**Enhancing Health Standards Compliance** A briefing on Gauteng's readiness for independent audit and certification by N

1. Gauteng Department of Health Status of Readiness for independent audit and certification by National Office of Standards Compliance BRIEFING TO THE PORTFOLIO COMMITTEE ON HEALTH05 SEPTEMBER 2012 1

2. Presentation outline • Purpose • Background • Examples of Quality Norms and Standards • Building Institutional Capacity • Establishments of Provincial Office of Standards Compliance • Establishment of Infection Prevention and Control Unit (IPC) • Implementation of a Responsive Complaint Systems 2

3. Presentation Outline cont… • Projects Implemented -17 non negotiables • Challenges • Conclusion • Recommendations 3

4. Provision of Amendment Bill • The National Health Act, 2003 amendment Bill provides for the establishment of the Office of Health Standards Compliance. • The object of the office are to protect and promote safety of users of health services • To monitor and enforce compliance by health establishments with norms and standards • To ensure investigation and disposal of complaints related to non compliance to norms and standards 4

5. PURPOSE To provide a brief to the Portfolio Committee on Health, on the state of readiness of the health establishments in Gauteng for audit and certification by the National Office of Health standards Compliance. 5

6. BACKGROUND • The National Health Act No. 61 of 2003 as amended prescribes that there is a need to develop a structure to monitor compliance of health care establishments, with normsand standards. • In August 2011 the Provincial Inspectorate for Health Establishments was commissioned in the Quality Assurance Directorate (QAD). 6

7. 6 Priority Areas Link to the National Core Standards (NCS) • National Core Standards 6 Priorities • Patient • rights 2. Safety, clinical risk Patient Rights: Values and attitudes Waiting times Cleanliness Patient Safety, Clinical Governance & Care: 4. Patient safety 5. Infection prevention and control 3. Clinical support services. 4. Public health 5. Leadership & corporate governance Clinical Support Services: 6. Availability of medicines and supplies Facilities & infrastructure: 3. Cleanliness 6. Operational management 7. Facilities & infrastructure 7

8. Preparatory work undertaken Work done by the Department to prepare health institutions for the implementation of quality norms and standards 8

9. Implementation of NCS and the Six Priority Areas • Quality Assurance Directorate has conducted information sharing sessions during 2010/2011 with all stakeholders including management at Provincial Office, district managers and Local authority. • This was with regards to the preparation of health establishments for the implementation of National Health Insurance (NHI), using the NCS and Six Priority Areas, self assessments and certification process. • Senior Management in the Department and other stakeholders including Unions were engaged at multilateral meetings in February 2011. 9

10. Building Institutional Capacity • Workshops and training sessions were conducted for Heads of Hospitals (CEOs), Senior Districts Managers including Local Authority on NCS and the Six Priority Areas. • This process which was initiated in the middle of 2010 is ongoing and includes continuous updating of managers on the latest developments from time to time. 10

11. Building Institutional Capacity cont… • About more than 3000 staff members have been trained to date. • The NCS were then distributed to all health care establishments. • 200 Quality Assurance coordinators were appointed at all levels and trained through the University of Pretoria. • Quality Assurance Directorate leads, support, monitors and provide guidance in the development and implementation of quality improvement plans at all facilities using the National Facility Improvement Model. 11

12. Establishment of a Provincial Office of Standards Compliance (POSC) • In line with the National Health Act, as amended, POSC and the Inspectorate Unit was established in August 2011 • with the main role of monitoring compliance to the prescripts of NCS and the 6 Ministerial quality priority areas. • The office conducts clinical audits and health care inspections on the average 31 clinics, 2 CHCs and 1 hospital monthly. • It also ensures implementation of recommendations emanating from the outcome of the complaints investigations. • Inspectors were drawn from various disciplines including doctors, nurses and the environmental health practitioners. • The POSC inspectors were trained by the NDoH on the assessment tools. 12

