Approach

The overall purpose of COHSASA is to make hospitals (and other health facilities) safer and better. The approach used is systems-based with a focus on technical, managerial, administrative, infrastructural and support systems. Ensuring that all systems improve simultaneously and consistently over time, COHSASA assists a range of healthcare facilities to meet and maintain quality standards. Healthcare professionals are trained to measure themselves against these standards and monitor improvements using our quality improvement methods via a web-based information system.

Our work shows us that strictly applied quality improvement methods can improve patient safety and the quality of care by guiding interventions, monitoring progress and identifying improvements. We also identify impediments to improvement and develop strategies to overcome them.

Because  COHSASA has worked primarily in developing countries (and most especially Africa) , it has created strategies to help facilities stay on the path to accreditation. In 2001, COHSASA pioneered a Graded Accreditation Programme to encourage and assist hospitals  that do not initially achieve accreditation, but which make significant strides, to continue the path to excellence.

Graded Accreditation

This is an approach where COHSASA rewards improved service provision by issuing Pre-Accreditation certificates at Progress, Entry and Intermediate levels. Progress certificates are also issued to individual departments within a facility, and to the facility as a whole, and these provide an incentive to continue the process of meeting increasing levels of compliance with standards, away from an initial baseline.

The challenge is to give recognition to work already completed and the intention of this approach is to encourage facilities to sustain the momentum towards accreditation. This is achieved by establishing a culture of institutionalised and long-term quality improvement. It is also to encourage a sense of ownership in the quality improvement process so that accreditation is the “cherry on the top” of the main objective — substantial, long-lasting quality improvement as opposed to an all-or-nothing window dressing approach.

The other approach that COHSASA has used to help facilities reach accreditation is a facilitated approach, where staff members from  COHSASA visit hospitals and provide assistance in understanding, implementing and monitoring compliance with the standards.

COHSASA provides data on the quality of health service provision to governing authorities so that it can be used for strategic decisions. In the past  26 years over 600 facilities have entered the COHSASA programme.