Quality leadership and improvement

Netcare Group quality management framework

The Netcare quality management system is designed to provide assurance of the highest quality of care in all Netcare facilities by adopting a multi-dimensional quality framework that includes over 300 measures for quality, a comprehensive quality improvement learning system, and a collective commitment by leaders and frontline employees to the Netcare Way behaviours.

We embrace the concept of the strategic Triple Aim (best patient experience, best outcomes and most cost-effective care) as the foundational principle and philosophy of our work in quality leadership. We have further strengthened our system by adding a fourth dimension of healthcare value creation, which is a commitment to building a dynamic system of engagement between healthcare leaders, staff, healthcare professionals and the patients and their families in the communities we serve, so that we continue to identify opportunities for learning and improvement.

Building a dynamic system of engagement between healthcare leaders, staff, healthcare professionals and the patients and families

Netcare Group quality leadership management framework

The Netcare Group quality leadership management framework is aligned to our pillars of excellence and guides our efforts to coordinate and align quality leadership programmes across all divisions and throughout all levels of the organisation.

Quality assurance, monitoring and measurement

How does Netcare provide assurance of the highest standards of quality?

Quality assurance, monitoring and measurement of quality indicators are critical to ensuring the effectiveness of the quality management system and to track progress in our quality programmes.

Quality indicators are quantitative measures that describe a particular healthcare process or outcome and the structures that impact patient outcomes. Netcare uses a variety of internal and external measures to inform our quality improvement initiatives, and we use international benchmarks as a further measure of our quality performance and to track global trends in quality healthcare measures.

In the absence of standardised national measures, we have made a concerted effort to ensure that our data is relevant and supports improvement, and to continually improve the accuracy of data and our processes. We also identify outliers within the business for shared learning. Teams at each facility are able to monitor their own performance through the use of extensive daily, weekly and monthly reports available to them. In addition, the overall progress and effectiveness of our quality management system is monitored monthly by senior management and by the various clinical governance structures in Netcare in accordance with their terms of reference.

The Office of Health Standards and Compliance is engaging with healthcare providers to develop a comprehensive and standard set of quality measures, in order to enable a valid comparison of quality performance across all SA hospitals. This will be incorporated into the National Core Standards regulations and guidelines. Once finalised, these standards and measures will be the first common framework for assessing quality assurance in healthcare facilities in SA. We have provided input on the standards, regulations and initial discussions on the quality indicators. A consistent set of quality measures will enable healthcare professionals and leaders to identify areas for improvement based on like-for-like data and will provide the public with the means to accurately access overall quality.

Quality assurance and clinical governance

All facilities in Netcare are reviewed against comprehensive quality and risk management criteria.

Reports are generated by facility, division and at Group level in order to highlight high performance and risk areas. Verification audits are undertaken by independent subject matter experts using a standardised tool that incorporates the Department of Health’s national core standards, Netcare’s additional set of standards and specific criteria based on trends and risks identified by the data. Audits take into account adherence to processes and best practices, and the impact that these have on each facility’s outcomes. A full suite of measures is also provided to our facilities to ensure that these learnings are incorporated into Group processes.

Pleasingly, there has been a narrowing of the gap between the highest and lower performing facilities over the past three years, demonstrating greater consistency of quality care across facilities.

Our quality assurance process is supported by risk-based policies and standard operational procedures. These policies undergo regular review by specialised departments, including nursing, pharmacy, technical and clinical engineering, and all other enabling functions. Improvement programmes are monitored by each facility’s leadership and expert teams are in place to provide training and development support where required.

Clinical governance

Our all-encompassing quality governance framework strives to ensure a transparent and accountable system for the provision of patient-centred, safe, high-quality care. We continuously invest in these governance structures and forums to support employee, doctor and patient engagement which enables the identification of risks and informs continuous quality improvement initiatives.

The Netcare clinical governance process is integrated into the overall quality leadership governance structures and allows us to incorporate clinical oversight with the many facets of quality in Netcare.

In 2015, we reached our highest level of performance against the Department of Health’s national core standards, as well as our own specific standards of care. Our hospitals scored 88% overall on the quality assurance audits.

Quality governance committees

Quality leadership board

  • Function: Oversees strategic priorities in quality leadership, and monitors clinical governance and performance against quality measures and goals across all divisions.
  • Comprises: Non-executive directors, management and clinical employees.
  • 2015 focus areas:
    • Successfully integrated quality assurance, quality risk management and quality improvement across all divisions.
    • Strengthened infection risk management, standardised patient feedback systems and expanded stakeholder engagement on quality.

