Ideal Clinic and Ideal Hospital framework

Question 1

Ideal clinic status elements:

Answer 1

The elements are weighed as Vital, Essential, and important

Question 2

In order for a facility to obtain ideal clinic status it must:

Answer 2

1. Have minimum score 90% of vital elements
2. 70 % essential elements
3. 69% of important elements
   # A facility can get high average and still fail to obtain ideal clinic status, because of failure to obtain the minimum per category.[above]

Question 3

Weighting of measures. [elements]

Answer 3

• Non-negotiable vital
• Vital
• Essential
• Important

Question 4

Non-negotiable vital elements

Answer 4

These are elements that can cause loss of life or prolonged period of recovery

Question 5

Vital elements

Answer 5

Extremely important [vital]. Require immediate and full correction. These affect direct service delivery and clinical care of patients and without these there may be immediate and long-term adverse effects on the health of the population.

Question 6

Essential elements

Answer 6

Very necessary. Require resolution within a given time period. these are process and structural elements that indirectly affect the quality and safety of clinical care given to patients

Question 7

Important elements

Answer 7

Significant elements that require resolution within a given time period. they are process and structural elements that affect the quality of the environment in which healthcare is given to patients

Question 8

How is the Scoring of the Elements done?

Answer 8

-Each element is scored according to the performance of the facility
GREEN - performance achieved
AMBER - performance partially achieved
RED - performance not achieved

Question 9

An Ideal Clinic has:

Answer 9

1. Range of services
2. Provides quality integrated health services
3. A clinic with good infrastructure
4. Adequate staff
5. Adequate medicine and supplies
6. Good administrative processes
7. Applicable clinical policies, protocols, guidelines and partner and stakeholder support.

Question 10

Operation Phakisa

Answer 10

A Presidential initiative in 2014 to bring experts, managers and frontline workers to collaboratively find innovative solutions to respond to barriers and challenges in the health system

Question 11

ICRM is a systems response to initial National Core Standards (NCS) assessment findings and challenges. What were the key findings?

Answer 11

Key findings focused on:
Facility classification
Health technology 
Physical infrastructure
Medicines and supplies management
Quality of care
Functioning of services

Question 12

Primary Health Care Clinics?

Answer 12

Is the first point of contact between the population and the health system.

It acts as a gatekeeper to higher levels of care

Need to promote good health outcomes, rather than just serve ill-health by offering a curative service

Question 13

Primary Healthcare Re-engineering?

Answer 13

• Aims to increase access of health services to the general public and to improve the quality of health services in general.
• District health system model with PHC as a platform for delivery of health services is the Main implementation mechanism.

Question 14

Why do patients bypass the clinics and just go to hospitals?

Answer 14

• Overcrowded facilities
• Long waiting lines
• Medication stock out
• Insufficient and inappropriately trained HR with poor attitudes.
• Poorly structured
• Inaccessible PHC clinics

Question 15

Operational inefficiencies

Answer 15

Inefficient process flow at all facilities:
All patients wait in one area for vital signs monitoring, resulting in bottlenecks and extending patient waiting times

No signage directing patients to appropriate area for waiting

No patient scheduling mechanism in place (patients only given return dates for follow-up, thus inappropriate staff allocation)

No mechanism for tracing defaulters

Poor quality of clinical records/multiple records for same patient

Very little health promotion

Question 16

Numerous challenges faced by Primary Health Care:

Answer 16

• The patients experience low-quality service delivery
• 80% of clinics are not fit for purpose
  -Lack of strong financial management causes PHC facilities to run out of funds early into the year
• ## 2-5 hours waiting

Question 17

Primary Healthcare Re-engineering

Answer 17

• District Clinical Specialist Teams,
• Integrated School Health teams
• Ward based PHC outreach teams
• Contracted General Practitioners

Question 18

Challenges in the Health sector:

Answer 18

• Ineffective and inefficient health system
• Impact of social determinants of health
• Complex quadruple burden of disease
• Quality of public health services

Question 19

National Department of Health Goals:

Answer 19

Goals are to:
Prevent disease and the reduce its burden, and promote health

Improve quality of care

Re-engineer primary healthcare

Universal health coverage

Question 20

What is the Vision and Mission of National Department of Health?

