which we find ourselves, with the coronavirus pandemic, this dedication to high quality care is even more important. The value of the systems and processes that you have in place at King Faisal is now deeply appreciated. It is the systems and processes and the commitment to quality that protect the patients and the staff. Never take short-cuts – keep doing the right thing every time.”
Construction on the hospital had begun in 1987 and was completed in 1991 with financial assistance from the Saudi Fund for Development (SDF). It was designed as a 200-bed facility. During the Rwandan Civil War, the hospital dealt mainly with casualties but became a fully-fledged public health care facility thereafter.
In 1998 the hospital turned into a private for-profit – institution as part of an agreement between the Ministry, private shareholders and Netcare International. This agreement came to an end after nine months and the hospital obtained registered status as a not-for-profit entity with funding from SDF, ministerial subsidies and local revenue generation.
King Faisal is one of three regional/referral/academic institutions in Rwanda and operates as a fully-fledged acute care facility with fulltime specialists in most of the major disciplines with further development of tertiary services envisaged. It admits paying patients.
In April 2016 a Concession Agreement for five years was awarded to the OSHEN Healthcare Group to manage the hospital; however, this contract was terminated prematurely in April 2019 due to the fact that OSHEN did not honour the agreement regarding important aspects, resulting in a loss of income, reduction of personnel and substandard service delivery. Subsequently, the oversight of the hospital reverted to the Rwandan Government.
King Faisal is a major resource in healthcare provision in Rwanda and offers the highest level of care locally. It admits paying patients funded from different sources ranging from private healthcare funders (insurers) to government subsidies. The hospital operates Rwanda’s medical referral funds and coordinates any patient referrals from Rwanda to other countries as approved by the Medical Referral Board. This referral rate has dropped substantially over the years because of the success in developing local clinical expertise.
Upgrading of the hospital facilities has been on the cards for several years but this has now started with a major phased building project, to be followed by rehabilitation of the existing buildings.
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If you are driving past Groote Schuur Hospital in the next month and wonder why the building is bathed in orange light, it is because the hospital has embraced the call by the World Health Organisation to mark the month of September – and particularly World Patient Safety Day (WPSD) on 17th September – as a day dedicated to the safety of both patients and staff.
In this dark year of COVID19 we need some light. The theme for this year’s WHO World Patient Safety Challenge is the well-being and care of healthcare workers. To promote WPSD, all participating countries are asked to light up monuments or iconic buildings in their towns and cities across the world. Last last year COHSASA arranged to light up the statue of Nelson Mandela on the Grand Parade – have a look at our video https://www.youtube.com/watch?v=kQGWlofUOUU&t=20s.
The WHO WPSD theme is to ensure the well-being and care of healthcare workers. After all, if they are in bad shape, how can they attend to the needs of patients? It has been estimated that the mental toll on health professionals and all those working in the healthcare system has been extreme. A shortage of personal protective equipment, isolation, social distancing, staff shortage, the nearness of death, the loss of colleagues – all these have conspired to turn COVID19 into a war and it has taken the lives of nearly 300 South African health workers.
Plans are in place to create a psychological support network for healthcare workers where they will receive up to four free sessions of counselling, attend support groups and have various programmes in place to deal with the stress they have to manage every day.
COHSASA, together with the Clinix Group and IQHealth Consulting, has arranged a World Patient Safety Webinar on 29th September at 10h00. The topic cover the Mental Health and Psychological Care for Health Care Workers and features five expert panellists, moderated by COHSASA CEO, Jacqui Stewart. The views expressed in this webinar and the information gained could be of value. If you need more details, email firstname.lastname@example.org.
Left Above: Jacqui Stewart (left), CEO of COHSASA hands over accreditation certificate to a proud Helderberg Hospice CEO, Gail Sykes.
Right Above: The dedicated staff of the helderberg Hospice
Sheer grit and determination of staff at the Helderberg Hospice in Somerset West in the Western Cape was required, and delivered, for the facility to receive its fifth accreditation in the middle of a global pandemic. The accreditation means that the hospice meets robust international standards as determined by the Council for Health Service Accreditation of Southern Africa (COHSASA).