Netcare executive management

  • Function: Sets annual quality leadership priorities and targets for each division and for the Group overall. Each division undertakes reviews of quality measures and goals bi-annually.
  • Comprises: Heads of all divisions within Netcare SA, the director of quality leadership and key enabling functions.
  • 2015 focus areas:
    • Reviewed each division’s progress against the goals set in the quality leadership scorecard.
    • Undertook quarterly quality risk reviews and management assurance.

National quality leadership review committee

  • Function: Reviews performance monthly across all improvement initiatives including patient care and safety, quality improvement skills, clinical quality improvement and regulatory compliance. Learnings from all improvement work and adverse events are shared and disseminated to relevant staff, clinicians and leaders.
  • Comprises: Director of quality leadership, heads of departments and leaders responsible for quality in each division.
  • 2015 focus areas:
    • Monitored progress against 2015 quality objectives and targets for all divisions, including quality assurance and innovation, patient care, quality improvement capability, clinician leadership and contribution to healthcare in SA.
    • Continued year-on-year improvement of quality measures.
    • Made good progress in spreading best practice and reducing variation between facilities.

Clinical practice committee

  • Function: Evaluates matters relating to clinical practice and codes of conduct for doctors across all divisions and evaluates actions in accordance with Netcare values and the requirements of the Health Professionals Council of South Africa. The committee’s terms of reference extend to reviewing admission privileges and dealing with unresolved issues on physician advisory boards at hospital general management level.
  • Comprises: Netcare executive management, hospital medical director and practicing clinician representation.
  • 2015 focus areas:
    • Review of clinical cases.

Clinical ethics committee

  • Function: Provides consultative expertise and input on clinical ethical issues for the organisation, its patients, employees and individual facilities. Additional sub-structures, such as those governing transplant, and trauma and emergency, also form part of the committee’s overall terms of reference.
  • Comprises: Netcare executives, senior and clinical leadership, as well as external representatives (an ethicist and health professionals from various clinical disciplines).
  • 2015 focus areas:
    • Disseminated deliberations and advice to the respective and relevant divisions. Referrals were received from across the Group.

Quality leadership department

  • Function: Works to expand quality improvement capabilities to all divisions in the Group, supporting the delivery of quality leadership strategies.
  • Comprises: The director of quality leadership and senior quality and clinical leaders.
  • 2015 focus areas:
    • Strengthened the alignment and leverage of systems and learning with regard to quality governance and improvement initiatives across all divisions.
    • Monitored and reported on divisional and group quality scorecards.
    • Provided expert quality improvement skills and project leadership for prioritised goals.
    • Continued building a network of frontline leaders skilled in the science of improvement.
    • Led Netcare’s contribution to SA healthcare quality improvement.

Patient experience

How Netcare monitors patient feedback to ensure patients and families have a positive experience. Patient-centred care is central to the Netcare quality leadership programme. We are guided by international best practice and the guidelines set out by the Department of Health, including the Batho Pele principles 1 and the Patients’ Rights Charter 2 as summarised below.

Batho Pele principles

The eight Batho Pele principles were developed to serve as acceptable policy and legislative framework regarding service delivery in the public service:

  1. Consultation: Listening to and taking account of patients’ views and paying heed to their needs when deciding what services should be provided.
  2. Access: Ensuring that patients are able to access the services provided easily and comfortably.
  3. Courtesy: Treating patients with consideration and respect.
  4. Setting standards: Making sure that the promised level and quality of services are always of the highest possible standard.
  5. Information: Providing patients with good information on the services available to them.
  6. Openness and transparency: Allowing patients to ask questions and responding to their queries honestly and frankly.
  7. Redress: Responding swiftly and sympathetically when standards of service fall below the promised level
  8. Value for money: Adding value to patients’ lives.
The Patients’ Rights Charter

The Patients’ Rights and Responsibilities Charter states that all patients have a right to:

  • A healthy and safe environment.
  • Participate in decision-making.
  • Access to healthcare.
  • Knowledge of one’s health insurance and medical aid scheme.
  • Choose health services.
  • Be treated by a named healthcare provider.
  • Confidentiality and privacy.
  • Informed consent.
  • Refuse treatment.
  • Be referred for a second opinion.
  • Continuity of care.
  • Complain about health services.

