Measuring Hospitals

Measuring Hospitals

Health minister Dr Manto Tshabalala-Msimang has declared herself generally ‘€œquite happy’€ with the performance of the 31 health facilities assessed in a rapid appraisal exercise to measure the ‘€œCore Standards for Health Facilities in South Africa’€.

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The full report was not released to the media at GF Jooste Hospital in Cape Town yesterday (SUBS: MONDAY), but rather a 10-page synopsis. ‘€œRed flag’€ areas needing urgent and immediate action in specific hospitals were also not revealed.

 Launched in Tembisa in April, the ‘€œCore Standards’€ tool assesses how hospitals and community health centres  measure up to seven ‘€œdomains’€ – safety, clinical care, governance, patient experience of care, access to care, infrastructure and environment as well as public health.

Hospitals in the better resourced provinces such as Gauteng, KwaZulu-Natal and the Western Cape generally achieved better overall results than some hospitals in Mpumalanga, the Eastern Cape and Limpopo.

How to retain qualified staff and poor infection control practices, especially within the context of tuberculosis, were common challenges faced by most of the 27 hospitals and four community health centres (CHC) assessed.

This was confirmed by Tshabalala-Msimang who yesterday alluded to the ‘€œweak infection control’€ in the TB wards and other parts of the hospitals.

She said new infection control measures included the banning of staff mobile phones in the wards and the removal of jewellery and watches at the start of a shift.

The minister was clear that dire shortage of human resources was the main hurdle in improving hospital services revealing that the health department was ‘€œon our way to India’€ and ‘€œpretty soon Russia’€ in an effort to recruit health professionals.

South Africa has in the past recruited doctors from Cuba, Iran and Tunisia.

The safety domain assessed patient safety such as the safe handling and storage of medicine, patient safety systems (patient education on safety and adverse incident management), infection prevention and control and medical device risk reduction (safe use of devices).

In relation to the safe handling and storage of medicine, the hospitals that performed well above standard included Chris Hani Baragwanath, George Mukhari, Tembisa, Edendale, Frere, Livingstone, Mahatma Ghandi, Jane Furse, Themba and GF Jooste Hospitals.

But Butterworth and Tshilidzini hospitals were in need of improvement.

Sizwe Tropical, Gauteng’€™s TB hospital, Edendale and Ngwelezana hospitals were found to be performing well above standard in terms of infection control.

Under the clinical care domain, several hospitals had failed to create, maintain and store medical records. These included Butterworth, Komani, George Mukhari, Tembisa, Edendale and Rustenburg hospitals, as well as Khayelitsha CHC, KwaMashu Polyclinic and Lilian Ngoyi CHC.

The corporate governance domain included a sub-section on management and planning where Butterworth, Frere, Livingstone, National, Pelonomi, Rustenburg and Taung hospitals were identified as performing well above standard.

The fourth domain, patient experience of care, saw Chris Hani Baragwanath, Edendale, National, Ngwelezana, Temba, Witbank, Kimberley hospitals and Nqamakwe CHC performing well in terms of having a functional complaints’€™ management system in place.

The domain focusing on access to care covers initiatives aimed at ensuring that patients have access to appropriate services within a reasonable period of time at the facility where they present or through a well-functioning referral system for both acute and chronic cases.

Tshabalala-Msimang said there was agreement that the referral system needed to be ‘€œtightened’€. She flagged the possibility of a ‘€œfee for those who bypass clinics to go to hospitals’€.

Edendale and Ngwelezana hospitals were the only two mentioned to have performed well in terms of seeing patients within an acceptable time.

In the domain of infrastructure and environment, the minister said they ‘€œget terribly worried’€ over the fact that healthcare delivery in some instances took place in an environment that was ‘€œless clean’€ and posed other health risks to users and healthcare workers.

She said the assessment tool allowed the department to immediately institute improvement plans in areas of concern.

The public health domain covered the active collaboration between the facilities and relevant healthcare and other organizations and the local community. These included health promotion and prevention programmes, integration of care and community involvement as well as disaster outbreak preparedness.

Tshabalala-Msimang said the results were already being used to develop plans to support facilities to immediately correct those areas which needed to be strengthened.

The assessment exercise included questionnaires with over 1 000 questions being completed by the relevant managers as well as the review teams from an outside province.

Asked if the report was subjective, Tshabalala-Msimang said ‘€œwe would not have spent the money, energy and effort to develop this tool if we wanted to cover things up’€.

Tshabalala-Msimang side-stepped questions on her future following the president’€™s resignation, but intimated that she did not have any plans to resign.