The CEO of COHSASA, Jacqui Stewart, is on record as saying that accreditation is not a sprint – it is a marathon. In the case of Helderberg Hospice, the journey has been 14 years from its first entry into the quality improvement and accreditation programme. Accreditation is not easy to achieve and it takes even longer to get to a point where quality improvement is embedded – in other words, it is simply a way of being in any institution. From the time Helderberg Hospice entered the programme in May 2006, it has achieved a two-year full accreditation and four three-year accreditations. The current accreditation is valid until August 2023.
Commenting on their latest accreditation, CEO of the Helderberg Hospice, Gail Sykes said:
“Every staff member of Helderberg Hospice has been involved, to a greater or lesser degree, helping us attain our COHSASA accreditation. Our organisation has followed the accreditation guidelines for many years and used it as a living template in order to ensure good governance and the best practices in every department. We have always been of the opinion that it must work for us and not the other way around – we cannot afford to window-dress any situation and that has therefore never been the case. The process itself is ongoing and we refer to the standards and resultant policies on a daily basis, ensuring that all protocols are followed.
“We must be one of the few organisations that had their final survey directly affected by the Covid-19 virus and resultant lockdown! Our external survey was scheduled to start on 24th March 2020, so with the announcement of the complete lockdown due to commence at midnight on the 26th, our survey had to be postponed at the very last minute. Accommodation and travel plans had to be changed and a new date requested. Our final survey eventually started on 14th July and we were all very pleased to finally reach a conclusion.
“We, as an organisation, are all very proud of our international COHSASA accreditation.”
CEO of COHSASA, Jacqui Stewart, commenting on conducting external surveys at this taxing time said, “We had to ensure that the environment would be safe for the surveyors. The team at Helderberg was able to do this and the surveyors were able to see all that they needed to. It is the only onsite activity that we have been able to do since March. I congratulate the Helderberg Hospice team on their achievement, which is great for their patients”.
Much too often South Africans hear of horror stories about our public sector health facilities and the lack of care. So, during the health crisis brought about by the coronavirus pandemic and an influx of patients with suspected COVID19, it is refreshing that Council for Health Service Accreditation of Southern Africa (COHSASA) personnel and their relatives have had positive experiences when attending public health clinics in Cape Town, specifically Tafelsig Clinic in Mitchell’s Plain run by Cape Town City Health and Hanover Park Day Hospital run by the Western Cape Province.
The COHSASA team has happy memories of working with Tafelsig Clinic when it was participating in the COHSASA accreditation programme. (COHSASA is a quality improvement organisation that assists health facilities reach high standards of care). Tafelsig was accredited three times against internationally recognised standards.
Memories aside, it seems quite fair to speculate whether the good service this clinic provides is, in part, due to the fact that certain beneficial processes and policies were put in place during the COHSASA programme persist to this day.
Being involved in setting standards and monitoring quality improvements in health facilities all around Africa makes our staff super sensitive to the level of care received and the implications for quality care and patient safety.
So, it is good to hear that they have felt cared for and health staff have gone out of their way to ensure that patients are carefully checked and cared for. Of course, things do go wrong, and we know that but these stories may go some way to dispel the overarching negativity that we might be feeling about everything at the moment.
Our resident Travel Coordinator, Roselyne October observed this about the City of Cape Town’s Tafelsig Clinic, situated in Kilimanjaro Street in Mitchell’s Plain:
“My mom- in-law of 83 had a nagging cough and after a few days she was tested at Tafelsig Clinic. On arrival she was assisted with great care to fill out the form. They checked her weight, her blood pressure, took bloods and took her temperature and told she had to wait a few minutes. She said it was a bit sore and she became quite tearful but happy she did it for peace of mind. She has not received results as to whether she is COVID19 positive, but she is feeling much better and her cough is almost gone.
Even though she was scared I think the staff really did an outstanding job.
Thank you to Tafelsig Clinic staff, I know during this period it’s not easy, but you really live out your oath daily for the community.”
