NATIONAL CORE STANDARDS FOR HEALTH ESTABLISHMENTS IN SOUTH

NATIONAL CORE STANDARDS FOR HEALTH ESTABLISHMENTS IN SOUTH AFRICA 10 th NATIONAL MIDWIFERY CONGRESS ST GEORGE HOTEL 05 DECEMBER 2012 BY: N. MAGINGXA

Contents Ø Ø Ø Some definitions Background Development of the Core standards National Core Standards - Purpose Policy and Legal contexts Structure of the Core Standards Six Ministerial Priority areas Interconnected standards NCS – Assessment Baseline Audit Conclusion

Some Definitions Ø Quality Ø Ø Standards Ø Ø Ø Getting the best results possible within the available resources. Statement of an expected level of delivery of quality. They reflect the ideal performance level of a health establishment in providing quality of care. Domain – an aspect of service delivery where quality or safety can be at risk

Background Ø Ø Ø SA has poor health outcomes. Some factors that contributed to this situation include: Ø Poor management. Ø Lack of accountability. Ø A culture of mediocrity rather than excellence. Ø Demotivated staff. NDo. H committed to provision of best quality care and health service delivery.

Development of core standards Core Standards for Health Establishments – piloted in 2008. Core Standards for Health Establishments – revised format piloted in March 2010. Core Standards for Health Establishments – finalised in 2011.

National Core Standards: Purpose Ø Set standards for quality service through defining and specifying what is expected in terms of quality in the health sector. Ø Develop a common definition of quality of care which should be found in all health establishments in South Africa. Ø Establish a benchmark against which health establishments can be assessed, gaps identified, strengths appraised, and guide quality improvement also; Ø Achieving compliance with the standards.

Policy context (1) Ø 10 -Point Plan of the National Department of Health 2009 -2014 and Strategic Plan for 2009 -2012. Ø“establishment of a quality management and accreditation body” Ø“improving the quality of health services” ØQuality of Health Care Policy of 2007 ØInfection and Prevention Control Policy of 2007.

Policy context (2) Ø Negotiated Service Delivery Agreement Ø Improve life expectancy Ø Improve mother and child health and survival Ø Reduce the impact of HIV/AIDS and Tuberculosis. Ø Improve health system effectiveness. Focusing on: Ø Ø Ø Ø Re-engineering primary health care Improving quality in health service delivery Information Human Resources Finance and Financing Infrastructure and Technology National Health Insurance

Legal context Ø Ø Ø Ø The National Health Act, 61 of 2003 Amended to include the role of Office of Health Care Standards Compliance (OHSC) as “a quality assurance body mandated to assess all health establishments for compliance with the National Core Standards”. The Office must: (a) Advise the Minister on the development of norms and standards for the national health system and the review of such norms and standards; (b) Certify health establishments as compliant with prescribed norms and standards; (c) Ensure compliance with prescribed norms and standards by health establishments; (d) Investigate complaints relating to the health system

Structure of the Core Standards Ø Ø 7 cross-cutting domains They are dependent on each other 1. Patient Rights 2. Patient safety, Clinical Governance, Care 3. Clinical Support Services Core business of the health system. 4. Public Health 5. Leadership and Corporate Governance 6. Operational Management 7. Facilities and Infrastructure Support system.

Structure of the Core Standards Domains § Domain - an aspect of service delivery where quality or safety can be at risk p Sub Domain - further break down the domains into subsections or critical areas which combined describe the scope of that domain Standard p Standards - define what is expected to be delivered in terms of quality care; reflect the expected situation resulting from successful implementation of a policy, procedure or system. Criteria p Criteria - elements setting out the requirements to achieve compliance with the standard; are measurable and achievable p Measures - the means or evidence for determining whether the criteria have been met; examine aspects that can be seen, heard or felt by the assessors and give reasonable assurance that a standard is met Sub Domain Measures

