An integrated approach required
Jacqui Stewart, CEO of COHSASA
The global commitment to reach the Sustainable Development Goals by 2030 include providing high-quality promotive, preventive, curative, rehabilitative, and palliative health services to all communities.
However, a recent joint global report by the World Health Organisation, the Organisation for Economic Co-operation and Development, and the World Bank Group, found that quality of care, particularly in low- and middle-income countries, is suboptimal and that, in several African countries, accurate diagnoses are made in some cases, as little as a third of the time, and clinical guidelines for common conditions are adhered to less than 45% of the time.
With an average of just one doctor to every 10 000 people in Africa, the lack of human resources contributes significantly to the challenges in delivering quality care to patients.
Jacqui Stewart, CEO of The Council for Health Service Accreditation of Southern Africa NPC (COHSASA) believes that issues of quality should take centre stage on health policy reform agendas and that aid funders could play an important role in assisting governments to drive cohesive quality programs. She adds that good resources, such as the WHO Toolkit on implementing a policy strategy, already exist but are not always implemented effectively.
Stewart adds that COHSASA, the only internationally accredited quality improvement and accreditation body for healthcare facilities in sub-Saharan Africa, sets quality standards which cut across the entire facility and empowers healthcare facility personnel to bring about improvements and meet standards through their own efforts.
“Accreditation is a marathon, not a sprint. Good quality and safety standards must be holistic and integrated across all levels and departments of a healthcare facility in order to result in better patient care,” she says.
Dr Lydia Okutoyi, Obstetric Gynecologist at Kenyatta National Hospital in Nairobi and speaker at this year’s Africa Health Conference, believes that child and maternal health are a good indicator of the quality of care within a country’s health system. She says that, while there has been some progress on the continent, there is still an unnecessary high burden of maternal mortality from preventable conditions, such as obstructed labour, sepsis, and abortion-related conditions.
Dr Okutoyi adds that improving quality and outcomes must be a holistic effort that includes empowering women to know when to seek care. Respectful care is another key factor in providing quality and safe care.
“Respectful care means not only care that is technically correct but must also enable the mother to feel safe through, for instance, applying good hygiene standards,” says Dr Okutoyi.
Both experts believe that communities can and do play a significant role in improving the quality and safety of care. In obstetric care, this could mean educating birth attendants or doulas on the danger signs during pregnancy, the importance of ante-natal care for the mother, or the establishment of ‘waiting homes’ close to a health facility for women who live in remote areas.
Stewart believes that by including quality and standards education at undergraduate level for all healthcare professionals, these principles would be inculcated into the health system and in turn would assist in bringing about system-wide positive change.
Both Jacqui Stewart and Dr Lydia Okutoyi will address delegates at the 9th Quality Management & Patient Safety conference, which features prominently on this year’s Africa Health Exhibition and Conference programme.
This day-long session will be held in partnership with COHSASA and will include topics such as:
- What is happening in Africa – An overview of interventions and strategies to bridge Reflecting on competing priorities for quality improvement in the African context
- Leading institutional change – Driving safety and quality measures in a Kenyan tertiary care training institution
- Reflecting on opportunities and quick wins for patient safety in Africa today
- COVID19 resiliency at the frontline
- The role of standards, regulation and accreditation in quality and safety
- Leadership for quality at all levels
Issued by HWB Communications Pty Ltd on behalf of Africa Health.
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Proud members of the team at Mediclinic Milnerton accept the COHSASA 4-year accreditation certificate from Jacqui Stewart, CEO of COHSASA. With her are facility Manager, Anne Marie Nortje and Rehana Olivier.
Despite the hardships imposed by the COVID19 pandemic, Mediclinic Milnerton has been awarded a four-year accreditation by COHSASA signifying that the healthcare facility has achieved a high level of excellence.
A COHSASA accreditation award means that Milnerton Mediclinic has entered a rigorous quality improvement programme and been assessed against, and complies with, standards recognised by the International Society for Quality in Health Care External Evaluation Association (IEEA), the global body overseeing accreditation and quality improvement programmes in healthcare organisations in 70 countries around the world. COHSASA itself is accredited by the IEEA as are its standards. COHSASA is the only accrediting body for healthcare facilities in Sub-Saharan Africa recognised by the IEEA.
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.
All facilities that receive an accreditation award must undergo an interim survey halfway through the period to ensure that standards are being maintained.
The following facilities have recently had remote surveys (called Interim Surveys) to check whether standards are being maintained halfway through a four-year accreditation award and COHSASA is please to report that they have maintained standards:
Nigeria LNG Hospital
Due to the COVID19 pandemic, COHSASA has had to change its implementation model to include hybrid evaluation surveys. This means that only one surveyor is onsite while two surveyors connect remotely from Cape Town.