In addition, every patient or client is considered to have responsibilities with respect to their own health and their engagement with the healthcare system.

Netcare patient feedback system

Patient and family-centred care is an important quality goal in all of our facilities. Our leaders, staff and healthcare professionals are dedicated to ensuring the highest level of service excellence and to providing clear communication to patients and their families so that they can understand their care programme and know how to best engage in managing their health. All of our facilities use the electronic Netcare patient feedback system to obtain regular feedback directly from patients using our services. In addition, patients are able to inform our healthcare leadership team of specific issues (compliments and complaints) through the Netcare customer service centre or by emailing the facility manager or its customer care team directly.

The leadership teams at our facilities also make personal rounds to ask patients and families about their experiences. This gives the leadership direct feedback of what is going well and also enables them to identify areas for immediate action or general improvement.

The Netcare hospital patient feedback systems reporting suite includes trends, summary dashboards and ward-level reporting. Using iPads, web-based and mobile surveys to engage with patients, the system provides reliable feedback on a daily basis, to help us improve our responsiveness, understand required changes to meet patient needs and improve patient-centred care.

Our patient feedback questions for hospitals are based on the United States’ (US) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), which allows us to benchmark ourselves against 4 000 US hospitals and health facilities that make use of this methodology. The survey asks patients questions about the clarity of communication, medication information, discharge planning, the hospital environment and the patient’s overall experience.

The table below shows ‘top-box’ (best possible) responses for the five specific areas that we have focused on in our quality leadership goals.

1 Department of Public Service and Administration. 1997. White Paper on transforming service delivery (Batho Pele White Paper) A guide. Capte Town: Siber Ink. http://www.info.gov.za/whitepapers/1997/18340.pdf (accessed 2015).
2National Patients’ Rights Charter. 2008. Health Professions Council of South Africa. http://www.hpcsa.co.za/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_3_patients_rights_charter.pdf
Netcare hospitals Definitely recommend Pain management Nursing communication Discharge information
(US 2015 average: 71%) (US 2015 average: 71%) (US 2015 average: 79%) (US 2015 average: 86%)
Number of responses 2015 2014 2015 2014 2015 2014 2015 2014
2015: 276,696
2014: 236,762
78.25% 75.89% 84.49% 81.21% 85.28% 83.27% 77.55% 72.29%

Netcare hospitals

Definitely recommend

2015: 78.25%
2014: 75.89%

(US 2015 average: 71%

Pain management

2015: 84.49%
2014: 81.21%

(US 2015 average: 71%

Nursing communication

2015: 85.28%
2014: 83.27%

(US 2015 average: 79%

Discharge information

2015: 77.55%
2014: 72.29%

(US 2015 average: 86%

Number of responses

2015: 276,696
2014: 236,762

Ref [www]: US 2015 average: http://www.hcahpsonline.org/Files/October_2015_Summary_Analyses_Survey_Results.pdf

All patients admitted to our hospitals, across all medical schemes operating in SA, as well as private-paying patients, are asked to complete the survey. A total of 78.25% (US 71.0%) patients responded that they would ‘Definitely recommend’ our facilities, and the overall rate out of 10 awarded to the hospital they were treated at was 8.62 (US 7.1). Since 2012, the use of the HCAHPS survey in our hospitals has resulted in steady year-on-year improvements in performance, both individually and collectively, due to initiatives implemented in response to feedback. 

Definitely recommended
81.3%

number of respondents:
31 844

Definitely recommended
88.2%

number of respondents:
102

Patient satisfaction
88.0%

number of respondents:
2187

Patient satisfaction
98.1%

number of respondents:
44 496

The HCAHPS survey measures ’top box’ performance and reflects the percentage of patients that score the most positive response. For example:

  • The ‘Yes, definitely’ score excludes ‘Probably yes’, ‘Probably’ and ‘Definitely no’ responses.
  • The ‘Always’ score excludes ‘Usually’, ‘Sometimes’ and ‘Never’ responses.
  • For ratings out of 10, only the 9 and 10 responses are included.
  • For ‘Yes’ and ‘No’ responses, only the ‘Yes’ responses are included.
We continue to measure patient experience results from all divisions and initiate business-specific improvements.