Answer 20

Vision: A long and healthy life for all South Africans

Mission: To improve health status through the prevention of illness and the promotion of healthy lifestyles and to consistently improve the healthcare delivery system by focusing on access, equity, efficiency, quality and sustainability

Question 21

What are the four outputs [strategic priorities] of the National Service Delivery Agreement?

Answer 21

1. Increase life expectancy
2. Decreasing maternal and child mortality?
3. Combating HIV and AIDS and decreasing the burden of diseases from TB.
4. Strengthening health system effectiveness

Question 22

What is the National Development Plan (2030)?

Answer 22

-It states that by 2030 South Africa should have:
=Raised life expectancy of at least 70 years
= Produce a generation of under 20s that are largely free of HIV
= Reduced the burden of disease
= Improved TB prevention and cure
= Achieved infant mortality rate of fewer than 20 deaths per 1000 and an under-5 mortality rate of less than 30 per 1000

= Equality, efficiency, effectiveness and quality of health care provision
= Universal health coverage
= Reduce risks posed by social determinants of disease.

Question 23

District Health System

Answer 23

• Comprises a well-defined population, living within a clearly delineated administrative and geographical area, whether urban or rural.
• It includes all institutions and individuals providing health care in the district, whether governmental, social security, non-governmental, private or traditional.

Question 24

The Ten Point Plan

Answer 24

1. Provision of Strategic leadership and creation of a social compact for better health outcomes;
2. Implementation of National Health Insurance (NHI);
3. Improving the Quality of Health Services;
4. Overhauling the health care system and improve its management;
5. Improving Human Resources Management, Planning and Development;
6. Revitalization of infrastructure;
7. Accelerated implementation of HIV & AIDS and Sexually Transmitted Infections National Strategic Plan 2007-11 and increase focus on TB and other communicable diseases;
8. Mass mobilization for better health for the population;
9. Review of the Drug Policy; and
10. Strengthening Research and Development

Question 25

The service delivery Challenges:

Answer 25

• The lack of leadership,
• Poor management of the HIV and AIDS pandemic
• An emerging epidemic of non-communicable disease, including stroke and heart disease, diabetes and cancers;
• childhood diarrhoea and malnutrition
• high levels of violence and accidents resulted in an increase in adult and childhood mortality.
• burden of disease,
• health worker shortages;
• deep-seated imbalance of resources and inequities in the distribution of personnel;
• a curative-oriented health service;
• and deficiencies in managerial capacity

Question 26

ANC National Health Plan - 1990

Answer 26

1. Every person has the right to achieve optimal health.
2. Primary Health Care (PHC) will form an integral part, both of the country’s health system, and of the overall social and economic development of the community.
3. Central to the PHC approach is full community participation in the planning, provision, control and monitoring of services

Question 27

White Paper for Transformation of Health System-1997

Answer 27

• Transformation focused on the organizational structure, authority and organization of services at a management level
• The district hospital provides level 1 (generalist) services to in-patients and outpatients (ideally on referral from a community health center or clinic)
  The hospital has between 30 and 200 beds, a 24-hour emergency service and an operating theatre.
  In some circumstances primary health care services are rendered where there is no alternative source of this care within a reasonable distance.

Question 28

Challenges in health sector

Answer 28

Burden of disease
Health system challenges
Quality of care

Question 29

Determination of Hospital status.

Answer 29

The status of the hospital will be determined when the minimum average percentages for Vital, Essential and Important elements have also been achieved.
A facility can obtain a high average score (70 to 99 percent) but still fail to obtain an Ideal Hospital category as they have failed to obtain the minimum average score for per weight category

Question 30

Depending on how a facility performs in a status determination, the facility will be categorized as?

