The most prestigious Academy in the field of quality and safety in patient care, The ISQua Academy of Quality and Safety in Health Care (IAQS), has welcomed two new members from Africa – Ethelwynn Stellenberg, Emeritus Associate Professor: Department of Nursing and Midwifery at Stellenbosch University and National Chairperson of the South African Medico-Legal Association. She is also a Board Member of COHSASA. The other new member from the continent of Africa is Lydia Okutoyi, Director of Healthcare Quality, Kenyatta National Hospital, Nairobi, and Founding President Society for Quality Healthcare Kenya. The Academy is an organisation that includes distinguished individuals who have made a significant contribution in the field of quality and safety in healthcare. The body is a touchstone, a mark of excellence of leadership within research, academia or service delivery in quality and safety, and is considered one of the highest honors that an individual working in this area can receive. Members of the Academy are elected in a strict nomination process by peers. Professor Stellenberg, although retired and living in the rural paradise of Betty’s Bay in the Western Cape, South Africa, is a busy person. Not only has she earned her stripes in the academic field of nursing science, but she continues to this day to work in partnership with her alma mater, Stellenbosch University, to make a difference to the health of South Africans.
Conducting research into malpractice litigation
She obtained a competitive National Research Foundation (NRF) award to conduct malpractice litigation in nursing practice in South Africa. This research study included two master’s degree and one PHD student. By 2018 she had shown the problems contributing to malpractice litigation in private healthcare, and continued the same research in the public sector in 2020. Prof Stellenberg noted that the research found that statistically there was no difference in the clinical care offered in the private and public sectors which led to adverse events and consequently litigation. Similar problems contributed to malpractice litigation. Statistics that showed a country-wide lack of leadership and poor clinical standards in South African healthcare facilities galvanised Prof Stellenberg when she was a Board Member of the Office of Health Standards Compliance (OHSC), the South African body that oversees compliance with standards in its health facilities. Says Professor Stellenberg: “I served on the board of the OHSC for six years and I was shocked at the outcome of inspections of our health institutions. With no exception, all provinces are affected. A major problem was management and leadership – corporate governance and operational management.
Facilities were non-compliant
“All these facilities were critically non-compliant,” says Prof Stellenberg. “We discovered that at a particular clinic, if the registered nurse was absent from the clinic, the gardener was giving out medicines to patients! So, I obtained funds to build the capacity in leadership and management of operational nursing managers in primary health care in two provinces in 2018-2021. An accredited programme of 60 credits offered by Stellenbosch University was implemented in 2018. There were at least 30 students in a group, but this number was eventually increased to 40 students in one of the provinces. We discovered a wide range of issues: some of these students working at clinics did not even know how to use a stethoscope! “COVID-19 interrupted this ambitious project with other academics to build capacity but in 2021, the Eastern Cape came on board as well. “The Eastern Cape has very high litigation levels for medical malpractice, and in 2021 they wanted us to start the tutorials urgently. We designed a module on malpractice litigation/clinical negligence as part of the accredited programme in capacity building in leadership and management of nursing service managers and operational nurse managers. “We extended the programme to cover all levels of care, not just primary health care. Our group of four academics now taught 56 students from all over the Eastern Cape. A second group of 60 students, supported by Discovery Health, were registered in 2022. The programme included 40 hours of practical, a week of face-to-face teaching and four hours of online lectures for five months. The pass rates were very good (87%) and only a few did not complete the required work.
Four provinces now involved
“The Free State now wanted to join, even if there was no funding available. Their DOH said they would pay whatever the university charged. Four provinces are now involved in this training, and it is ongoing. A total of 60 students from the Free State will be registered in the programme. There is every likelihood that the programme will be extended beyond nurses to all categories of hospital workers, depending on what they need to learn.” If that is not enough to keep Prof Stellenberg busy, she is also the National Chairperson of the South African Medico-legal Association (SAMLA). Of interest is the high rate of malpractice litigation in healthcare in South Africa which could be an astronomical expense if all cases went to court. To reduce legal costs and avoid lengthy court cases, SAMLA has conducted a pilot study offering free mediation to 50 litigation cases involving the Gauteng Department of Health and 100 cases for the Road Accident Fund. “Mediation is saving millions of rand by avoiding court,” she says. “We are also working on a new foundation programme in medico-legal practice to teach healthcare professionals about the subject. All this is done online. The programme starts in August 2023.” Prof Stellenberg was a reluctant nominee for the ISQua Academy. She is modest. Her actions to uplift the poor in the Western Cape would exhaust anybody else and her efforts are focused, principled and waste-free. For example, a school in Kuilsriver (a suburb on the northern edge of Cape Town) with many problems approached a Japanese shipping company for R50 000. Prof Stellenberg was asked for her opinion on how this potential donation could best be used. After a brief orientation of the issues, she immediately said the school needed a social worker paid for three years, with an office and all resources paid by the shipping company to sort out many of the schools underlying social problems. The school agreed, set up an office, employed a social worker, got the learners into numeracy and literacy projects, retrained retired teachers, and created a school environment where the learners received many prizes. “Their frowns turned to smiles. We need to prevent problems, not put our fires,” she says of the school project that cut across cultural barriers, economic barriers (the rich and poor worked together to create a better school) and racial barriers. This project – and many others like it including one at the West Coast fishing village of Paternoster which is now a popular tourist resort – earned Prof Stellenberg the University of Stellenbosch Rector’s Award for excellence in community engagement. For Prof Stellenberg there is no such thing as retirement: “My end will be the day my eyes close…” For more information on the ISQua Academy of Quality and Safety, see this link: https://isqua.org/resources-blog/blog/international-academy-of-quality-and-safety.html