Botswana begins the health accreditation journey...

Xhosa and Airstrip primary healthcare clinics, feeder clinics for Mahalapye Hospital and Phutadikobo Clinic, situated in the same district as Scottish Livingstone Hospital, have all achieved compliance with standards that have been internationally accredited. The clinics were accredited earlier in the year but celebrations were combined for all the facilities in December to make a big splash! Two wonderful ceremonies were held at Mahalapye and Scottish Livingstone Hospitals.

Scottish Livingstone District Hospital is situated in Molepolole, in the Kweneng East District. The hospital operates as a district hospital and supports a number of surrounding primary healthcare facilities. It is also a designated centre for certain specialised services such as cardiac surgery and ophthalmology.

Mahalapye District Hospital is situated in Parwe Kgotla in Mahalapye village in the Central District region. The village lies halfway between Gaborone (in the south) and Francistown (in the north); the major cities of Botswana. The facility became a district hospital in 1960. A new hospital building complex was completed in 2008 and it currently operates as a fully fledged district hospital with selected secondary services.

These hospitals entered the COHSASA programme in 2009 and they have slowly but consistently worked their way to achieving full accreditation through the implementation of comprehensive quality improvement projects in all areas of hospital operations.

Also handed out at the accreditation ceremonies were the newly-established Katrin Kleijnhans Quality Awards which were given to deserving recipients chosen by their peers at the facilities.

All these facilities were enrolled into a pilot programme with COHSASA and Management Sciences for Health (MSH) in 2009 through the Southern Africa Human Capacity Development Coalition (SAHCD) supported by PEPFAR funding from the US Centre for Disease Control in Botswana.

“Despite a range of serious obstacles, Botswana Ministry of Health and Wellness has persevered with the incremental process of quality improvement and the accreditation of these health facilities marks the beginning of a serious change in the systemic strength of health institutions in this country. By identifying common deficiencies across hospitals, the Ministry was able to intervene and, laudably, make necessary changes,” says COHSASA CEO, Jacqui Stewart.

COHSASA embedded the quality improvement and assurance activities by holding training workshops for representatives from the hospitals and the Ministry of Health and Wellness. These workshops focused on standards interpretation and evaluation and quality improvement methodologies. Thereafter there was an ongoing programme of skills development and support to build local capacity. This enabled the Ministry of Health and Wellness to take over the quality improvement activities, with COHSASA being responsible for the accreditation.

A total of 18 hospitals and clinics are now in the COHSASA accreditation programme in Botswana and the Ministry asked COHSASA to develop healthcare quality standards for that country.

Speaking at the accreditation ceremony, the Minister of Health and Wellness of Botswana, the Hon. Dorcas Magkato said, “Enrolment into this programme has helped the facilities to strive to provide patients with high-quality and safe healthcare services.

“The benefits of accreditation processes are multiple and include among others: improved quality and safety of care; explicit, documented processes; effective teamwork; reduced costs; and enhanced organisational cultures. In other words, accreditation is a process that drives the full scope of improvement which necessarily encompasses the structures, processes and outcomes of service delivery. Let me tell you that the award of full accreditation status reflects high individual and organisational performance.”

www.cohsasa.co.za

Quality improvement and patient safety programmes

The Council for Health Service Accreditation of Southern Africa (COHSASA), a not-for-profit organisation based in Cape Town in South Africa, assists a range of healthcare facilities to meet and maintain quality standards and thereby provide safe, quality services.

In the past 21 years of operation, COHSASA has worked in over 600 facilities in both the public and private sectors in South Africa, Botswana, Swaziland, Lesotho, Namibia, Rwanda, Nigeria, Uganda, Zambia, Tanzania, Ghana, Egypt and Kenya. COHSASA runs programmes in a range of facilities including hospitals, clinics, hospices, emergency medical services, environmental health offices and rehabilitation/sub-acute establishments.