13. Establishment of Infection Prevention and Control Unit(IPC) • The unit is headed by a trained IPC Officer. • 14 retired nurses were incorporated into the unit to monitor and report on weekly basis on areas of risk especially in neonatal units and maternity sections. • There has been 50% reduction in Neonatal preventable infection incidences during 2011/2012 financial year. 13

14. Implementation of a Responsive Complaints System • A customer care unit was established within QA directorate in 2005 • to deal with all complaints from patients and the public at large. • A complaints call centre was established in June 2010. • It operates 24 hours a day even on public holidays and weekends. • There is also a toll free Telkom hotline (0800 203 886). • Reporting systems were put in place with clear timelines. • The complaints resolution rate is over 95% in 25 working days. • The Call centre received 2, 600 calls in 2011/12 financial year. 14

15. Projects implemented to address the 17 Non Negotiables Cleanliness • Partnership has been established with Private Health Partners, namely • Industroclean • Professional Development Foundation (PDF). Industroclean • Sponsors the cleanest hospital competition • Is offering forty (40) bursaries to train cleaning staff. Professional Development Foundation (PDF) is in the process of training hundred (100) cleaners at selected institutions. 15

16. Reduction of waiting times at frontline areas • Reduction of waiting times at frontline areas, i.e.Outpatients Department, Pharmacy and Accident & Emergency Areas: • This has assisted in the development of provincial benchmarks in these areas. • This is evident on the self assessment(conducted from April to August 2011) and baseline(conducted June to December 2011) results where most of institutions were found to be compliant. 16

17. Infection prevention and control projects • The Department has formedpartnership with the private health sector. • One of the companies is Life Care. • The infection control unit is driving the Best Care Always (BCA) project that is aimed at addressing hospital acquired infections. 17

18. Challenges The major concerns were non compliance to NCS due to: • Limitations of the Infrastructure • Some hospitals and clinics were not designed as health care facilities, • The buildings are dilapidated which impacts negatively in all Six Priority Areas. • e.g. Patient safety, IPC isolation areas, cleanliness, lack of storage areas and waiting areas. • Budgetary constraints • Shortage of staff at all levels. 18

19. Response Status of readiness for an independent audit by the National Office of Health Standards Compliance • The information is based on the results of the institutional assessments conducted using the National tools between April 2011 and March 2012. • Of the 32 Hospitals only 7 hospitals have consistently obtained non compliance A. 19

20. Non Compliant • Non compliance status indicates that the facility has notsatisfied one or more vital measures that are not negotiable Non compliant A • The following hospitals have performed well though they have not satisfied the vital measures. 20

21. Non compliant A • Central Hospitals Steve Biko Academic Hospital Charlotte Maxeke Johannesburg Academic • Regional Hospitals Leratong Hospital Pholosong Hospital Tambo Memorial Hospital. • District Hospitals Pretoria West Hospital. . 21

22. Continued • Specialized Psychiatric Hospital: Weskoppies Hospital • District Health Services: Community Health Services and all clinics are still in the process of putting systems in place 22

23. Complaints Management System There is a functional complaints management system in place. It is accessible to the public to lodge complaints through the toll free number. This system involves the following process. • capturing a complaint • acknowledgement of receipt of complaint to the complainant • investigation of a complaint 23

24. Continued • Providing the complainant with feedback on the outcomes of the investigation • Instituted remedial action and corrective measures to avoid recurrence of similar incidences in future • Commonest complaints coming through are about staff attitudes, waiting times for medical interventions, hospitality services and alleged medical errors. 24

25. Province state of readiness Gauteng provincial state of readiness for the implementation of norms and standards • The Province has already implemented the norms and standards (National Core Standards including the Six Ministerial quality priority areas) at all health institutions, including hospitals and clinics. 25

26. Province readiness • There is a well established Provincial Inspectorate that supports the institutions in implementing quality improvement plans to ensure that gaps identified during the assessments are closed. • There is also a well establishedcomplaints system in place that is responsive to patients and public complaints. • Facility assessments reports show improvement in terms of their compliance to the norms and standards though there are some areas that need strengthening. 26

27. Recommendations It is recommended that the Health Portfolio Committee notes the brief. 27