Responding to patient feedback

We have achieved improvements in patient satisfaction on discharge information received, pain management while in hospital and medication information received when at home. A collaborative team of pharmacists working with nursing colleagues at each hospital have made great strides in developing a medication information process for patients while in hospital and after discharge. These efforts have improved our patient feedback scores from a 66% ’top box’ score in 2014 to 74% in 2015.

Patient feedback indicates that we need to improve the information provided to them on symptoms and health problems that they should be aware of once discharged from hospital. In addition to over 50 procedure-specific discharge information leaflets, we have worked with nursing and doctor groups to develop and test general patient information leaflets for four major categories: emergency, maternity, surgical and medical. We are tracking the impact of this initiative at six pilot hospitals, with early indications showing positive results. Pilot findings will inform the next stages of the project.

Patient safety and clinical outcomes

In line with international best practice, Netcare hospitals measure a set of key indicators for patient safety as well as specific clinical processes and outcomes recognised globally as important for patient care. These include infection prevention, antibiotic stewardship, preventing blood clots and best practice after a myocardial infarction (heart attack).

In 2015, Medicross completed a health promotion drive for hypertension screening and compliance to medication and National Renal Care continued to track the international clinical outcome measures for dialysis patients. Netcare 911’s clinical quality assurance programme was further strengthened through the implementation of a national morbidity and mortality programme, which reviews selected cases and ensures that learnings are rapidly disseminated to teams on the ground.

Infection prevention and control

Netcare’s infection prevention programme is designed to prevent the risk of spread of infections. This is done through active monitoring and surveillance by dedicated staff as well as the implementation of standard operating practices, education and specific infection improvement programmes at the frontline of care.

All Netcare divisions have implemented a risk-based approach to infection prevention and control that focuses on sustained improvement of outcomes and compliance to best practice care for infection risk areas. Sharing ideas for improvement and measurement of outcomes across divisions and facilities has enabled faster learning and optimised our risk management strategies.

The roll-out of the electronic laboratory system in our hospitals has been an important milestone in advancing our management of infection prevention and control, particularly in terms of the four most common infection risks in hospitals. We use strict tracking measures and definitions stipulated by the Centre for Disease Control.

We are proud to have achieved year-on-year improvement in all four infection risks, namely central line bloodstream infections, ventilator associated pneumonia, catheter associate urinary tract infections and surgical site infections. A total of 32 hospitals reached zero infections for central line bloodstream infections and 18 hospitals reached a zero rate for ventilator associated pneumonia in 2015. We are committed to driving a ’Going for zero’ campaign to continue to address the growing risk of healthcare associated infections around the world. 

Hand hygiene

Hand hygiene (including washing with soap and water or using alcohol hand gel or spray), is recognised internationally as a critical factor for preventing the spread of infection. 

Staff and leaders use every opportunity to reiterate our commitment to hand hygiene and drive awareness programmes on a regular basis and we have outstanding participation by all staff in World Hand Hygiene Day, which is held annually in May.

All Netcare facilities are monitoring their hand hygiene programmes by using the World Health Organization (WHO) hand hygiene assessment criteria. We also actively monitor the five moments of hand hygiene and compliance across our wards and units, and results are shared with frontline teams and healthcare professionals.

We have furthermore increased communication on the importance of hand hygiene through high visibility signage throughout our facilities.

Reminders and information for patients and families are also displayed prominently and alcohol hand sanitisers are placed in public areas throughout the hospital including entrance areas, coffee shops and hallways so they are readily accessible to staff, patients, families and other visitors.

Multidrug-resistant infections

Infections due to multidrug-resistant bacteria, commonly known as “superbugs”, are a leading cause of morbidity and mortality globally, both in the community and in hospitals. We collaborate closely with experts locally and internationally to inform our policies and standard operating procedures to manage the risks for these infections. Our preventative measures include patient pre-admission risk review, screening of long-stay intensive care unit (ICU) patients, enhanced cleaning programmes, hand hygiene compliance and our Group-wide antimicrobial stewardship programme.

Training on the standard operating procedures for risk management of infections has been undertaken for each region of operation in SA and all staff at facility level. Presentations have also been made at continuing medical education events, physician advisory boards, and infection prevention and control sub-committees attended by clinicians. Two audits on preventative measures were undertaken in 2015 covering all hospitals, with findings yielding a final rating of compliance to processes of over 90%.