There is a strong focus on building capacity. The COHSASA programme helps healthcare professionals to measure themselves against standards. This approach teaches healthcare workers how to monitor improvements using quality improvement methods, internationally accredited standards and a web-based information system.

COHSASA has achieved global recognition and is the only African health facility accrediting body that is accredited by the International Society for Quality in Health Care (ISQua). Since it achieved its first accreditation award from ISQua in 2002, the Council has maintained its accredited status with three further accreditations. Its current ISQua accreditation status is valid until December 2018.

Two sets of its standards – for hospitals and palliative care – are currently accredited by ISQua and COHSASA’s Surveyor Training Programme is accredited by ISQua until 2018.

The programme developed by COHSASA builds capacity in local organisations so that they can take ownership of the programme from the outset. Initial training is followed by a baseline assessment, where all departments in a facility are assessed against the standards. In an average hospital (+/- 100 beds) about 3,500 measurable elements are evaluated. Quality Advisors (QAs) then train and support staff in quality assurance concepts, quality improvement methods and self-evaluation so that ownership of the data and the overall programme is quickly established.

The Council has introduced a graded recognition process where incremental levels of progress in achieving compliance with standards are recognised through certification. COHSASA certifies departments within facilities and also facilities that do not achieve full accreditation but have achieved acceptable and safe levels of standards compliance and service delivery. This has the effect of encouraging efforts towards full compliance with standards and institutionalising quality improvement.

The web-based electronic COHSASA Quality Information System (CoQIS) allows facility staff to have access to a continuous, easy-to-use management tool that assists them to run their establishments efficiently. CoQIS captures all the evaluation data compiled by surveyors and quality advisors during a baseline survey. This enables users to understand the baseline situation in healthcare facilities, identify deficiencies, prioritise interventions and monitor improving compliance with standards at individual facilities and across groups of them.

The information system enables personnel in healthcare facilities to have direct access to quality improvement data so that they can monitor their performance against standards. CoQIS supports ongoing quality improvement programmes in all areas of healthcare facilities and enables management at all levels to make informed decisions when responding to deficiencies. CoQIS guides hospital management and clinical staff to make targeted, realistic and sustained interventions that will improve quality in a facility.

In addition to its own programmes, the Council also uses the extensive knowledge and experience of its quality advisors to support and train clients using other quality programmes such as the SafeCare Programme and the National Core Standards. The capacity building approach is used to develop skills in quality improvement and quality assurance methods, including self-evaluation against standards and developing quality improvement plans and programmes to address identified deficiencies. The level of assistance provided to clients is determined by client need.

Patient Safety is an integral part of quality health care. In 2006, the Council became the distributer for the Australian Advanced Incident Management System (AIMS) and successfully supported the implementation of a major patient safety programme in the Free State Province.

A similar electronic system, PatSIS, has now been developed by the Council. The patient safety programme currently uses a call centre, located at the Council, where all reported incidents are captured into the system. As soon as the incident is captured, the information is available to the users. When the most serious incidents occur, the hospital CEO and relevant officials are immediately notified by a text message.

The users are required to manage each incident according to agreed protocols, which vary according to the severity of each incident. The process is monitored by the call centre team and by the relevant officer in the facility. The local Department of Health oversees the whole process. The setup of PatSIS can be configured to meet client needs – either with a remote or local call centre or with centralised or remote technical assistance.

The quality improvement and patient safety programmes together offer a highly efficient and effective mechanism for improving patient and staff safety. They enable staff to take responsibility for the quality of patient care and provide invaluable data for research to identify trends that can further improve the care of patients. With staff doing the right thing first time and avoiding errors, the cost effectiveness of care is also improved.

COHSASA offers its services to meet individual client needs so that healthcare facilities are equipped for the long-term to meet the safety and quality health needs of the population they serve in the most efficient and cost-effective manner possible.

¹ The Council for Health Service Accreditation of Southern Africa January 2017
² The Council for Health Service Accreditation of Southern Africa January 2017