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Shining light on quality management in Africa

Interview with Jacqui Stewart, Chief Executive Officer, The Council for Health Service Accreditation of Southern Africa (COHSASA), Cape Town, South Africa

Named as one of the 100 most impactful healthcare leaders by the World Health and Wellness Congress in 2019, Jacqui Stewart, Chief Executive Officer, The Council for Health Service Accreditation of Southern Africa (COHSASA), Cape Town, South Africa, will be chairing a panel on quality management at the upcoming Omnia Health Live Africa. Ahead of the event, Omnia Health Insights had a chat with Stewart about the importance of accreditation for healthcare organisations.

Stewart has been with COHSASA since 2005 and says that the organisation's standards provide a blueprint for good practice and enables facility teams implementing them to put in place systems and processes that will ensure things are done correctly. One of the challenges in patient safety, she highlights, is that people aren't open and honest to talk about a mistake and more needs to be done to disclose and explain to the patient if something goes wrong.

She says: “Within any healthcare setting, things can go wrong. But what we find is that if the standards are implemented correctly, and people do the right thing, most of the time, when something does go wrong, the system can deal with it. So, people are aware that there's a problem that has occurred, and they're honest and open about discussing it. It's about embedding quality in the everyday work of every healthcare professional and ensuring no shortcuts are taken. Right, from the receptionist to the CEO of the hospital, everybody has to take responsibility for doing the right thing.”

It is also important to create an environment of “just culture”, she adds. This means that if somebody does make a mistake, the first thing to be done is not to punish them, but to find out what happened, and making sure that people are not fearful to report incidents and that similar events don't happen in the future.

Quality management review process

At the start of the accreditation process, COHSASA trains the healthcare facility team on how to implement the standards and how they can evaluate their service against those standards and then look at the improvements that need to be put in place to comply with them. Currently, their standards are written in English, however, for some English might not be their first language, so the organisation works hard to ensure everybody understands the meaning of the standards correctly.

“Accreditation is a continuous process,” explains Stewart. “It's not a tick-box exercise, it's more of a process of changing behaviours. For example, in a system for reporting negative incidents, we want the staff to manage those incidents, learn from it, track it, and monitor over time so that it becomes the norm. Once the standards have been implemented, we want to ensure that they're embedded within. Currently, we do an on-site survey where we send several surveyors; usually, if it's a hospital, it will be for five days. The team will review every single department against the standards and check that the documentation and evidence are there and will interview the staff. Not only do we want to see what is written down, but we want to see the people do the right thing. We also interview patients, and have adopted what we call trace methodology where we will take a patient record and follow that patient through the hospital and observe their whole journey and see which departments they visited, how they were treated and that it's properly documented, and that the staff understand what they're doing.”

She adds that due to COVID-19, some of their work such as training had to be done remotely. COHSASA has also started to do some smaller surveys remotely with the help of smartphones and asking staff to show the day-to-day operations through the technology.

Stewart emphasises: “I think technology has a great role to play here. COHSASA has an incident reporting system that is online, where the staff can call into a call centre and report an incident in real-time, and it gets captured into the system. The details are available immediately. I think that's important because if somebody has to sit down and write a report, they're going to leave it for later. Also, when something goes wrong, healthcare professionals are in a bit of shock and they're upset because they don’t like doing things wrong. Therefore, they might forget some of the steps of what happened. We have a cascade of questions to help people ensure they get all the information correctly imported straightaway.”

COHSASA works throughout Africa and incorporates lessons from all these different countries to ensure that its accreditation standards are applicable everywhere. At the start of the accreditation journey, some services of the healthcare facilities are usually not up to the mark, but along the way when they see improvement in the services, it becomes more of a collaboration and a powerful partnership.

“I think for the future, accreditation has a big role to play. I always say it's not a sprint, it's a marathon because it's about ensuring quality. Your first accreditation is actually the first step, the challenge, however, is to stay accredited and maintain those standards. COHSASA is constantly looking at how we can raise the bar. We're also collaborating with some countries to help them develop their accreditation systems. I think that's important to help people take ownership in their own countries and know that they don’t always need help from the outside. I want to ensure COHSASA remains up there with the best of the best and is a shining light on quality in the continent,” she concludes.

Omnia Health Live Africa

Stewart will be the moderator at the ‘Quality and safety lessons learned from COVID in the African context’ session on Monday, October 12, 13:00 CAT at Omnia Health Live Africa.

She said: “We will be discussing the lessons learned from COVID-19, in the context of Africa. We have panellists who work in different spheres of the healthcare sector and are from Namibia, Rwanda, Kenya and Nigeria, so it's a good spread from across the continent. We will look at finding some positives from COVID-19. One of the interesting topics we will talk about is the focus on hand hygiene during the pandemic, as this has had a positive impact on other diseases such as hepatitis. We will also explore the innovations and lessons learned from the pandemic and how can we share these across Africa.”

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