Netcare antimicrobial stewardship programme

Resistance to antibiotics is rising to dangerously high levels in all parts of the world, with an increased potential to compromise our ability to treat infectious diseases. The WHO is leading a global campaign ‘Antibiotics: Handle with care’, which calls on individuals, governments, health and agriculture professionals to take action in addressing this threat by only using antibiotics when necessary and as prescribed.

Our antimicrobial stewardship programme, which was initiated in 2011, has continued to progress in 51 Netcare hospitals and has resulted in a significant decrease in antibiotic consumption and an improvement in how antibiotics are used. The programme is driven by pharmacists who collaborate with frontline nursing teams and are supported by a strong base of clinician leaders that provide crucial back-up and clinical input into the programme.

While each hospital’s programme is adapted to local risks, we monitor the implementation of high impact antimicrobial stewardship activities and benchmark these across all hospitals.

The table below shows the consistency and spread of antimicrobial stewardship activities across Netcare hospitals.

Rating 2015 Target
Reviewing antimicrobial stewardship criteria within the pharmacy on a daily basis 100% 100%
Documenting level 1 interventions on a standardised template daily 98% 95%
Participating in the surgical prophylaxis project 86% 85%
Antimicrobial stewardship activities committee meets regularly with a clinician advisor 86% 85%
Have implemented the antimicrobial stewardship prescription chart 82% 80%
Reviewing antimicrobial stewardship in wards outside of ICU 84% 80%

Three of Netcare’s papers on antibiotic stewardship were published in 2015; two in peer-reviewed SA journals and one in the international Infectious Diseases and Therapy journal.

More recently (June 2016), Netcare was honoured to have a paper on a five-year review of our programme published in Lancet ID – one of the most prestigious international infectious disease journals.  

Health and safety risk management

In addition to ensuring that healthcare is patient-centred, we have a commitment to manage health and safety risks to ensure that harm is prevented. Our Group-wide learning system for monitoring and reporting safety includes safety programmes in specific focus areas and the timely dissemination of learnings from reported adverse events and near misses that occur during treatment. In addition to facility-level responses and risk management, adverse events are reviewed monthly by the national quality leadership review committee. Our approach is driven through the concept of ‘a promise to learn, a commitment to act’.

In addition to sustained actions relating to the risks of pressure sores and falls, our focus in 2015 has been on the following aspects:

  • Strengthening medication safety
    We have completed a detailed measurement process to monitor the effective implementation of the medication safety programme across all facilities and wards. This includes a comprehensive set of high alert medication safety guides, as well as tools to ensure safe dispensing and medication administration. The measurement process provides a baseline for further improvement and has identified best practice facilities for shared learning and replication. It is driven through our clinical pharmacy services in collaboration with nursing services.
  • Advancing the prevention of blood clots
    Extended hospital stay, surgery and being immobile for long periods of time are among the highest risks for developing blood clots. We have adopted global best practices for the prevention thereof, including documented risk assessments, monitoring of appropriate preventative therapy to ensure timely administration and, where medication is used, monitoring the dosage according to the patient’s condition.

Leadership focus on quality

Our strategic plan for quality and safety is underpinned by a multi-dimensional Group-level quality scorecard that we use to track progress against the goals set at Group-level for each division and at each facility.

Management teams at each facility are responsible for the day-to-day management of quality and for driving improvement initiatives relevant to their facility’s trends and goals. Quality outcomes and process measures form a significant percentage of performance management measures for all senior and frontline managers. Progress reviews are done in monthly meetings and during leadership walkabouts and leadership communication sessions which take place daily or weekly.

Internal benchmarking takes place across similar type and sized facilities and our quality audits identify specific actions required to achieve quality goals. Our overall quality performance improved year-on-year for all divisions.

Frontline staff engagement in quality improvement

Staff engagement in quality improvement is crucial to ensure we build on our firm foundations for quality and harvest the ideas and leadership skills of employees at the frontline of care to evolve and improve quality.

The Netcare Way of Improvement uses internationally recognised quality improvement methodology to train employees. It has a strong emphasis on measurement, innovation and improving systems and processes.

Changes are first piloted and tested in discrete areas and, if successful, is then replicated and adapted across multiple locations. Regular quality improvement learning events are held across all divisions, regions and facilities. A survey of frontline hospital leadership teams indicates that 77% of the respondents had received quality improvement training and 41% had led and documented an improvement project in 2015.

