PHC: Quality and National Core standards

Question 1

QUALITY OF CARE

Answer 1

• Getting the best results possible within the available resources.
• It is the level of attainment of (i) health systems’ intrinsic goals for health improvement and (ii) responsiveness to legitimate expectations of the population.

Question 2

What are the elements of Quality of care:

Answer 2

1. Effective
2. Efficient
3. Accessible
4. Acceptable
5. Equitable
6. Safe

Question 3

The many elements to Quality of care

Answer 3

1. Effective : delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities. Based on need of the patient.
2. Efficient: delivering health care in a manner which maximizes resource use and avoids waste.
3. Accessible: timely, geographically reasonable, skills and resources are appropriate to medical need. Delivering health care that is timely, geographically reasonable, and provided in a setting where skills and resources are appropriate to medical need of the community.
4. Acceptable (aka Patient centred): takes into account preferences and aspirations of individual service users and the cultures of their communities.
5. Equitable: does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location or socioeconomic status
6. Safe: minimizes risks and harm to service users

Question 4

OFFICE OF HEALTH STANDARDS COMPLIANCE [assess the quality of health care]

Answer 4

Vision: Safe and Quality Healthcare for ALL South Africans
Mission:
- We act independently, impartially, fairly and fearlessly in guiding, monitoring and enforcing health care safety and quality standards in health establishments to serve the people of South Africa
(In this mission they don’t specify whether the health establishments are in he public sector or not)

Question 5

History of Office of Health standards compliance

Answer 5

• National Health Act of 2003
  
  • Recognised the need to foster good quality health services and made provision for an “Office of Standards Compliance” to be created within the Department of Health (DOH)
  • Also provided for inspectorates of health establishments to be established in all provinces.
• The Office was established in 2008 within the DoH
  
  • played an active role in driving quality assurance systems in the public health sector.
  • co-ordinated the development of a comprehensive set of National Core Standards for Health Establishments (NCS)
• 2011
  
  • Decision to introduce NHI [national health insurance]
  • National inspectorate of health establishments was set up within the DoH.
• 2013
  
  • Promulgation of the National Health Amendment Act
  • OHSC was established
    
    • Not within the DoH [they wanted to be seen as impartial so, wouldn’t be influenced by the department of health]

Question 6

How does the Office of Health Standards Compliance protect and promote the health of users of health services

Answer 6

They do so by:

1. Monitoring and enforcing compliance by health establishments with norms and standards prescribed by the Minister of Health in relation to the national health system.
2. Ensuring consideration, investigation and disposal of complaints relating to non-compliance with prescribed norms and standards for health establishments in a procedurally fair, economical and expeditious manner.

Question 7

Office of Health Standards Compliance: 4 key areas

Answer 7

Office of Health Standards Compliance: 4 key areas

1. Compliance Inspectorate, Certification and Enforcement : manages the inspection of health establishments to assess compliance with national health systems’ norms and standards, certify health establishments as compliant or non-compliant with prescribed norms and standards and take enforcement action against non-compliant health establishments.
2. Health Standard Design, Analysis and Support
   
   • Provides technical, analytical and educational support in relation to research, development and analysis of norms and standards
3. Complaints management and Office of the Health Ombud
4. Corporate Services: provide the financial, human resources, IT and administrative support necessary for the OHSC to deliver on its mandate.

Question 8

National Core Standards for Health Establishments in South Africa

Its Purpose

Answer 8

• Develop a common definition of quality care which should be found in all health establishments in South Africa
• Establish a benchmark against which health establishments can be assessed, gaps identified and strengths appraised
• Provide for the national certification of compliance of health establishments with mandatory standards

Question 9

National Core Standards (NCS) are not meant to be punitive

Answer 9

• A single set of National standards
• Existing requirements (“nothing new”)
• Focused at facility level, how patients receive care
• Participative and learning process of development
• Comprehensive, prescriptive.
  It does dictate to a health establishment that you should have this and that , but of course somethings aren’t relevant in some establishments e.g public vs private.
• Structured into crosscutting “Domains”
• Detailed tool for external assessment

Question 10

NCS 7 Domains

Answer 10

1. Patient rights: Respect and dignity
2. Patient safety, Clinical governance and care: infection prevention and control
3. Clinical support services: Pharmaceutical services, Mortuary services
4. Public health: Environmental control, Disaster preparedness
5. Leadership and corporate governance: Oversight and accountability
6. Operational management : Employee wellness, Medical records
7. Facilities and infrastructure: Buildings and grounds, Linen and laundry, Waste management.

Question 11

MEASURES

Answer 11

• Can be observations, checking documents, checklists
• 4 categories:
  1. Extreme (X): most likely to cause serious harm to both patients’ safety and staff; therefore not negotiable for compliance to be awarded to a facility. 100% compliance required.
  2. Vital (V): ensure safety of patients and staff are safeguarded – prevent unnecessary harm or death. 90% compliance required.
  3. Essential (E)
  
  • fundamental to the provision of safe, decent quality care.
  • provide an in-depth view of what is expected within available resources
  • 80% compliance required
    
    4. Developmental (D)
  • elements of quality of care to which health management should aspire to in order to achieve optimal care. 60% compliance required

> Measures are weighted: X 40%, V 30%, E 20%, D 10%

Question 12

Performance color codes:

Answer 12

Green: Doing well/insignificant
Yellow: Minor
Orange: Moderate
Red: Major 
Maroon: Catastrophic

Question 13

Fast Track / Priority Areas - aiming to be green at

Answer 13

1. Values and attitude of staff
2. Cleanliness
3. Waiting times
4. Patient safety and security
5. Infection prevention and control
6. Availability of basic medicines and supplies

Question 14

NCS Regulations

Answer 14

• Domain1: Patient / User Rights
  
  • 1.2 Information to patients
  • 1.3 Physical access
• Domain 2:Patient Safety - Clinical governance & Clinical Care
  
  • 2.2Clinical management for improved health outcomes
  • 2.6Infection prevention and control
• Domain 3. Clinical Support Services
  
  • 3.1 Pharmaceutical services
  • 3.2 Diagnostic services
  • 3.3 Therapeutic and support services
  • 3.4 Health technology services

Question 15

NCS: Criticism

Answer 15

• Some measures are unachievable for some health establishments
• Paper-based exercise; no follow-up
• Is it being implemented in private sector?
• What happens if a facility is non-compliant?
• DoH has since launched the ‘Ideal Primary Health Clinic’ and “Ideal Hospital’ frameworks – in support of health establishments fulfilling the criteria of NCS.