While AHP doctors primarily focus on providing clinical care to patients, many contribute to the overall quality of care provided in under-resourced rural South African hospitals through the design and implementation of quality improvement projects (QIPs).
In the United Kingdom, there is an increasing focus on junior doctors’ potential to transform healthcare and a number of initiatives including programmes by royal colleges, workforce deaneries and health departments have been tested to engage them in quality improvement. As a result of the focus on quality improvement in the National Health Service (NHS), British doctors are inclined to design and implement QIPs when the opportunity presents itself, most often to improve patient care.
Quality improvement projects can be simple yet still effective – for example, the Eastern Cape Province has the lowest child survival in South Africa, with an infant mortality rate of 62.0 per 1000 live births. An AHP doctor in the Eastern Cape Province identified an opportunity to strengthen the routine collection of data on inpatient child mortality. The doctor, working with the Medical Manager and other colleagues, was able to introduce a locally-adapted version of the Child Health Problem Identification Programme (ChIP), a nationally recognised system for auditing and collecting data regarding childhood inpatient mortality. This data is submitted regularly to a national log. A programme of monthly meetings was established where this data was presented to paediatrics staff, local clinic staff, hospital doctors and hospital management, and specific cases were selected and discussed to identify ways to improve child survival at the hospital.
Another example is at a hospital in Ehlanzeni district in Mpumalanga Province. There an AHP doctor found that patients were not undergoing ultrasound tests they needed at a referral hospital. Upon investigation, the doctor discovered that private transport was too expensive for patients to get to the referral hospital, and often the hospital was unable to transport patients for tests. The doctor worked with the hospital’s Medical Manager to establish an ultrasound outreach service from the referral hospital. The new system is simple: doctors add patients requiring ultrasounds to a list, and once 20-30 patients have been identified, an ultrasonographer is invited to run a Saturday clinic at the local hospital. Enabling patients to see a sonographer closer to home means that health-seeking behaviours are encouraged and the barriers-to-entry for diagnosis and treatment are lowered.
In addition, last year in August, some AHP doctors presented their quality improvement projects at the Rural Doctors Association of Southern Africa (RuDASA) conference held in Grahamstown. Dr Mike McGovern, Medical Officer at Madwaleni Hospital in Eastern Cape Province presented “Safe Caesars: A Caesarean safety checklist improves behaviours of staff in a small rural hospital”, and Doctors Oliveira, Thevarajan, and Stovin from Rietvlei Hospital had a poster presentation entitled “The introduction of INR monitoring cards for patients receiving Warfarin at Rietvlei Hospital, Kwa Zulu Natal, South Africa.”
In a recent survey we undertook with some AHP doctors around quality improvement projects, they shared some of the lessons that they have learned from implementing quality improvement projects in South Africa compared to implementing then in the United Kingdom in the NHS. These lessons include ensuring buy-in and collective ownership with local staff right from the beginning of the project, keeping the project simple, ensuring that projects are designed to be sustainable after the implementing doctor’s tenure, and being aware that QIPs are less common in South Africa so AHP doctors should take time to establish themselves and being mindful of possible resistance to their project activities. Of major importance is the collection of data, before and after the project’s implementation. Making clearer links between quality improvement projects and the National Core Standards for Health and engaging Clinical Managers early on in the project are also recommended for a successful outcome.
For more information on AHP doctors QIPs during your experience in South Africa, please contact Dr Oliver Johnson, AHP’s Strategy and Technical Advisor at firstname.lastname@example.org.