COVID-19: patient safety and quality improvement skills to deploy during the surge

COVID-19: patient safety and quality improvement skills to deploy during the surge

Authors: Anthony Staines, Rene Amalberti, Donald M Berwick, Jeffrey Braithwaite, Peter Lachman, Charles A Vincent
The authors suggest a five-step strategy and actions through which Patient Safety and Quality Improvement staff can meaningfully contribute during a pandemic by employing their core skills to support patients, staff and organizations.

Latest COHSASA accreditations

Latest COHSASA accreditations

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.

The entrance of Kingsbury Hospital in Claremont Medical District.

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.

 

Should you get a COVID19 test or not?

Should you get a COVID19 test or not?

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.”

What our clients say about us

What our clients say about us

A loyal client responds…

(Above)The South Coast Hospice team and below the late, beloved Dr Andre Nell who saw beyond the wheelchair.

One way to determine if you are meeting your client’s needs is to ask them!

COHSASA decided to find out what one of our most loyal clients, the South Coast Hospice, thought about quality improvement, accreditation and the COHSASA programmes and standards. This is a client that has achieved five full accreditation awards. See Table below.

Facility Name Award Status Award period Year Awarded Awarded On Year Expires Score External
South Coast Hospice Association Intermediate Level 2 2005 2005/03/18 2007 79
South Coast Hospice Association Full Accreditation 2 2006 2006/06/26 2008 99
South Coast Hospice Association Full Accreditation 3 2008 2008/09/12 2011 99
South Coast Hospice Association Full Accreditation 3 2011 2011/11/12 2014 99
South Coast Hospice Association Full Accreditation 4 2015 2015/05/15 2019 99
South Coast Hospice Association Full Accreditation 4 2019 2019/11/22 2023 97

We submitted pertinent questions to the Operations Manager, Shamila Clothier (viewed as a COHSASA champion who keeps policies and processes up to date) and CEO, Diane Van Dyk, to find out what they really think of COHSASA and its processes and standards and what benefits (if any) they derived from the process.

This is what they said.

When did you first encounter COHSASA?

The COHSASA Accreditation process was launched at the August 2004 Hospice Palliative Care Association of South Africa (HPCA) conference in Rustenburg. South Coast Hospice was part of the pilot project and we had our first COHSASA Accreditation survey in November 2004. We were first awarded an Intermediate Level award but after a focus survey, we were awarded full accreditation in February 2005. We had no prior knowledge of the standards we were to be measured against.

What was your initial response to the standards and the process you were facing?

 As we had been chosen as a pilot site, we had a lot of things in place already. However, the initial COHSASA standards that we were measured against were difficult. As part of the pilot development, the South Coast Hospice had been measured against conventional hospital standards. We were an 8-bed patient unit! It was clear the standards needed reviewing and made appropriate for hospices. A Standards Development Committee was established between COHSASA and the HPCA for just such a review.

Did you feel you received adequate support throughout the process?

 Yes. HPCA placed mentors in each Province in South Africa to guide the hospices in the accreditation process and how to interpret the standards.

How do you think accreditation has helped you?

 The accreditation process has helped us in maintaining high-quality standards in all areas of the hospice, from direct patient care to support services.

What benefits do you think you have got out of the process – both direct and indirect?

 Direct – The accreditation process makes us re-evaluate all areas of the hospice and then we can focus on quality improvement and assurance. As CEO, I also believe that the accreditation process acts as a great team builder as all departments are aware of working together to achieve high standards. It certainly allows us all to gain insight into what each department is doing and what they are striving for and this knowledge engenders mutual respect between departments.

Indirect: We have a quantitative evidence base to prove the quality of the hospice services to funders and potential funders.

How do you think patients have benefited from the quality improvement and accreditation process?

 The level of care and service is constantly under scrutiny in terms of satisfaction surveys, incident reporting, and file audits. These processes ensure that the patient is always receiving the best quality care.

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?

 Not really. The polices are constantly reviewed in terms of changes in legislation and the environment. The accreditation process does cost us money and we must fund-raise for this and include it in our budget. Also reviewing policies, printing and stationery does cost a lot of time and money. However, it is worthwhile investment, to ensure compliance and it also helps guide the process when new staff are recruited into the organisation.

 Do you think donors were more attracted to you because of your accreditation status?

YES, and NO. Some donors are impressed, and others are not really interested. We are of the opinion that the donors are not informed as to who COHSASA is. Some donors think that the COHSASA certificate is our registration certificate. South Coast Hospice over the years has had to really adapt to the changing times regarding funding and accreditation keeps us on track.  This is especially true when new staff come on board – it maintains the level of service that is expected from us.

 Do you think surveys should be unannounced?

 Pre-announcing the survey ensures that all team players are available for the survey. It also helps to prepare the staff for the survey.

If you could change one thing about the COHSASA programme what would that be?

The hospices must be given an opportunity to comment on the revised standards before they are implemented.

 

 

 

 

 

 

 

 

Latest COHSASA accreditations

Latest COHSASA accreditations

The healthcare facilities listed in the table below have been awarded accreditation by COHSASA.

A COHSASA accreditation award means the healthcare organisations have entered a rigorous quality improvement programme and have been assessed against, and comply 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.

Hospitals and clinics that initially enter the programme and meet standards are awarded two-year accreditations and as the journey in excellence continues, awards of longer duration are given. A four-year accreditation award from the Council should signal to patients that a facility has sustained standards over a commendable period.

Cure Day Hospitals, Somerset West recently accredited

Name of Facility Location Accreditation Award
Cure Day Hospitals Bellville Bellville, Cape Town, W. Cape Three Years’ Full Accreditation
Cure Day Hospitals Somerset West Somerset West, W. Cape Three Years’ Full Accreditation
Cure Day Hospitals Midstream Midrand, Gauteng Two Years’ Full Accreditation
South Coast Hospice Association Port Shepstone, KZN Four Years’ Full Accreditation
Mediclinic Brits Brits, North West Province Four Years’ Full Accreditation
Mediclinic Muelmed Pretoria, Gauteng Four Years’ Full Accreditation
Mediclinic Nelspruit Nelspruit, Mpumalanga Four Years’ Full Accreditation
Mediclinic Vereeniging Vereeniging, Gauteng Four Years’ Full Accreditation
New Vaal Colliery Health Centre Vereeniging, Gauteng Four Years’ Full Accreditation
Nigeria LNG Hospital Bonny, Rivers, Nigeria Three Years’ Full Accreditation