A structured provider quality management system is in place to guarantee the quality of the medical care available in the delivery system. The objectives of the quality management system are:
1. Ensure delivery of quality medical care services
2. Ensure compliance with contractual obligations
3. Ensure compliance with agreed standards, protocols and work plans
4. Ensure adequate and appropriate usage of donated medical equipment
5. Ensure patient satisfaction
The HCHP quality management system is hinged on the tripod of asset improvement, skills improvement and process improvement. Three complementary initiatives exist to address each of the elements of the HCHP quality focus. These are:
1. Infrastructure and equipment upgrade grant which addresses asset improvement
2. Continuing medical education which addresses skills and process improvement
3. Practice guidelines which address process improvement
A robust monitoring and evaluation system also exists to monitor and ensure continuous improvement along each of the three elements of the HCHP quality focus.
Provider Infrastructure and Equipment Upgrade
Provider asset (structural and equipment) upgrade is one of the quality improvement initiatives implemented to ensure that enrollees receive quality care from all the providers in the network.
Subsequent to a needs analysis of all the participating providers, an upgrade plan was drawn up with the in-put of the providers. All participating primary care providers had some infrastructural upgrade which included renovation of existing buildings, supply of air-conditioners and fire-extinguishers, provision of bore-holes and in one instance the completion of a new clinic building.
The provider upgrade also included the donation of various medical equipment to the healthcare providers. Insurance and maintenance costs were paid for by the HCHP. The use of these donated equipment is however not restricted to the HCHP enrollees, the providers are allowed to utilize the equipment to provide required care to their fee-for-service clientele and other categories of patients. These equipment have increased the capacity of the providers to attend to more patients and the commensurate revenue increase has benefitted them immensely.
The upgrade ensures that the providers have all basic equipment and infrastructure required to provide quality healthcare services. HCHP care coordinators work with the providers to ensure appropriate utilization of the equipment donated. Consequent to the upgrade, the provision of quality health care services has improved particularly we have seen an improvement in the use of laboratory services to support clinical diagnosis and management of the enrollees especially malaria parasite microscopy.
HCHP is also encouraging adoption of Information Technology through the supply of IT equipment and internet access, making it possible to communicate easily with the providers. The systems supported by training from HCHP also help the providers administratively and clinically, including standardized coding of investigation, diagnosis treatment.
The provision of ambulances to several of the participating providers has also ensured the prompt and timely transfer of patients from primary to secondary providers when the need arises.
Continuing Medical Education
In conjunction with the PharmAccess Foundation, the HCHP designed a continuing medical education curriculum for the participating providers that addresses pertinent medical conditions of public health significance. Healthcare quality management and data management training modules are also included in the curriculum. The trainings are designed to complement the provider infrastructure and equipment upgrade programme to ensure the provision of quality care to all the HCHP enrollees.
HCHP's continuous training of the providers ensures consistency with a focus on quality and evidence based medical care. With continuous health care worker capacity building, the enrollees will continue to benefit from the added knowledge and skill which ultimately translated to improved healthcare services. The providers will also apply their acquired knowledge and skill to their non HCHP clientele thereby impacting on the health of the community.
The workshops typically involve all categories of healthcare workers in the hospitals i.e. Doctors, Nurses, Administrators, Laboratory and Pharmacy personnel. This approach stimulates an integrated or systems view of the medical condition, in which all weak links in the service chain are addressed and strengthened. The choice of training topics is guided by the utilization statistics. The workshops focus on the most prevalent conditions to ensure that evidence-based care and quality services are dispensed by the healthcare providers.
These are sets of standards, criteria or specifications required in the care of patients for particular medical conditions. They are quality management mechanisms designed to aid providers in making decisions about the most appropriate course of treatment for specific clinical cases. These guidelines help to standardize the care given to enrollees for specified conditions across board. Practice guidelines are developed form evidence based studies with the in-put of specialists and clinicians involved in patient care. These practice guidelines are subsequently reviewed with the providers before they are adopted and implemented. Practice guidelines have been developed for the more common conditions which afflict majority of the scheme members. Practice guidelines are presently available for malaria, hypertension and diabetes. Compliance with clinical practice guidelines are evaluated routinely during case management activities and case file audits.
Provider Accreditation - COHSASA Safecare Standards
Council Of Health Service Accreditation Of South Africa (COHSASA) replaces the on-track system of PAF for M&E and is a joint collaboration between PAF and COHSASA. SafeCare standards are within 13 service elements; Management and leadership, Human resource management, Patient rights and Access to care, Management of information , Risk management, Primary health care services, In-patient care, Operating theatre and anaesthetic services, Laboratory services, Diagnostic imaging services, Medication management , Facility management services and Support services.
Quality of service improvement is the ultimate goal thus enhancing staff capacity development. The structure and organisation of the standards meet the requirements of the International Society for Quality in Health Care (ISQua).