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.”
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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.
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.
|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|
Dr Temitope.I. Bakare BDS, MPH, FMCFD (pictured here), is a Nigerian. She is a Quality Improvement Mentor (presently overseeing QI projects in two General Hospitals in Lagos State). She is also a Consultant Family Dentist with a Masters in Public Health. She often felt frustrated at the majority of past public health conferences which focused on “Governance” because its implementation was way beyond her reach.
In June 2019 she encountered the COHSASA CEO, Jacqui Stewart, who gave a presentation at ISQua’s regional conference in Lagos on Patients’ Experience of Care. “Jacqui so inspired me with solutions she tendered which were low hanging fruits for the average frontline worker. I decided to take advantage of the wonderful concessions offered to delegates from LMICs and attended the ISQua conference in Cape Town”.
In January this year, President Muhammadu Buhari launched the second National Strategic Health Development Plan from 2018-2022 to attain the Universal Health Coverage in Nigeria. This included quality improvement strategies in six cluster areas of the country. Although, Lagos state was not included in the 1st phase, quality improvement trainings and projects had commenced across the board at the 26 General Hospitals since 2016.
Temitope says the ISQua conference had empowered her with feasible action plans she could easily execute back home. “The conference was such a well-organised and professionally rewarding experience for me. ISQua must be commended for offering special rates to African delegates”.
The content of the conference was well-balanced and gave her some practical guidance on how to fix immediate problems in her clinical setting. To fix some of these would not cost anything! “The traditional African opening ceremony for her was a ‘wow’ experience with delegates in different traditional attires. This created a feeling of unity amongst the over 1000 delegates from 84 countries. “I learnt so much from both “The African Community of Practice and The Learning Journey Sessions” (which spanned three days) on Data, Co-production and Patient Safety”.
Take home points from these three Learning Journeys included: i) The need to resonate on the stories behind the data, ii) The need to synthesize “patients’ lived reality” with “health workers reality of care” and iii) being empowered to take up the safety challenge on medication without harm (especially in the areas of Poly pharmacy & Multi morbidity in her two facilities). She also learnt about the amazing potential of digital platforms to enhance the efficiency of patient care especially the role of smart mobile phones in educating patients (PharmAcess & MDoc Sessions). The 4th pillar, used in strengthening the South African Health System, discussed in the plenary session by The Minister of Health, Dr, Zweli Mkhize, also struck a chord in her.
The need for neighbouring private companies around health facilities to step up with their Corporate Social Responsibility in strengthening the health system was noted. At the drive for patient safety, coordinated by WHO, the CEO of ISQua, Peter Lachman, advocated that to “sustain” patient safety, we, the health professionals needed to “engage” and also “nurture” networks with politicians, policy makers and clinicians in our local and international vicinities. He also emphasized that patients should be treated for health and not for disease. Knowing the context of a patient’s life would provide invaluable information for successful clinical outcomes. “I’m so impressed by ISQua and what it has to offer” Temitope says. “I have already started mobilising my colleagues to save for Florence 2020.”
To read more about Dr Temitope. I. Bakare’s experience on each of the conference days at ISQua2019 go to these links:
For three days, COHSASA personnel acquired a glimpse of the work being done internationally in the field of quality improvement and safety in healthcare when well over 1000 delegates from 84 countries gathered at the CTICC in Cape Town, for the annual International Society for Quality in Health Care Conference – a first for Africa. From the opening session, with wonderful drumming, singing and dancing to the closing session, it was a time of magic and learning. The general consensus: roll on next year when we can meet again in Florence!
Click here for extended videos:
Cultural Performance at ISQua’s 36th international conference in Cape Town.
Opening session of ISQua’s 36th annual conference in Cape Town, South Africa