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 show Service Providers where they fall short, without providing them with the support required to address those shortcomings. One of the strategic priorities of the APCC is “to improve the capability of its members”. During the 2019 / 2020 financial year, the Board approved a budget of R2 million towards the mentorship of APCC Service Providers.
2. Aim of the APCC Mentorship Programme
The aim of the APCC Mentorship Programme is to support APCC Service Providers to comply with the Standards for Palliative Healthcare Services. Figure 2 illustrates the Mentorship Programme within the APCC Service Provider Quality Improvement Cycle.
3.APCC Service Provider Mentorship Tools
3.1 Hospice Self-Assessment Tool (SAT)
During 2015, the HPCA (now APCC) developed an online cloud-based Self-Assessment Tool (SAT) based on the Standards for Palliative Healthcare Services. The SAT enables APCC Service Providers to assess themselves at any time against the Standards for Palliative Healthcare Services. APCC Service Providers can pace themselves through the SAT in preparation for Internal Follow-up Surveys or just to identify their strengths and challenges in being compliant.
3.2 Hospice Development Plan (HDP)
Based on the results from Internal Follow-up Surveys of APCC Service Providers in the APCC Accreditation Programme, a Development Plan is drafted and agreed to between the member that was surveyed and the APCC. The Development Plan identifies the Palliative Healthcare Standards where the member needs to be strengthened, including the external expertise and timeframes required to do so and the date for the next Internal Follow-up Survey. A member may participate in several Internal Follow-up Surveys before it reaches a 4 Star rating and can participate in a Pre-COHSASA Internal Survey.
It is generally accepted that peer-to-peer learning is one of the most effective ways of learning. This is particularly true when it comes to building the capacity of members since the expertise required to do so are generally not that of a ‘specialist expert’ but are more general in nature and are more related to systems, processes and procedures. In the APCC Mentorship Programme, fully accredited 5 Star Members are used as Mentors to other developing members. Most of the mentorship received by 1 to 4 Star Members is provided by a fully accredited 5 Star Mentor Member. If a 3 or a 4 Star Member has a particular strength in certain Standards, they may also be used as a Mentor for those Standards. Using Mentor Members to mentor other members, benefits both the member receiving the mentorship and the member giving the Mentorship, since the Mentor is remunerated through the APCC Hospice Mentorship Fund (HMF) for the mentorship it provides. Consequently, mentorship becomes an additional source of income to Mentor Members. The additional source of income also serves as an incentive to Star 1 to 4 members to become fully accredited 5 Star Mentor Members.
3.4 Member Mentorship Fund
Given the importance that APCC member service providers provide the best possible Palliative Care, Mentorship of Service Providers is one of the key strategic priorities of APCC. The Funds for mentorship are used to pay Mentor Members to mentor other members. The Hospice Development Plan, resulting from Internal Follow-up Surveys, will identify the areas in which a 1 to 4 Start Hospice needs mentoring. The Mentor Member that provides the mentoring will then be paid from the Hospice Mentorship Fund to do the mentoring.