The first hospital to be accredited by COHSASA using a “hybrid” model (remote surveys included in the implementation of the programme) has received a three-year award. This is the Lady Pohamba Private Hospital in Windhoek, Namibia. The second hospital to achieve a three-year accreditation by this method is the Arwyp Medical Centre in Kempton Park, Gauteng. Both hospitals were delighted to receive news of their achievement this week.
A remote survey, increasingly being used by healthcare accrediting agencies in a COVID19 world, means that – where feasible and accurate – surveyors will review compliance issues in hospitals on Zoom (or other digital platform) with the assistance of at least one surveyor physically on site. The development has come about due to travel and social distancing restrictions imposed by the pandemic.
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 External Evaluation Association (IEEA), the global body overseeing accreditation and quality improvement programmes in healthcare organisations in 70 countries around the world.
COHSASA itself is accredited by the IEEA as are its standards. COHSASA is the only accrediting body for healthcare facilities in Sub-Saharan Africa recognised by the IEEA.
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. All facilities that receive an Accreditation Award must undergo an interim survey halfway through the period to ensure that standards are being maintained.
It is thus possible to safely assume that both the Lady Pohamba Hospital in Windhoek, Namibia and the Arwyp Medical Centre in Kempton Park, Gauteng are well on their way to achieving consistent safe and high levels of care.
The Council for Health Service Accreditation of Southern Africa (COHSASA) has elected a new Chairperson and Vice-Chairperson to lead the organisation.
The new Chairperson is Dr Bradley Beira (MTechC (Chiro), ICSSD, BCom Law (Unisa), LLM (UK), a corporate advisor with many years of international and South African board and executive experience. Dr Beira, Managing Director of the Advisory Group, has expertise in the application of a risk-managed approach to compliance, governance and legal and regulatory frameworks. He is the Chairperson of Safe Surgery South Africa, Chairperson of Hospice Wits and a corporate advisor to the South African Medico-Legal Association.
Commenting on his election, Dr Beira said, “I have been passionate about the healthcare experience for 35 years. I recognise that access to quality healthcare involves many people – patients and their families; practitioners and their support colleagues; people supporting the medical technology and device industry; medical funders and legislators. Promoting ongoing and continuous improvement in care quality – and the experience related to accessing quality health care – takes coordinated and selfless effort from everyone in every sector of the health industry.
Full spectrum of health care
“I have had the privilege of working across the full spectrum of health care: private practice, health risk, in the non-profit space, with health insurers and funders and as a medicolegal advisor. I have also had the privilege of collaborating with remarkable people to positively influence the ongoing journey towards the highest quality health services for the widest number of users.
“It was with great pleasure that I accepted an appointment as a Board member of COHSASA in 2020 and it is my honour to serve as Chairperson of the Board as of 2021.”
The newly elected Vice Chairperson is Mr Nhlanhla Nene, the former Minister of Finance in South Africa
Mr Nene, who was appointed as Minister of Finance in 2014 in South Africa and re-appointed in 2018, holds several non-executive board memberships, Chair and advisory positions including with the Thebe Investment Corporation, Arise BV, the Empact Group, Grobank and GroCapital Boards of Directors.
He was a student activist in the 70s and served as a shop steward at the Metropolitan Life Insurance Company during the first industrial action in the financial sector under the banner of SACCAWU. He gradually rose through the ranks of the ANC holding various leadership positions.
He was elected as a local government councillor in the first democratic municipal elections in 1996 and elected to the National Assembly as an MP in 1999.
Mr Nene has a B Com (Honours) degree from the University of Western Cape. He is an Honorary Adjunct Professor at the University of the Witwatersrand Business School and serves as resource person in the Harvard Ministerial Leadership Program, held annually at Harvard School of Public Health.
Said Mr Nene on his appointment as vice-Chair: “l am truly humbled by this election to the position of vice-chairperson, less than two years since joining COHSASA. During this short period, I have been immensely impressed with the work that the organisation is doing in the accreditation of health services in Southern Africa and beyond.
COHSASA standards become the norm
“My understanding of the challenges and quality requirements in the sector has been enhanced and I look forward to a time when the quality standards COHSASA promotes become the norm both in the private and public health facilities. I believe that working together with other health standards authorities we can achieve quality, patient safety and universal health care for our communities in the region and continent. “
CEO of COHSASA, Ms Jacqui Stewart, thanked outgoing Chairperson and vice-Chairperson, Ms Sharon Slabbert and Professor Gert van Zyl, for their outstanding contribution to COHSASA. She said both had contributed enormously to the well-being of the organisation in their years of service. Both will remain on the Board.
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”.