Dr Paul Nkurunziza, acting Director for City Health, and his team commented:
“It is wonderful to read such a positive story. At City Health we take client satisfaction and the Batho Pele principles very seriously. It is heart-warming to see the Tafelsig management and team actually putting them into practice. It is also clear that our long association with COHSASA continues to bear fruit in the way our staff approach their work in general and their clients in particular. To Tafelsig Facility Manager and your team, we say ‘Well done! You have totally embraced the patient centred approach.’
Another COHSASA team member, Cheryl Adams, had this to say about her experience at Hanover Park Day Hospital.
“My mother and daughter are both patients at Hanover Park Day Hospital. Since the beginning of the lockdown, the facility started delivering patients’ chronic medication at home, thus removing the need for patients to physically collect them.
“The normal procedure is for patients to see a doctor every six months for a script for the medication. Due to the pandemic and lockdown, the scripts were extended from 6 months to 12 months.
“My mother has pulmonary hypertension and is required to have a blood test done every six weeks. When she visits the facility, she is not expected to wait at reception. She is allowed to go straight to the relevant department to draw blood and is in and out of the facility within half an hour. The next day they call her to let her know the correct dosage of Warfarin that she should take. From a patient perspective, I’m impressed with the changes the day hospital implemented to accommodate and limit risk to patients.”
Dr Keith Cloete, Head of the Western Cape Health Department says: “It is heart-warming to us all when a member of the public takes the time and makes the effort to give recognition to our staff members. I am immensely proud of the frontline staff of the Western Cape Department of Health, that continue to serve our communities with humility, empathy and compassion, during this difficult time”.
The first Life Healthcare hospital in South Africa, the Kingsbury Hospital in Claremont, Cape Town, has been accredited for two years by the Council for Health Service Accreditation of Southern Africa (COHSASA). We spoke to the Hospital Manager, Christine Malan, to find out how and her team she experienced the COHSASA programme. Here are her answers to our questions – they reveal an honest response to our programme. No filters!
When did you first encounter COHSASA?
My first encounter was when Life Healthcare indicated that they are investigating obtaining accreditation from COHSASA.
What was your initial response to the standards and the process you were facing?
Initially it was a bit overwhelming, but as we became more comfortable with the layout and processes, we came to realise that it captures our daily processes and procedures.
Did you feel you received adequate support from COHSASA throughout the process?
How do you think accreditation has helped you?
It has allowed us to view our way of work from a different angle, to find new approaches to problem-solving and find sustainable solutions to support continuous improvement.
What benefits do you think you have got out of the process – both direct and indirect?
Direct – The process challenged my way of thinking and reviewing processes.
Indirect – I have seen how some of staff have developed and how they have stepped up to challenges that might have been outside of their normal scope of practice or function.
How do you think patients have benefitted from the quality improvement and accreditation process?
Any improvement to processes and quality will benefit our patients as our patients remain at the centre of everything we do.
Although accreditation costs money and is regarded as an investment, do you think you ultimately saved money (over the long run) because of processes and policies that had to be in place?
It is difficult to say without doing a return of investment calculation. We have BSI accreditation (ISO 9001) which assisted with the planning and processes, but at this early stage it would be difficult to calculate or comment on whether we will save money in the long run.
Do you think surveys should be unannounced?
Certain aspects of the surveys were unannounced like night visits. To me that was sufficient as we would still want staff to have a learning opportunity and ensure that appropriate resources are available to support an effective survey.
If you could change one thing about the COHSASA programme what would that be?
The frequency of the self-evaluations is very strenuous. That might be due to the current Coronavirus pandemic, but if these were twice a year instead of every 8 weeks, if would in my view allow for more in-depth evaluation and effective (cost and resources).
The entrance to the Kingsbury Hospital in Claremont Medical District, Cape Town.
Latest hospital accreditations awarded by COHSASA
The first Life Healthcare hospital in South Africa, the Kingsbury Hospital in Claremont, Cape Town, has been accredited for two years by the Council for Health Service Accreditation of Southern Africa (COHSASA).
This means that the hospital meets over 3 800 rigorous criteria to provide safe, quality care to its patients. This is especially important during the current Coronavirus Pandemic where hospital systems are under strain, particularly in the Western Cape where there appears to be a higher caseload than in other provinces.
