NATIONAL CORE STANDARDS FOR
HEALTH ESTABLISHMENTS IN
SOUTH AFRICA
10th NATIONAL MIDWIFERY CONGRESS
ST GEORGE HOTEL
05 DECEMBER 2012
BY: N. MAGINGXA
Contents
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Some definitions
Background
Development of the Core standards
National Core Standards - Purpose
Policy and Legal contexts
Structure of the Core Standards
Six Ministerial Priority areas
Interconnected standards
NCS – Assessment
Baseline Audit
Conclusion
Some Definitions
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Quality
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Standards
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Getting the best results possible within the
available resources.
Statement of an expected level of delivery of
quality.
They reflect the ideal performance level of a health
establishment in providing quality of care.
Domain – an aspect of service delivery where
quality or safety can be at risk
Background
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SA has poor health outcomes.
Some factors that contributed to this situation
include:
 Poor management.
 Lack of accountability.
 A culture of mediocrity rather than excellence.
 Demotivated staff.
NDoH committed to provision of best quality care and
health service delivery.
Development of core standards
Core Standards for Health Establishments –
piloted in 2008.
Core Standards for Health Establishments –
revised format piloted in March 2010.
Core Standards for Health Establishments –
finalised in 2011.
National Core Standards: Purpose
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Set standards for quality service through defining and
specifying what is expected in terms of quality in the
health sector.
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Develop a common definition of quality of care which
should be found in all health establishments in South
Africa.
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Establish a benchmark against which health
establishments can be assessed, gaps identified,
strengths appraised, and guide quality improvement
also;
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Achieving compliance with the standards.
Policy context (1)
10-Point Plan of the National Department of
Health 2009-2014 and Strategic Plan for
2009-2012.
“establishment of a quality management and
accreditation body”
“improving the quality of health services”
Quality of Health Care Policy of 2007
Infection and Prevention Control Policy of
2007.
Policy context (2)
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Negotiated Service Delivery Agreement
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Improve life expectancy
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Improve mother and child health and survival
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Reduce the impact of HIV/AIDS and Tuberculosis.
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Improve health system effectiveness. Focusing on:
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Re-engineering primary health care
Improving quality in health service delivery
Information
Human Resources
Finance and Financing
Infrastructure and Technology
National Health Insurance
Legal context
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The National Health Act, 61 of 2003
Amended to include the role of Office of Health Care Standards
Compliance (OHSC) as
“a quality assurance body mandated to assess all health
establishments for compliance with the National Core
Standards”.
The Office must:
(a) Advise the Minister on the development of norms and
standards for the national health system and the review of such
norms and standards;
(b) Certify health establishments as compliant with prescribed
norms and standards;
(c) Ensure compliance with prescribed norms and standards by
health establishments;
(d) Investigate complaints relating to the health system
Structure of the Core Standards
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7 cross-cutting domains
They are dependent on each other
1. Patient
Rights
2. Patient safety, Clinical
Governance, Care
3. Clinical Support Services
Core business
of the health
system.
4. Public Health
5. Leadership and Corporate Governance
6. Operational Management
7. Facilities and Infrastructure
Support
system.
Structure of the Core Standards Domains
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Domain - an aspect of service delivery where
quality or safety can be at risk
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Sub Domain - further break down the domains into
subsections or critical areas which combined
describe the scope of that domain
Standard
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Standards - define what is expected to be
delivered in terms of quality care; reflect the
expected situation resulting from successful
implementation of a policy, procedure or system.
Criteria
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Criteria - elements setting out the requirements to
achieve compliance with the standard;
are
measurable and achievable
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Measures - the means or evidence for determining
whether the criteria have been met;
examine
aspects that can be seen, heard or felt by the
assessors and give reasonable assurance that a
standard is met
Sub Domain
Measures
Domain 2: Patient Safety Clinical governance &
Clinical Care
Sub Domain: Infection Prevention and
Control
Standard: An Infection Prevention and
Control Programme is implemented
Criteria: A formal structure exists to
monitor all aspects of infection
prevention and control
Measures:
1. Terms of reference of the committee are
available
2. Minutes of the committee indicates that
control measures are regularly discussed,
analyzed and actions have been taken to
reduce infection rates
3. The committee makes recommendations
on antibiotic usage for the establishment
4. Statistics on common health care
associated infections demonstrate that they
are in line with acceptable benchmarks
Example
Domain and Sub Domains
1. Patient Rights
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
Respect and dignity
Information to patients
Physical access
Continuity of care
Reducing delays in care
Emergency care
Access to package of services
Complaints management
Domain and Sub Domains cont.
2. Patient Safety - Clinical
governance & Clinical Care
2.1 Patient care
2.2 Clinical management for improved health outcomes
2.2 Clinical leadership
2.4 Clinical Risk
2.5 Adverse events
2.6 Infection prevention and control
3. Clinical support services
3.1 Pharmaceutical services
3.2 Diagnostic Services
3.3 Therapeutic and Support Services
3.4 Health Technology Services
3.5 Sterilization services
3.6 Mortuary
Domain and Sub Domains cont.
4. Public Health
4.1 Population based service planning and
delivery
4.2 Health promotion and disease prevention
4.3 Disaster preparedness
4.4 Environmental control
5. Leadership and Corporate
Governance
5.1 Oversight and accountability
5.2 Strategic management
5.3 Risk management
5.4 Quality improvement
5.5 Effective leadership
5.6 Communication and public relations
Domain and Sub Domains cont.
