Leaders need to inspire frontline health workers to drive quality improvement in hospitals
It is essential that frontline healthcare staff such as doctors and nurses are empowered to take ownership for quality and the safety of patients, delegates at the Hospital Association of South Africa (HASA) 2015 conference in Cape Town heard on Monday.
“Regulations are important to provide a framework, but a culture of safety needs to be created,” said Dr Peter Lachman, Deputy Medical Director at Great Ormond Street Hospital. “When standards are sent down to the front line and they feel they don’t own it, it is very difficult to implement.”
He said the education of doctors and nurses needed to be reformed to include quality improvement, alongside other disciplines such as anatomy, physiology and pathology. “There are a number of challenges including the conservatism of the medical profession as well as hierarchies that operate in hospitals that means the patient is not always listened to,” added Lachman. “There is a belief that harm is inevitable and that safety is resource related, but often by improving safety one patient at a time that you’ll start a movement.”
Lachman said healthcare workers seldom set out to intentionally harm patients and it was possible to make small changes with sustainable results.
Former CEO of the Office of Health Standards Compliance (OHSC), Dr Carol Marshall said the National Core Standards had been designed to protect patients from harm.
Marshall said mock inspections in public sector hospitals and clinics conducted by the OHSC found large variations in the quality of health services delivered between the types of health establishment, provinces and individual establishments.
“Quality problems often have an underlying cause such as weak leadership and accountability, bureaucracy and capacity constraints relative to workloads and budgeting,” said Marshall. “In the public sector, centralised authority is a major challenge as it means it’s often difficult to hold people accountable for problems over which they have no control. “She said regulation is just one of the many mechanisms government was using to manage quality in hospitals, including certification, councils, monitoring indicators and strengthening the voice of users through an Ombud.
Dr Dena van den Bergh, Director: Quality Leadership at Netcare told delegates that hospital managers played a critical role in leading organisations. They needed to declare patient experience a personal priority and transparently discuss results with their frontline teams to continue improving.
“You can have tools and data, but unless you understand your process and you make quality improvement a culture, you’re unlikely to change the system,” she said. “It’s essential to discuss both the successes and failures, create focus and energy and leadership at every level.”
According to the Hospital Association of South Africa (HASA) Chief Executive, Dumisani Bomela, the addition of quality care in the conference demonstrates the emphasis private hospitals are placing on constantly improving quality care. He said, “In a highly competitive sector, it is a non-negotiable that private hospitals constantly improve patient care – the sessions we have set aside at this conference are designed to help private hospitals share their successes, and to learn from each other.”
New technologies could bring down costs of healthcare
Digitisation could radically transform the way healthcare is delivered and bring down costs, delegates at the Hospital Association of South Africa’s 2015 conference heard in Cape Town.
Smart devices to track inventories, equipment and even patients and doctors in real time as they travelled around the hospital were just one of many new devices on the market, said Dr Imraan Munshi, a partner at McKinsey & Company.
He said there were close to 160 000 high technology health applications now available and that could transform patient record keeping, biometrics tracking, appointment scheduling and inventory management. “We’re seeing technology and social media increasingly being used to keep patients informed and connected during treatment,” he added. “Mobility and technology can be harnessed to improve patient satisfaction.”
Teleconsultations where doctors consulted patients over the phone via Skype or online were proving popular and effective in some markets, saving time and costs for both patients and doctors.
“Focus on the high impact opportunity areas first,” Munshi advised.
He said hospitals could use data to target care and use real time analytics to make the best use of resources. Manual tasks could be automated to reduce both time spent on administration and to reduce variation. Clinicians and patients also no longer needed to be located in the same place.
Also speaking at the HASA conference, Expert Principal at McKinsey, John Drew said as people became wealthier, healthcare played a bigger part in their lives. With income growth, the proportion of the disposable income consumers spent on healthcare grew over time. “But healthcare spend globally needs to be curtailed as current growth rates are not sustainable,” he added. “New business models and innovative approaches are needed.”
Dr Bhavna Patel, CEO of Groote Schuur told the conference that a new innovation hub had been established at the 975-bed public hospital.
“We want to create a culture of finding innovative solutions to improve healthcare,” she said. Patel outlined a number of programmes that had been successfully implemented to improve waiting times, infection control and utilisation of infrastructure such as beds and surgical theatres.
CEO of HASA, Dr Dumisani Bomela said innovation lay at the centre of developing person-centred healthcare in hospitals. “When it comes to innovation, it’s not always about novelties or the latest technologies, it is about any change that can be leveraged to improve the processes and outcomes,” he said. “Quite often it is simple things that can achieve that.”