An audit tool for relicensing inspection to assess quality and patient safety in eThekwini private hospitals

Abstract

Background In South Africa, the National Core Standards are advocated as the cornerstone for improving quality and patient safety in health care organisations. To align to the Department of Health’s legislative and policy mandates, the Office of Health Standards Compliance developed the National Core Standards for Health Establishments in South Africa that provide a benchmark of quality of care against which the delivery of health services can be monitored. Through the implementation of the National Core Standards (NCS), an assessment of a health facility’s compliance to service standards can be measured.

Aim The aim of this study was to develop an audit tool for relicensing inspection to assess quality and patient safety in eThekwini private hospitals

Methodology An exploratory sequential mixed methods research design was used to assess nursing staff perceptions regarding the current relicensing audit process and the existence of best practice standards in (n=4) private hospitals in eThekwini district. A purposive sampling technique was employed to recruit clinical managers in the qualitative phase of the study. A total of (n=24) participants were interviewed from approximately 40 clinical managers, guided by data saturation; (n=9) from Hospital A, (n=7) from Hospital B, (n=5) from Hospital C and (n=3) from Hospital D. The clinical managers are the unit managers (middle management) and nursing services managers (higher management) in charge of all clinical services in the hospital and are directly involved in relicensing inspections. In the quantitative phase of the study, a simple random sampling technique was employed to include nursing staff in direct contact with the patients. The total population of nurses was 569 of which 270 were sampled for the study. The approach adopted for qualitative data analysis was an inductive approach. The concepts identified were translated into codes, then codes translated into themes and categories. The themes according to which data was organised were based on the conceptual framework that guided the study. The quantitative data was analysed using version 23.0 of the Statistical Package of Social Services. In the documentation review phase a total of 59 documents were reviewed from each hospital, amounting to 236 documents.Quantitative content analysis was used to analyse the documentation using a deductive approach. The goal was to identify important themes or categories within the content of the documents that corroborated with findings of both phases of the study and as related to the NCS and the Batho Pele principles.

Results The results of the study showed that the participant private hospitals in eThekwini district have not fully implemented the approach to practice standards and healthcare audits in relation to three clinical domains of the National Core Standards and the Batho Pele Principles. Although best practice policies and procedures exist in private hospitals in eThekwini district, the results of the study showed that there is inconsistent checking of the clinical domains in the participant hospitals during relicensing inspections. Recommendations from participants for a standardised audit process led to the development of an audit tool for relicensing inspections based on the National Core Standards and the Batho Pele Principles for private hospitals in eThekwini district