Domain 2: Patient Safety Clinical governance & Clinical Care Sub Domain: Infection Prevention and Control Standard: An Infection Prevention and Control Programme is implemented Criteria: A formal structure exists to monitor all aspects of infection prevention and control Measures: 1. Terms of reference of the committee are available 2. Minutes of the committee indicates that control measures are regularly discussed, analyzed and actions have been taken to reduce infection rates 3. The committee makes recommendations on antibiotic usage for the establishment 4. Statistics on common health care associated infections demonstrate that they are in line with acceptable benchmarks Example

Domain and Sub Domains 1. Patient Rights 1. 1 1. 2 1. 3 1. 4 1. 5 1. 6 1. 7 1. 8 Respect and dignity Information to patients Physical access Continuity of care Reducing delays in care Emergency care Access to package of services Complaints management

Domain and Sub Domains cont. 2. Patient Safety - Clinical governance & Clinical Care 2. 1 Patient care 2. 2 Clinical management for improved health outcomes 2. 2 Clinical leadership 2. 4 Clinical Risk 2. 5 Adverse events 2. 6 Infection prevention and control 3. Clinical support services 3. 1 Pharmaceutical services 3. 2 Diagnostic Services 3. 3 Therapeutic and Support Services 3. 4 Health Technology Services 3. 5 Sterilization services 3. 6 Mortuary

Domain and Sub Domains cont. 4. Public Health 4. 1 Population based service planning and delivery 4. 2 Health promotion and disease prevention 4. 3 Disaster preparedness 4. 4 Environmental control 5. Leadership and Corporate Governance 5. 1 Oversight and accountability 5. 2 Strategic management 5. 3 Risk management 5. 4 Quality improvement 5. 5 Effective leadership 5. 6 Communication and public relations

Domain and Sub Domains cont. 6. Operational management 6. 1 Human resource management & development 6. 2 Employee Wellness 6. 3 Financial Resource Management 6. 4 Supply chain Management 6. 5 Transport and fleet management 6. 6 Information management 6. 7 Medical records 7. Facilities & Infrastructure 7. 1 Buildings and grounds 7. 2 Machinery and utilities 7. 3 Safety and Security 7. 4 Hygiene and cleanliness 7. 5 Waste management 7. 6 Linen and laundry 7. 7 Food services

National Core Standards: Measures Risk rating Classification measures 1. Extreme Vital Those that ensure that the safety of patients and staff are safeguarded so as not to result in unnecessary harm or death. These are non negotiable measures 3. Medium Essential Those considered fundamental to the provision of safe, decent, quality care and are designed to provide an in-depth view of what is expected within available resources (for example: clinical risk management and quality improvement processes; or guidelines for maternity care). 4. Low Developmental Those elements of quality of care to which health management should aspire to, in order to achieve optimal care. While non-compliance with these standards does not necessarily constitute a risk to patients, they form an integral part of a comprehensive quality health care system. Developmental standards enhance the health establishment’s ability to provide optimal care and reflect continuous improvement. 2. High of Definition

Six Ministerial Priority Areas Ø Ø Critical areas that must be improved upon by all facilities. Areas of major concern for our patients Largely reflect the first 3 domains. Fast-track improvement by all facilities is required in: Ø Values and attitudes of health care staff Ø Cleanliness in facilities Ø Waiting times – queues and delays Ø Patient (and staff) safety and security Ø Infection prevention and control Ø Availability of medicines and supplies

Relationship of 6 fast-track priorities and the core standards 1. Patient Rights 2. Patient safety, Clinical Governance, Care 3. Clinical Support Services 4. Public Health 5. Leadership and Corporate Governance 6. Operational Management 7. Facilities and Infrastructure Patient Safety, Clinical Governance & Care 4. Patient safety. 5. Infection prevention & control. Clinical Support Services 6. Availability of medicines and supplies.