6. Operational management
6.1 Human resource management & development
6.2 Employee Wellness
6.3 Financial Resource Management
6.4 Supply chain Management
6.5 Transport and fleet management
6.6 Information management
6.7 Medical records
7. Facilities & Infrastructure
7.1 Buildings and grounds
7.2 Machinery and utilities
7.3 Safety and Security
7.4 Hygiene and cleanliness
7.5 Waste management
7.6 Linen and laundry
7.7 Food services
National Core Standards: Measures
Risk rating
Classification
measures
1. Extreme
Vital
Those that ensure that the safety of patients and staff are
safeguarded so as not to result in unnecessary harm or
death. These are non negotiable measures
3. Medium
Essential
Those considered fundamental to the provision of safe,
decent, quality care and are designed to provide an in-depth
view of what is expected within available resources (for
example: clinical risk management and quality improvement
processes; or guidelines for maternity care).
4. Low
Developmental
Those elements of quality of care to which health
management should aspire to, in order to achieve optimal
care. While non-compliance with these standards does not
necessarily constitute a risk to patients, they form an integral
part of a comprehensive quality health care system.
Developmental
standards
enhance
the
health
establishment’s ability to provide optimal care and reflect
continuous improvement.
2. High
of
Definition
Six Ministerial Priority Areas
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Critical areas that must be improved upon by all
facilities.
Areas of major concern for our patients
Largely reflect the first 3 domains.
Fast-track improvement by all facilities is required in:
 Values and attitudes of health care staff
 Cleanliness in facilities
 Waiting times – queues and delays
 Patient (and staff) safety and security
 Infection prevention and control
 Availability of medicines and supplies
Relationship of 6 fast-track
priorities and the core standards
1. Patient
Rights
2. Patient safety,
Clinical Governance,
Care
3. Clinical Support
Services
4. Public Health
5. Leadership and Corporate
Governance
6. Operational Management
7. Facilities and Infrastructure
Patient Safety,
Clinical
Governance &
Care
4. Patient safety.
5. Infection
prevention &
control.
Clinical Support
Services
6. Availability of
medicines and
supplies.
Values and attitudes of health
care staff
Evidence that:
 Patients are treated and cared for in a respectful
manner.
 Patients attest through positive satisfaction surveys
 Complaints procedure in place and used to improve
service delivery.
 Leaders at all levels provide supervision and positive
role modelling.
Reducing Waiting times
Evidence that:
 Waiting times are monitored and
 Improvement plans implemented
 Queues managed and there is
 Proper triaging of patients
 Waiting times for elective procedures efficiently
managed.
Cleanliness in facilities
Evidence that:
 Patients satisfied with facility cleanliness.
 Public areas e.g. toilets, grounds kept clean
 Availability of adequate cleaning materials
 Proper waste management
 Availability of checklists
Patient safety
Evidence of:
 Proper care according to the guidelines.
 Special care to high risk patients ( pregnant,
frail/aged, mentally ill, children etc)
 Proactive risks identification to prevent adverse
events.
 Prompt management of adverse events.
 Mortality and morbidity meetings held.
Patient safety cont.
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Adequate physical safety
Laboratory and X-ray turn around within acceptable
time lines.
Clinical audits are conducted
Patients educated about medication intake as well as
side effects.
Emergency plans and outbreak readiness
Hospital board involved in quality improvement
Infection Prevention and Control
(IPC)
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Availability of an IPC policy
A formal system is in place.
Standard precautions are monitored ( hand
washing, waste disposal).
Strict infection prevention observed ( food and
milk preparation areas)
General waste management practices.
Availability of medicines and
supplies
Evidence that:
 Essential medicines and supplies in stock
 Procurement, payment and delivery processes, are
reliable and on time.
 Stock levels are properly managed to prevent stock
shortage and loss.
 Functional PTC exists in facilities or district.
 Patients given adequate information about the
dispensed medication.
Interconnected Standards
module
on DHIS
1.4
National Core Standards (NCS)
Assessment
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Separate tools for each facility type used to collect
information to determine compliance/noncompliance.
Data is captured:
 As the Core Standards Module on DHIS
Results are reported:
 On the DHIS as a report indicating compliance
per domain and per priority area.
Example of tool
Example of a facility outcome
report
Overall outcome:
compliant or non
compliant
E = 0%-20%
D = 20%-39%
C = 40%-59%
B = 60%-79%
A = 80% - 100%
Provisional score:
grade A - E
Outcome: Compliant vs Noncompliant
 For a facility to be “compliant” it must meet all
vital
measures on assessment.
 If the facility is “non-compliant” on even one
vital measure this results in an overall
outcome of “non compliant”.
Baseline Audit
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In 2011 Health Systems Trust (in partnership with
HISP, MRC, ARUP and EXPONANT) entered into a
cooperative agreement with NDoH:
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To conduct an independent audit of all public health facilities
in the country to assess compliance with the NCS.
Process
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Baseline audit followed self assessment that was driven by
quality assurance managers in facilities.
Audit commenced March 2011 and completed March 2012.
4210 facilities in the country audited.
A preliminary report of the baseline audit results was given
by teams at district, sub – district and facility (Hospitals)
level.
All facilities were expected to develop quality improvement
plans based on the findings from the preliminary reports.
Conclusion
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The significant goal of the core standards is
 “To assist in improving quality of care in all
health establishments”.
The primary activity therefore by supervisors,
managers and all staff members is to ensure that
 “Compliance with standards becomes a norm
through implementation of a continuous quality
improvement process”
References
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NDoH, Towards Quality of Care for Patients, National Core
Standards for Health Care Establishments, 2011
NDoH, Towards Quality of Care for Patients, Fast Track to
Quality, The six most critical areas for patient-centred care,
2011
NDoH, National Core Standards Toolkit, 2011
NDoH, Guideline use of database, National Core Standards for
Health Care Establishments, 2011
THANK YOU
Nomthandazo Magingxa
Email: nomthandazo.magingxa@hst.org.za
Tel: 0716067459
http://www.hst.org.za