NORMS AND STANDARDS COMPLIANCE INSPECTIONS 16 17 January

NORMS AND STANDARDS COMPLIANCE INSPECTIONS 16 – 17 January 2019 Mpumalanga Province 1

OUTLINE 1. VISION & MISSION OF THE OHSC 2. MANDATE OF THE OHSC 3. APPOINTMENT OF INSPECTORS 4. TYPES OF INSPECTIONS 5. INSPECTION PROCESSES & METHODOLOGY 6. SCORING & RISK RATING 7. Code of conduct 8. Reports 2

VISION AND MISSION OF THE OHSC VISION Safe and Quality Healthcare for all South Africans MISSION We act independently, impartially, fairly and fearlessly on behalf of the people of South Africa in guiding, monitoring and enforcing healthcare, safety and quality standards in health establishments 3

MANDATE OF THE OHSC s 78. Objects of the Office The objects of the office are to protect and promote the health and safety of users of health services by: v. Monitoring and enforcing compliance by health establishments with prescribed norms and standards. v. Ensuring consideration, investigation and disposal of complaints relating to breaches of norms and standards. 4

MANDATE OF THE OHSC continued This mandate contributes to two distinct interdependent priority outcomes. These are: but v. Reductions in avoidable mortality, morbidity and harm within health establishments through reliable and safe health services. v. Improvements in the availability, responsiveness and acceptability of health care standards. 5

TYPES OF INSPECTIONS v. Routine Inspections: Every health establishment to be inspected according to the National Health Act 61 of 2003 as amended once in four (4) years. v. Additional Inspections: An inspector may, at any time, subject to section 82(1) of the Act, conduct an additional inspection, provided that he or she has reasonable grounds to believe that ‒ • Such an inspection is needed to establish whether non-compliance has been remedied within the health establishment; • The health establishment is contravening the act or any relevant regulations; • There are serious breaches of norms and standards, based on the indicators of risk; or • The ombudsman findings demonstrate that continued exposure to the health care services provided by health establishment may pose a severe risk to users or health care personnel. 6

TYPES OF INSPECTIONS continued v. Risk-based Inspections: Triggered by Early Warning System(EWS), targeted for persistent or critical non compliance and Ombudsman findings. 7

Appointment of inspectors • In terms of section 80(2) of the Act an inspector must be a qualified health professional, who is registered with the Allied Health Professions, the Health Professions Council of South Africa, the South African Nursing Council, or the South African Pharmacy Council, referred to in the • definition of "statutory health professional council" in section 1 of the Act

Appointment of inspectors ( Cont. ) • The Chief Executive Officer must issue a person who has been appointed as an inspector in terms of section 80(2) of the Act with a certificate of appointment as an inspector, in accordance with section 80(3) of the Act, once the person has successfully completed a minimum training programme approved by the Office.

Appointment of inspectors ( Cont. ) • The certificate of appointment as an inspector must include, at a minimum, the following information: (a) The name and surname of the inspector; a unique identification number supplied by the Office; (b) the date of issuance; the address and contact details of the Office; (c) a form of photographic identification. The signature of the Chief Executive Officer.

Inspection strategy • An annual inspection strategy guide the inspection activities of the Office. • The annual inspection strategy will be published on the Office’s public website, and include the following: 1. An approach to prioritising, scheduling and conducting inspections; and 2. resources for the implementation of the inspection strategy.

Procedure Manual • The Office developed an inspection procedure manual and tools for inspectors to ensure that • Inspections are carried out in a consistent, fair, equitable and transparent manner

Code of conduct for inspectors as in section 80(2) of the Act states that A copy of the code of conduct for inspectors referred to in sub-regulation (1), must be signed by all the inspectors prior to the commencement of their duties and will be publish in Government Gazette.