A COHSASA accreditation award means the healthcare organisation has entered a rigorous quality improvement programme and has been assessed against, and complies with, standards recognised by the International Society for Quality in Health Care (ISQua), the global body overseeing accreditation and quality improvement programmes in healthcare organisations in 70 countries around the world. COHSASA itself is accredited by ISQua as are its standards.
The healthcare facilities listed below have also been awarded accreditation by The Council for Health Service Accreditation of Southern Africa (COHSASA), a not-for-profit company (NPC) based in Cape Town.
Healthcare facilities that initially enter the programme and meet standards are awarded two-year accreditations and as the journey in improving quality continues, awards of longer duration are given. A four-year accreditation award from the Council should signal to patients that a facility has sustained an excellent level of standards over a commendable period.
|Name of Facility||Location||Accreditation Award|
|Life Kingsbury Hospital||Claremont, Cape Town||Two Years’ Full Accreditation|
|Mediclinic Durbanville||Durbanville, Cape Town||Four Years’ Full Accreditation|
|Mediclinic Cape Gate||Cape Town||Three Years’ Full Accreditation|
|Nairobi Women’s Hospital, Adams Branch||Nairobi, Kenya||Three Years’ Full Accreditation|
|King Faisal Hospital||Kigali, Rwanda||Four Years’ full Accreditation|
In the table above, it is thus possible to safely assume that the standards of quality and patient safety in both Mediclinic Durbanville and King Faisal Hospital in Rwanda have reached long-term and institutionalised levels. Mediclinic Cape Gate has been accredited a commendable three times since it opened. Nairobi Women’s Hospital, Adams Branch has been accredited for a second time and is the first hospital in Kenya to achieve COHSASA accreditation. The rest of the hospitals in this private Kenyan group are working towards accreditation.King Faisal Hospital is a public sector hospital in Rwanda, and this is the hospital’s sixth accreditation award.
All facilities that receive accreditation awards must undergo either a remote or onsite interim survey halfway through the period to ensure that standards are being maintained.
As the full impact of the lockdown announced by the State President, Cyril Ramaphosa, begins to take hold, many South African are wondering whether they should get tested for the Coronavirus and if so, how do they go about it. The Hospital Association of South Africa (HASA) has provided some useful website links for your use. Mark Peach, Executive of Public Affairs says:
“As we speak, the pathology labs are under tremendous pressure. So too, many hospitals. Understandably, many people are worried, and many are walking in to both and demanding testing. Many are asymptomatic and have not been exposed to anyone positive for the coronavirus. Consequently, supplies are under strain, staff are increasingly in distress, and hospital protocols are being disregarded. Can we start by getting this message out, that there is a protocol as to who should, and who should not be treated. That protocol is here, under the heading “Criteria for Person Under Investigation (PUI)”: http://www.nicd.ac.za/diseases-a-z-index/covid-19/. Also,
1. Please note the following freely available information and resources:
a. The NICD website (http://www.nicd.ac.za) and the Department of Health information portal at https://sacoronavirus.co.za/ are indispensable.
b. All the private hospitals have a range of information and communication tools (see http://www.netcare.co.za; http://www.lifehealthcare.co.za; http://nhn.co.za; http://www.mediclinic.co.za; http://www.lenmed.co.za), among others.
c. Mediclinic has an online personal risk assessment tool. Fill in the fields and find out in a minute whether a test is necessary. It is at https://www.mediclinic.co.za/en/corporate/corona-virus/covid-19-risk-assessment-tool.html. Please share this as widely as you can. An assessment preceding testing will reduce the pressure on path labs and hospitals. Let people know.
d. Discovery Health also has a highly informative and useful Covid-19 information hub at http://www.discovery.co.za as does GEMS at https://www.gems.gov.za/corporate/news-and-events/COVID—12-Coronavirus
3. As you know, our future success in managing Covid-19 depends on the success we have in enforcing and observing social distancing. I have made excellent infographics available at https://1drv.ms/u/s!Ao780VrDACpfZ3AdmUslCsuAF8Q?e=Z1aAUB that you can download and share. Included is a wonderful flow chart that deals with the management of fellow South Africans from identification, to diagnosis and through to discharge – this is indispensable for the physicians among you.”