Ideal Clinic and Ideal Hospital framework Flashcards

1. Policy environment 2.Public health expenditure 3. Progress in achieving health outcomes 4. Challenges in the health sector 5. Health sector reforms.

1
Q

Ideal clinic status elements:

A

The elements are weighed as Vital, Essential, and important

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2
Q

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

A
  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]
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3
Q

Weighting of measures. [elements]

A
  • Non-negotiable vital
  • Vital
  • Essential
  • Important
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4
Q

Non-negotiable vital elements

A

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

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5
Q

Vital elements

A

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.

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6
Q

Essential elements

A

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

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7
Q

Important elements

A

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

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8
Q

How is the Scoring of the Elements done?

A

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

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9
Q

An Ideal Clinic has:

A
  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.
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10
Q

Operation Phakisa

A

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

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11
Q

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

A
Key findings focused on:
Facility classification
Health technology 
Physical infrastructure
Medicines and supplies management
Quality of care
Functioning of services
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12
Q

Primary Health Care Clinics?

A

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

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13
Q

Primary Healthcare Re-engineering?

A
  • 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.
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14
Q

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

A
  • Overcrowded facilities
  • Long waiting lines
  • Medication stock out
  • Insufficient and inappropriately trained HR with poor attitudes.
  • Poorly structured
  • Inaccessible PHC clinics
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15
Q

Operational inefficiencies

A

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

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16
Q

Numerous challenges faced by Primary Health Care:

A
  • 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
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17
Q

Primary Healthcare Re-engineering

A
  • District Clinical Specialist Teams,
  • Integrated School Health teams
  • Ward based PHC outreach teams
  • Contracted General Practitioners
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18
Q

Challenges in the Health sector:

A
  • Ineffective and inefficient health system
  • Impact of social determinants of health
  • Complex quadruple burden of disease
  • Quality of public health services
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19
Q

National Department of Health Goals:

A

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

Improve quality of care

Re-engineer primary healthcare

Universal health coverage

20
Q

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

A

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

21
Q

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

A
  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
22
Q

What is the National Development Plan (2030)?

A

-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.

23
Q

District Health System

A
  • 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.
24
Q

The Ten Point Plan

A
  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
25
Q

The service delivery Challenges:

A
  • 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
26
Q

ANC National Health Plan - 1990

A
  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
27
Q

White Paper for Transformation of Health System-1997

A
  • 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.
28
Q

Challenges in health sector

A

Burden of disease
Health system challenges
Quality of care

29
Q

Determination of Hospital status.

A

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

30
Q

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

A
  1. No category achieved
  2. Silver
  3. Gold
  4. Platinum
31
Q

Ideal Hospital Framework components

A
  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
32
Q

Benefits of Ideal Clinic

A
  • 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
33
Q

What is an ideal Hospital Framework?

A

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

34
Q

What is an ideal Hospital?

A

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
35
Q

The Rationale for Ideal Hospital Framework.

A

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

36
Q

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

A
  • Funding constraints
  • Inadequate human resource distribution and allocation
  • Ageing infrastructure
  • Inadequate revenue collection
  • Inefficient supply chain management
37
Q

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

A

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.

38
Q

Strategic Goals [ideal hospital]

A

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

39
Q

Specialist Hospitals

A

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

40
Q

Central Hospitals

A

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

41
Q

Tertiary Hospitals

A

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

42
Q

Regional Hospitals

A

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.

43
Q

District Hospitals

A

(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.

44
Q

Hospitals are classified into five categories:

A
  1. District
  2. Regional
  3. Tertiary
  4. Central
  5. Specialized
45
Q

Hospital Management

A

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.