In 2015, we recorded a record level of employee participation in Netcare’s quality leadership improvement initiatives. A total of 261 (2014: 163) improvement projects were submitted as abstracts to international and national professional academic events. Of these, just over 150 projects were submitted to the Netcare Quality Leadership Awards which recognise individuals and teams who have positively impacted patients’ lives through quality initiatives.

Our interactive central quality leadership intranet portal is available to frontline leaders across all divisions and encourages collaboration, the sharing of information and knowledge building between facilities in Netcare. We are encouraged by the increasing number of staff referring to the portal. In 2015, over 70 000 downloads of quality data and information were accessed by staff from the quality leadership intranet portal.

Winners of the 2015 Quality Leadership Awards

Improve patient safety during hospital stay by reducing preventable fall rate

Project Lead: Susan Coetzee – unit manager: neuro-orthopaedic ward (Netcare N1 City Hospital)

Co-author: Yvonne Faber (Netcare N1 City Hospital)

Preventing falls and resultant injuries requires strong leadership and vigilance as well as the active

engagement of the multi-disciplinary team involved in caring for patients.

Under the leadership of Sr Susan Coetzee, the neuro-orthopaedic team at Netcare N1 City Hospital developed a comprehensive strategy for change to reduce falls by using existing tools diligently and adapting them as learnings emerged, as well as introducing new ideas through various cycles of brainstorming, testing and evaluating these ideas over a three year period.

The results of this collective work resulted in a decreased rate of falls in the unit which has been sustained and further improved 10 months after the initial project was submitted for the quality leadership awards. In addition, Netcare N1 City Hospital has shown a decrease in falls per

1 000 paid patient days from 2.37 in 2013 to 1,81 in the year to date to May 2016.

Learning is a gift - even when pain is your teacher

Project lead: Soekie Grant – Professional nurse, pain management (Netcare Milpark Hospital)

Co-authors: Pamela Yako (Netcare Mulbarton Hospital); Esme Cross (Netcare Park Lane Hospital); Catherine Smith (Netcare Krugersdorp Hospital); Jenni Subeke (Netcare Rosebank Hospital); Charlotte Botha (Netcare Olivedale Hospital); Magda van Vuuren (Netcare Union and Netcare Clinton hospitals); Lillian Seiso (Netcare Rand Hospital); William Smith (Netcare Rehabilitation Hospital).

Inadequate pain control contributes to delayed wound healing, increased length of hospital stays and higher mortality rates. Pain impacts overall patient outcomes and may also affect psychosocial factors which can cause depression and anxiety.

Following a successful project to improve the level of patient feedback regarding pain control at Netcare Milpark Hospital, the project lead mobilised and led a multi-hospital team from 11 hospitals to share learnings and roll out a pain improvement initiative across the Gauteng South West Region.

The collaboration led to a systematic review of existing programmes for pain management, including

strengthening the pain management knowledge base for ward ‘pain-link nurses’, by working together with a committed team from nursing Education. In addition, there was active engagement with nurse leaders, hospital general managers, doctors and anaesthetists to support the pain improvement journey.

The collective actions from participating hospitals resulted in an improvement in the overall GSW region patient feedback scores on pain management from 77.9% to 83.6% for July 2014 to June 2015. These results have been sustained at 83.7% from June 2015 to June 2016.

Clinician leadership and engagement in quality improvement

Clinician leadership in clinical advisory panels and localised medical forums

Engaging with doctors is key to our quality improvement programmes, therefore specific doctor engagement forums have been established to bring relevant medical expertise and clinical leadership to our quality initiatives. These forums include the physicians advisory boards in hospitals, the clinical practice committee and clinical ethics committee, as well as Group-wide educational and review structures, such as morbidity and mortality meetings and continuous medical education events.

Localised medical forums within individual business units and hospitals include, among others, infection prevention and antibiotic stewardship committees, and theatre safety committees. These forums aim to ensure frontline doctor engagement and interdisciplinary team interaction and input in relation to patient care.

2015 focus areas:

  • 166 physician advisory board meetings were held across all hospitals with 93% compliance to criteria regarding review of clinical and quality outcomes.
  • 86% of antibiotic stewardship committees had active clinician leadership.
  • All level 1 and 2 accredited trauma units held the required minimum of 10 morbidity and mortality meetings. 88% of level 3 and 4 trauma units fully complied with the required four or more morbidity and mortality meetings to be held annually.
  • 100% compliance to Netcare 911 targets for morbidity and mortality review.
  • National Renal Care held 10 regional doctor forums with active clinician participation.
  • 113 continuing professional development programmes were held for medical practitioners, paramedics and nurses.
  • 22 projects in collaboration with, or co-authored by, doctors were submitted as abstracts to professional conferences or the Netcare Quality Leadership Awards.