Inspection Process • An inspector must, before commencing with an inspection contemplated in section 82 of the Act, issue a notice of inspection to the health establishment. The notice of inspection should include, at least, the following information: (a) the purpose of the inspection; (b)the date of the inspection; (c) the estimated duration; (d)The number of authorised personnel expected to take part in the inspection; (e)The contact details of the inspector primarily responsible for the inspection; and

Inspection Process The responsibilities of the health establishment. During an inspection, the health establishment must make available the necessary staff, resources and space to allow inspectors to complete the inspection in a timely and expeditious manner. (3) An inspector may question any user, occupant, health care personnel or any person on the premises of a health establishment about any information that is relevant to the inspection, or require the person in charge to produce any document, record or material for inspection. (4) The person in charge may provide the inspector with any relevant information, documents, records, objects or materials for the inspector's consideration during the inspection visit.

Inspection Process An inspector must prepare an inspection plan, which sets out a clear approach to carrying • Out the inspection for each health establishment to be inspected. • The inspection plan referred to in subregulation (4) must be appended to the Notice of Inspection referred to in subregulation 13.

INSPECTION PROCESSES & METHODOLOGY v. Inspections methods include: I. Observation II. Documents review III. Patient record analysis IV. Patient and staff interviews v Evidence is collected for both compliant and non compliant measures. 17

SCORING & RISK RATING SCORING v Compliant = 1 v Non compliant = 0 v Not Applicable (N/A) needs Classification of Measures RISK RATING Cut off levels EXTREME HIGH 100% VITAL Above 90% ESSENTIAL MEDIUM Above 80% DEVELOPMENTAL l. OW Above 60% substantive evidence v No partial compliance v Any Extreme measure failed will result in over all non compliance of the HE

Proposed Compliance Status Framework Score Grade Risk Outcome Rating Inspection frequency 80% + A <20% Good 4 Yearly 70 -79% B 21 -30% Satisfactory 2 Yearly 60 -69% C 31 -40% Fair 1 Yearly <59% D >41% Poor 6 -12 months 19

Types of Health Establishment 1. PUBLIC HOSPITALS 2. PUBLIC CLINICS AND CHCS 3. PRIVATE HOSPITALS AND CLINICS 20

FUNCTIONAL AREAS 21

Functional areas – Hospital Non Clinical services Management Hospital Inpatient services CEO/ Hospital Manager Clinical Management Group Infection control HR management Procurement Occupational risk management Communications/PRO Management information systems Case management Occupational Health & Safety Financial management Facility management Administrati ve Waiting areas services Record archive/departme nt Reception, help desk and Switchboard Public areas Support services Facility Infrastructure Mortuary services CSSD Cleaning services Food services Laundry services Maintenance services including gardens Waste management Transport services Security services Clinical services 22 Medical ward x 3 Surgical ward x 3 Maternity ward Paediatric ward x 3 Newborns Neonatal ICU TB Isolation room HIV/AIDS Intensive care or high care units x 4 Operating theatre x 4 Procedure room Psychiatric ward: – Acute ward – Child and adolescent unit – Forensic Obervation unit – Long term ward – State patient unit Antenatal clinic Oral health Overnight/short stay ward Out patient services Outpatient department Accident and Emergency unit Procedure room Clinical support services Blood services Laboratory Health technology services Pharmacy Radiology Medical Supplies Therapeutic support services: – Physio – Occupational – Speech – Optometry

Functional areas of a Clinic Non Clinical services Clinic Management Clinical services Outpatient services Clinic manager/ HOD Clinical services General services Clinical support services Maintenance and support Pharmacy/ Medicine cupboard 23

Functional areas of a CHC Non Clinical services CHC Management Clinical services Outpatient services CHC manager Accident and Emergency unit Maternity Obstetrics unit Clinical services Generic ward Support services Maintance and support Clinical support services Pharmacy/Medicine cupboard 24

Inspection Reports v. The following reports will be given to the person in charge within 20 working days post inspection: I. III. IV. Standard technical report Functional area technical report Evidence report Quality Improvement template v. Comments relating to the findings will be expected from the health establishment within 20 working days post preliminary feedback meeting 25

INSPECTION PROCESS v. Inspections assess: Insert picture • systems, processes and procedures that promote and ensure quality health services • evidence that quality and safety are seen as important • that managers put in place systems to ensure basic quality of care is provided within the health establishment • what is seen at the time of inspection and not the reason why 26

. In conclusions We want to ensure that the health care system in South Africa provide the best quality health care possible 27

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