Values and attitudes of health care staff Evidence that: Ø Patients are treated and cared for in a respectful manner. Ø Patients attest through positive satisfaction surveys Ø Complaints procedure in place and used to improve service delivery. Ø Leaders at all levels provide supervision and positive role modelling.

Reducing Waiting times Evidence that: Ø Waiting times are monitored and Ø Improvement plans implemented Ø Queues managed and there is Ø Proper triaging of patients Ø Waiting times for elective procedures efficiently managed.

Cleanliness in facilities Evidence that: Ø Patients satisfied with facility cleanliness. Ø Public areas e. g. toilets, grounds kept clean Ø Availability of adequate cleaning materials Ø Proper waste management Ø Availability of checklists

Patient safety Evidence of: Ø Proper care according to the guidelines. Ø Special care to high risk patients ( pregnant, frail/aged, mentally ill, children etc) Ø Proactive risks identification to prevent adverse events. Ø Prompt management of adverse events. Ø Mortality and morbidity meetings held.

Patient safety cont. Ø Ø Ø Adequate physical safety Laboratory and X-ray turn around within acceptable time lines. Clinical audits are conducted Patients educated about medication intake as well as side effects. Emergency plans and outbreak readiness Hospital board involved in quality improvement

Infection Prevention and Control (IPC) Ø Ø Ø Availability of an IPC policy A formal system is in place. Standard precautions are monitored ( hand washing, waste disposal). Strict infection prevention observed ( food and milk preparation areas) General waste management practices.

Availability of medicines and supplies Evidence that: Ø Essential medicines and supplies in stock Ø Procurement, payment and delivery processes, are reliable and on time. Ø Stock levels are properly managed to prevent stock shortage and loss. Ø Functional PTC exists in facilities or district. Ø Patients given adequate information about the dispensed medication.

Interconnected Standards module on DHIS 1. 4 6 prio ri ties

National Core Standards (NCS) Assessment Ø Ø Ø Separate tools for each facility type used to collect information to determine compliance/noncompliance. Data is captured: Ø As the Core Standards Module on DHIS Results are reported: Ø On the DHIS as a report indicating compliance per domain and per priority area.

Example of tool

Example of a facility outcome report Overall outcome: compliant or non compliant E = 0%-20% D = 20%-39% C = 40%-59% B = 60%-79% A = 80% - 100% Provisional score: grade A - E

Outcome: Compliant vs Noncompliant Ø For a facility to be “compliant” it must meet all vital measures on assessment. Ø If the facility is “non-compliant” on even one vital measure this results in an overall outcome of “non compliant”.

Baseline Audit Ø In 2011 Health Systems Trust (in partnership with HISP, MRC, ARUP and EXPONANT) entered into a cooperative agreement with NDo. H: Ø Ø To conduct an independent audit of all public health facilities in the country to assess compliance with the NCS. Process Ø Ø Ø Baseline audit followed self assessment that was driven by quality assurance managers in facilities. Audit commenced March 2011 and completed March 2012. 4210 facilities in the country audited. A preliminary report of the baseline audit results was given by teams at district, sub – district and facility (Hospitals) level. All facilities were expected to develop quality improvement plans based on the findings from the preliminary reports.

Conclusion Ø Ø The significant goal of the core standards is Ø “To assist in improving quality of care in all health establishments”. The primary activity therefore by supervisors, managers and all staff members is to ensure that Ø “Compliance with standards becomes a norm through implementation of a continuous quality improvement process”

References Ø Ø NDo. H, Towards Quality of Care for Patients, National Core Standards for Health Care Establishments, 2011 NDo. H, Towards Quality of Care for Patients, Fast Track to Quality, The six most critical areas for patient-centred care, 2011 NDo. H, National Core Standards Toolkit, 2011 NDo. H, Guideline use of database, National Core Standards for Health Care Establishments, 2011

THANK YOU ØNomthandazo Magingxa ØEmail: nomthandazo. magingxa@hst. org. za ØTel: 0716067459 Øhttp: //www. hst. org. za