Engaging with doctors is key to our quality improvement programmes.

Contribution to SA quality improvement

Netcare is committed to supporting quality improvement in the SA healthcare system by actively engaging in industry and government forums, quality committees and task teams. We encourage staff to serve in leadership roles and contribute to professional organisations such as emergency care, various nursing specialities and leadership forums, the infection prevention society and clinical pharmacy associations. We actively participate in public-private learning collaborative projects aimed at sharing ideas to implement best practice across all health facilities in South Africa.  

Best Care Always (BCA) Quality Improvement (QI) Summit Awards

Netcare was proudly presented by teams from a number of divisions, bearing testimony to the spread of quality improvement skill throughout the Group. A total of 34 abstracts were accepted for display after independent peer review by national quality improvement experts.

Netcare teams won 14 out of a potential 30 awards at the 2015 BCA Quality Improvement Summit. Awarded were:

  • Four Netcare authors out of the 10 winners in the BCA Quality Improvement Award category.
  • Ten Netcare teams out of 20 winners in the BCA Excellence Award category.

BCA Quality Improvement Award category

Topic Primary author Hospital Co-authors and team members
(First name, Surname)
Medication safety - DVT compliance and prophylaxis Joanne Kelham Netcare Sunninghill Hospital Amanda Bornman, Lungelwa Makasi, Bev Hewitt
Pharmacist Intervention Improves the Early Administration of Antimicrobials across 33 Private Hospitals. Angeliki Messina Quality leadership department Dena van den Berg, Vishala Gokool, Lisete Vieira, Inga Jenkinson, Nirasha Singh, Tarina Jacobs
Using and ongoing programme of parent feedback to develop a practical an sustainable model of family centred care in NICU Tanya Pitt Netcare Waterfall City Hospital Dr Natasha Ramdhar, Bernadette Simpson, Nazmira Khan
QI Skill and access to information builds buy-in and improves patient satisfaction outcomes Ansie Zietsman Quality leadership department Dena van den Bergh, Mande Toubkin, Carin le Hanie, Shannon Nell
Feedback on cleaning performance using UV technology may improve cleaning of common touch points in the healthcare environment. Lesley Devenish Quality leadership department / Netcare Milpark Hospital Ronell van der Watt
Learning is a gift – even when pain is your teacher! Soekie Grant Netcare Milpark Hospital Pamela Yako, Esme Cross, Catherine Hattingh, Jenni Subke, Charlotte Botha, Magda van Vuuren, Lillian Seiso, Christa du Toit, Bill Smith, Dena van den Bergh, Ronell van der Watt, Ansie Zietsman
The Journey to Sustain Surgical Prophylaxis in a Private Hospital Setting Maletje Griesel Netcare Christiaan Barnard Memorial Hospital Marilyn Leadsom
Time Saves Lives Craig Grindell Netcare 911 Kobus Steyn Shalen Ramduth Belinda Smith, Nico Joubert, Werner Pienaar, Chris Piek
Reduction of CLABSI in a Neonatal Unit - "Bundles of Joy" Liz Hudson Netcare Christiaan Barnard Memorial Hospital Marilyn Leadsom, Lesley Matthews, Dr Alida Nel, Charmaine Thompson, Zarn Wortley
The Building Blocks of a Sustainable Antibiotic Stewardship Program, to include the reduction of antibiotic utilisation and infection rates Marilyn Leadsom Netcare Christiaan Barnard Memorial Hospital Maletje Griesel, Dr R van Dyk,
Dr P Budnik, Dr M Moodley
Decrease in ED Waiting Time Salochni Naidu Netcare Sunward Park Hospital Cheryl Nagel
Corporate responsibility and sustainability - How we can make a difference Richard Speares Netcare Alberlito Hospital Kavish Lutchmarinarain, Burton Govender
Developing a communication approach to engage ED teams Mande Toubkin Emergency and trauma department Ansie Zietsman, Nicky Baltsoucos, Linda Pretorius, Coenie Bezuidenhout, Sue-ann Mohapi, Jacky Arends, Carin Cloete, Lisa hawkswort, Lizaan van Rooyen
Collective high impact leadership (CHIL) - A 100 day intervention to cocreate a step change in patient feedback scores across 17 hospitals Dena van den Bergh Quality leadership department Ansie Zietsman, 17 HGMs

