Monday, October 13, 2014

Not so different after all

I'm so pleased to be in Johnannesburg to present some sessions in association with the Hospital Association of South Africa at a quality improvement summit hosted by Best Care . . . Always!

As summarized on their website:

BCA campaign supports South(ern) African healthcare organisations as they implement specific, internationally recognised, evidence-based interventions that enhance patient safety and constitute current best practice in hospital care. BCA is inclusive and enrolls hospitals from both private and public sectors. There is no fee to join. Participating hospitals should be willing to make evidence-based changes at a faster pace, share ideas with others, measure results and report on progress.

In preparation for the event, I had a chance to tour two local hospitals, Wits Donald Gordon Medical Center and Charlotte Maxeke Johannesburg Academic Hospital.  They are just this far apart, 1.2 kilometers, physically:

But institutionally, they exemplify different worlds, as Gordon is a private hospital with under 200 beds, running profitably with payments from individuals and private insurance companies. Under national law, the doctors are not permitted to be employees of the hospital.  Maxeke is a large public tertiary hospital with over 1000 beds and 4000 admissions per month, with tight finances supported by government funding. The doctors are public employees.

But I discovered a hidden commonality between the two places.  First I met these two women at Gordon, Winnie and Ronel. They are part of a cadre of folks who have implemented quality and safety protocols, training, and documentation in several wards and units in the hospital.  They have focused on reducing the incidence of central line infections, ventilator associated pneumonia, catheter-associated urinary tract infections, and other such issues.  Although they are quick to point out they still have a lot of room for improvement, the results are clearly showing.

The team employs a "Welsh cross" as a visual cue to their staff as to progress.  Every month, the cross is posted in a highly visible location showing on which days an infection has occurred.  (In this case, for example, there was one blood stream infection on August 24, and 2 respiratory tract infections on August 12 and 14, and one other infection on August 25.)   The cross acts as a reminder of the need to be vigilant but is also a way to provide positive feedback to the staff about the efficacy of their actions.  The women noted, "We're not satisfied unless every day is green!"

Meanwhile, less than two kilometers away in the Maxeke public hospital, these two women work.  They are Constance and Phindi.  They, too, have started a program in quality improvement, focusing first on reducing VAP in the neuro-intensive care unit.  Following the same bundle of care used at Gordon, there has been a substantial reduction in pneumonia cases.  And, lo and behold, look at what's posted on the wall of their ICU! The women noted, "We're not satisfied unless every day is green!"

Coincidence? Well, no, because BCA has been holding training sessions for hospital folks--public and private--across the country. They offer advice on protocols, staff training, and the kind of institutional infrastructure and tools need to support patient quality and safety programs.

But these four women have never met one another.  While they are separated by a short distance, they live in two different worlds of patient care.  Yet, in a way, if they traded places tomorrow, they would all feel at home with the sense of purpose and passion inherent in their clinical improvement work.

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