Answer 30

1. No category achieved
2. Silver
3. Gold
4. Platinum

Question 31

Ideal Hospital Framework components

Answer 31

1. Admin
2. Clinical org
3. Clinical gov
4. Diagnostic and therapeutic services
5. HR for Health
6. Support services
7. Infrastructure
8. Operational management
9. Governance

Question 32

Benefits of Ideal Clinic

Answer 32

• Improved oversight on the status of clinic in real time
• Data immediately available on equipment and infrastructure status of all clinics-thus able to quantify needs and related costs
• Serves to motivate staff at clinics and district officials to improve facility status and service delivery

Question 33

What is an ideal Hospital Framework?

Answer 33

Initially designed to cater for District Hospitals
Expanded to include other levels of hospitals- Elements are viewed as minimum criteria for other level of hospitals
Incremental approach for other level of hospitals

Question 34

What is an ideal Hospital?

Answer 34

A hospital with:

1. Good infrastructure
2. Efficient patient administrative processes,
3. Adequate and appropriately managed staff,
4. Provides evidence based clinical, therapeutic and diagnostic services.
5. continuously improving quality of clinical care, optimization of hospital processes, finance, system and risks mitigation and management

Question 35

The Rationale for Ideal Hospital Framework.

Answer 35

Ideal Clinic Realisation and Maintenance (ICRM) conceptualised in 2013.
Operation Phakisa Lab in 2014 developed implementation plan for rapid scale up of Ideal Clinic
In 2015, the Ideal Clinic Program was launched

Question 36

Challenges affecting health system in South Africa- impact on Hospital.

Answer 36

• Funding constraints
• Inadequate human resource distribution and allocation
• Ageing infrastructure
• Inadequate revenue collection
• Inefficient supply chain management

Question 37

National Health Act, 2003 (Act no 61 of 2003)

Answer 37

to provide a framework for a structured uniform health system within the Republic, taking into account the obligations imposed by the Constitution and other laws on the national, provincial and local governments with regard to health services; and
to provide for matters connected therewith.

Question 38

Strategic Goals [ideal hospital]

Answer 38

-Prevent disease and reduce its burden.
-improve the readiness of health facilities for its implementation;
-Improve health facility planning by implementing norms and standards
-

Question 39

Specialist Hospitals

Answer 39

has a maximum of 600 beds and provides specialised health services like psychiatric services, tuberculosis services, infectious diseases and rehabilitation services

Question 40

Central Hospitals

Answer 40

have a maximum of 1200 beds, and provide tertiary and central referral services and may provide national referral services; must provide training of health care providers; conduct research; receives patients referred to it from more than one province; and must be attached to a medical school as the main teaching platform

Question 41

Tertiary Hospitals

Answer 41

between 400 and 800 beds and provides specialist level services provided by regional hospitals;
provides intensive care services under the supervision of a specialist or specialist intensivist; may provide training for health care service providers;
and receives referrals from regional hospitals not limited to provincial boundaries

Question 42

Regional Hospitals

Answer 42

between 200 and 800 beds
Provides health services in the fields of internal medicine, paediatrics, obstetrics and gynaecology, and general surgery; and in at least one of the following specialties namely; orthopaedic surgery; psychiatry; anaesthetics; diagnostic radiology; trauma and emergency services.

Question 43

District Hospitals

Answer 43

(a) serve a defined population within a health district and support primary health care;
(b) provide a district hospital package of care on a 24 hour basis;
(c) have general practitioners and clinical nurse practitioners primary health services;
(d) provide services that include in-patient, ambulatory health services as well as emergency.

Question 44

Hospitals are classified into five categories:

Answer 44

1. District
2. Regional
3. Tertiary
4. Central
5. Specialized

Question 45

Hospital Management

Answer 45

The NDoH set out to improve the overall management of the healthcare system. Regulation R 186, Policy on Management of Hospitals were published in 2012.