Quality assurance of apcc service providers mentorship programme

1. Introduction

While the National Health Amendment Act (Act No. 12 of 2013), and the resulting establishment of the Office of Health Standards Compliance (OHSC), is welcomed as an important step towards Quality Assurance (QA)[ Quality Assurance (QA) measures compliance against Standards] in healthcare, its challenge is that it only represents one side of the Quality Improvement (QI)[ Quality Improvement (QI) is a continuous improvement process focused on processes and systems] coin i.e. that of establishing Standards and auditing healthcare Service Providers against these Standards. It does not provide a mechanism for building the capacity of Service Providers to comply with these Standards. Quality Improvement (QI) is a two-sided coin, it must provide the Standards to be reached, and the mentorship required to enable Service Providers to reach these Standards. Without mentorship, the Standards only shows Service Providers where they fall short, without providing them with the support required to address those short comings. One of the strategic priorities of HPCA is “to improve the capability of its members”. During the 2019 / 2020 financial year, the HPCA Board approved a budget of R2 million towards the mentorship of HPCA Service Providers.

2. Aim of the HPCA Monitoring, Evaluation & Reporting Programme

The Aim of the HPCA Monitoring, Evaluation & Reporting Programme is to report on the patient care services provided by HPCA Service Providers and to use this information for Quality Improvement of patient care services and reporting to stakeholders including Medical Schemes.

3.The Hospice Data Management System (HDMS)

In 2011, HPCA developed the Hospice Data Management System (HDMS)[ The HPCA HDMS was developed with a grant from First National Bank] in collaboration with then Airborne Consulting[ Airborne Consulting was created in 2004 and is a majority BEE owned company that specializes in information technology and management consulting..]. The purpose of the HDMS was to develop a national cloud-based patient care data management system that could be used by HPCA Service Providers to capture and report on the actual delivery of Palliative Care services at an individual patient level; a patient group level (e.g. by diagnosis; age group; gender; population group; medical scheme; etc.); and at an organisational / geographic regional level (e.g. individual hospice; health sub-district; health district; provincial; and national). The HDMS was originally built on a Microsoft SQL Server 2008 platform and was upgraded SQL Server 2016 in 2020. The HDMS is a highly sophisticated cloud-based patient care management system that can report on all patient care services provided to any patient at any point in time.

4. Measuring the Quality of Care

HPCA has developed and implemented three programmes designed to measure quality in one way or another. Figure 9 identifies each Programme and what each Programme measures.

The HPCA Standards are essentially designed to ensure that a Hospice has the policies, systems, processes and procedures in place, which enables the Hospice to deliver quality Palliative care. There is no guarantee that a Hospice that complies with the Standards will in fact provide quality Palliative Care even though its capacity to do so would be significantly enhanced through compliance with the Standards.
In addition to measuring the number of patients cared for collectively or in multiple categories (e.g. by age; diagnosis; gender; population group; category / level of illness; geographic distribution etc.), the HDMS measures the quality (intensity) of care given to a patient. The quality (intensity) of care received by patients is measured in terms of the following four parameters:

  • the frequency of care. How often and how many times does the patient receive care (visits)?
  • the duration of care. What is the duration of these visits? How much time does the carer spend with the patient?
  • the number and range of interventions received by the patient. Is the patient receiving the appropriate number and range (i.e. physical; psychological; social; spiritual) of interventions commensurate with their level of illness?
  • the human resource capacity (i.e. qualifications and experience) used to provide the interventions. Are the interventions provided by persons (e.g. Home Based Carer; Professional Nurse; Social Worker; Medical Doctor; Spiritual Counsellor etc.) who have the appropriate qualifications and experience given the level of illness of the patient?

During the 2021 / 2022 financial year, HPCA and is members provided palliative care for 15,793 patients and provided support for 22,699 family members of the above patients, amounting to a total of 38,492 clients. Patients that are cared for by HPCA members are cared for by an interdisciplinary team including a Medical Doctor, Professional Nurse, Social Worker and Home Based Carers trained in palliative care. Approximately 97% of patients cared for by HPCA members are cared for at home and 3% are cared for by Hospice In-Patient Units (IPUs). During the 2021 / 2022 financial year, HPCA members conducted 340,345 home based care visits which included 2.9 million interventions of which 65% were clinical, 18% psychological, 12% social and 2% spiritual.

Research undertaken by the S.A. Medical Research Council shows that palliative care at home, could save the Public and Private health care sectors millions of rand per annum. Research shows that hospice palliative care is more cost effective than both Public Sector and Private Sector palliative care.