Topic: Medication safety - DVT compliance and prophylaxis
Primary author: Joanne Kelham
Hospital: Netcare Sunninghill Hospital
Co-authors and team members: Amanda Bornman, Lungelwa Makasi, Bev Hewitt


Topic: Pharmacist Intervention Improves the Early Administration of Antimicrobials across 33 Private Hospitals.
Primary author: Angeliki Messina
Hospital: Quality leadership department
Co-authors and team members: Dena van den Berg, Vishala Gokool, Lisete Vieira, Inga Jenkinson, Nirasha Singh, Tarina Jacobs


Topic: Using and ongoing programme of parent feedback to develop a practical an sustainable model of family centred care in NICU
Primary author: Tanya Pitt
Hospital: Netcare Waterfall City Hospital
Co-authors and team members: Dr Natasha Ramdhar, Bernadette Simpson, Nazmira Khan


Topic: QI Skill and access to information builds buy-in and improves patient satisfaction outcomes
Primary author: Ansie Zietsman
Hospital: Quality leadership department
Co-authors and team members: Dena van den Bergh, Mande Toubkin, Carin le Hanie, Shannon Nell


Topic: Feedback on cleaning performance using UV technology may improve cleaning of common touch points in the healthcare environment.
Primary author: Lesley Devenish
Hospital: Quality leadership department / Netcare Milpark Hospital
Co-authors and team members: Ronell van der Watt


Topic: Learning is a gift – even when pain is your teacher!
Primary author: Soekie Grant
Hospital: Netcare Milpark Hospital
Co-authors and team members: Pamela Yako, Esme Cross, Catherine Hattingh, Jenni Subke, Charlotte Botha, Magda van Vuuren, Lillian Seiso, Christa du Toit, Bill Smith, Dena van den Bergh, Ronell van der Watt, Ansie Zietsman


Topic: The Journey to Sustain Surgical Prophylaxis in a Private Hospital Setting
Primary author: Maletje Griesel
Hospital: Netcare Christiaan Barnard Memorial Hospital
Co-authors and team members: Marilyn Leadsom


Topic: Time Saves Lives
Primary author: Craig Grindell
Hospital: Netcare 911
Co-authors and team members: Kobus Steyn Shalen Ramduth Belinda Smith, Nico Joubert, Werner Pienaar, Chris Piek


Topic: Reduction of CLABSI in a Neonatal Unit - "Bundles of Joy"
Primary author: Liz Hudson
Hospital: Netcare Christiaan Barnard Memorial Hospital
Co-authors and team members: Marilyn Leadsom, Lesley Matthews, Dr Alida Nel, Charmaine Thompson, Zarn Wortley


Topic: The Building Blocks of a Sustainable Antibiotic Stewardship Program, to include the reduction of antibiotic utilisation and infection rates
Primary author: Marilyn Leadsom
Hospital: Netcare Christiaan Barnard Memorial
Co-authors and team members: Maletje Griesel, Dr R van Dyk, Dr P Budnik, Dr M Moodley


Topic: Decrease in ED Waiting Time
Primary author: Salochni Naidu
Hospital: Netcare Sunward Park Hospital
Co-authors and team members: Cheryl Nagel


Topic: Corporate responsibility and sustainability - How we can make a difference
Primary author: Richard Speares
Hospital: Netcare Alberlito Hospital
Co-authors and team members: Kavish Lutchmarinarain, Burton Govender


Topic: Developing a communication approach to engage ED teams
Primary author: Mande Toubkin
Hospital: Emergency and trauma department
Co-authors and team members: Ansie Zietsman, Nicky Baltsoucos, Linda Pretorius, Coenie Bezuidenhout, Sue-ann Mohapi, Jacky Arends, Carin Cloete, Lisa hawkswort, Lizaan van Rooyen


Topic: Collective high impact leadership (CHIL) - A 100 day intervention to cocreate a step change in patient feedback scores across 17 hospitals
Primary author: Dena van den Bergh
Hospital: Quality leadership department
Co-authors and team members: Ansie Zietsman, 17 HGMs

For comprehensive information on the Netcare Group’s Quality and clinical governance, click here