About COHSASA                                                                                                       

COHSASA assists health care facilities to meet quality standards and maintain those standards once they have been achieved. Through its quality improvement methods, our organisation empowers health care professionals to measure themselves against these quality standards and monitor the improvements.

COHSASA provides data on the quality of health service provision to governing authorities so that it can be used for strategic decisions. In the past 10 years over 600 facilities have entered into the COHSASA programme.

In 1994, the Pilot Accreditation Programme for South African Health Services was launched as a research and development programme in the Faculty of Medicine at the University of Stellenbosch under the directorship of Dr Whittaker. The programme grew rapidly and evaluation research showed that it was well received and perceived to be of considerable value to participating facilities. The rapid expansion of the programme resulted in the perception that it was too big for a single department and not an appropriate function of the University.

The emergence of COHSASA as an independent, non-partisan unit was a logical development. In 1995, in a memorandum of agreement, the University of Stellenbosch transferred the accreditation copyright and obligations to COHSASA, which was registered as a not-for-gain organisation and started operations in 1996.

Over the past decade COHSASA has developed accreditation programmes for hospitals, sub-acute care, psychiatric facilities and programmes, primary health care clinics, home healthcare services, general practitioners and medical scheme administrators. It has also developed the HIV and AIDS District Evaluation Tool (HIV-DET) to systematically evaluate the quality of HIV care provided to patients. Uniquely, the programme evaluates a geographically defined district, rather than just component hospitals and clinics. In that way, the management of HIV care for a whole community can be evaluated, alongside the assessment of care provision.

COHSASA Standards                                                                                                  

In addition to standards for hospitals, COHSASA — in consultation with health professionals — has drafted standards for sub-acute care, home healthcare services, psychiatric facilities and programmes, primary healthcare clinics and general practitioners.

Philosophy
The underlying philosophy of the standards is based on principles of quality management and continuous quality improvement and aims to accommodate legal and ethical aspects. The standards can be used to guide the efficient and effective management of a healthcare organisation and guide the organisation and delivery of patient care services, and efforts to improve the quality and efficiency of those services.

Development
The Council’s sixth edition of Standards for Hospitals has accommodated important developments on the international front and is a comprehensive and universal set of standards and criteria.

Because medical, nursing and health management science is in constant change, COHSASA routinely assesses the content and applicability of its standards. Over the past nine years, major professional bodies have assisted with the development and refinement of the standards.

In this “distillation” process, COHSASA has taken into account the feedback from over 500 public and private facilities that have participated in its programmes, the comments of its field staff, as well as the lay public with whom it comes into contact. COHSASA has a formal policy to review and, if necessary, to update its standards at regular, prescribed intervals.

The current standards have been devised according to a set of principles developed by the International Society for Quality in Health Care (ISQua), in collaboration with over forty countries, to guide the content and structure of accreditation standards for hospitals.

The JCIA (Joint Commission International Accreditation) of the United States, using the experience of thirty other countries, has developed a set of international accreditation standards for hospitals, based on the ISQua principles. The JCIA appointed a sixteen-member international task force for this initiative. It consisted of experienced physicians, nurses, administrators and public policy experts who actively guided the development of the international accreditation standards.

The members represented six major world regions: Latin America and the Caribbean, Asia and the Pacific Rim, the Middle East, Central and Eastern Europe, Western Europe and Africa. Dr Stuart Whittaker, MD of COHSASA, was a member of that task force and contributed significantly to the development of the standards by introducing concepts and standards developed by COHSASA in South Africa. While COHSASA recognises the importance of the international acceptance of our standards, such standards need to be relevant and adjusted to suit South African conditions. COHSASA’s sixth edition of Standards for Hospitals has been officially recognised by ISQua.

Standards have been developed in three phases.

In the first (“normative”) phase, we researched current international literature and consulted professional bodies such as the Society of Anaesthesiologists of South Africa, The South African Association of Surgeons and other professional bodies for suggested standards and criteria.

During the second ("empirical") phase, these standards and criteria were tested in pilot healthcare facilities and further adapted to meet the specific needs of the South African situation.

In the third ("accommodation") phase, the final standards were prepared to achieve accommodation between academia and the coal-face, ensuring that patient care, patient and staff safety, and legality were not compromised.

Organisation

COHSASA’s earlier standards were “service” based, i.e. standards were set for each specific managerial, clinical and support service based on essential functions. The current standards are organised around the important functions common to all healthcare organisations (“function” based) and are grouped by those functions related to providing patient care and those related to providing a safe, effective and well-managed organisation.

The standards are organised into the following sections:

A. Health Care Organisation Management
B. Patient Care (including diagnostic and pharmaceutical services)

In assessing the standards, Section A is applied to all elements of Section B.

C. Ancillary Services
D. Professional Services

Content
The content of standards fits into the two general categories of patient care and management of the organisation. Standards that focus on patient care address at least: patient rights, access to care, continuum of care, patient assessment, care planning and the delivery of care and, when appropriate, education of the patient and his or her family.

Standards that focus on management of the organisation address at least: leadership of the organisation, roles and responsibilities of staff, management of information, creation and maintenance of a safe environment for patients, infection prevention and control, quality management and human resource management.

The programme sets common standards for all service areas that are based on essential functions:

In addition to these common and essential standards, there are service-specific standards that define the specific requirements of individual services, e.g. infection control in laundries, radiation protection in radiology departments, etc.

Standards that relate to the effective and efficient management of HIV/AIDS in patients across the continuum of care have been incorporated into COHSASA’s existing corpus. Over the last year COHSASA has developed and tested a set of standards for the measurement of the efficacy of district HIV and AIDS services, using this approach, each service in a district is assessed against a common set of district standards covering the continuum of care provided to HIV+ patients.

Analysis
The analysis of standard assessment data is dependent on a computerised information “diagnostic” system, which establishes the degree of compliance of criteria, standards and service elements.

The output is in the form of text and graphical reports that clearly show strengths and weaknesses of the facility as a whole, as well as those of individual departments and services.

The data and information generated in these processes is of fundamental value, not only in the standard assessment process, but also to the management of a facility. The reports can be used to identify deficiencies and monitor interventions that address problem areas.

COHSASA’s information system is able to exclude standards that are scored as Not Applicable (NA) in a particular facility (for example, not all hospitals have a nuclear medicine capability). The system also has the capacity to allocate weighted values to criteria.

Criteria
The criteria of a standard are those requirements of the standard that will be reviewed and assigned a score during the accreditation survey process. The criteria simply list what is required to be in full compliance with the standard. Each standard has intention statements to guide and educate staff regarding the requirements of criteria compliance with the standards.

The criteria, in turn, define each standard and specify the conditions required for compliance. The criteria are used to evaluate the degree to which facilities meet the standards in terms of quantity and quality. They may be:

The Programme                                                                                                         

The programme is continuously updated, adapted and improved as a result of ongoing research and input from participating facilities.

COHSASA offers two kinds of programmes:

The FAP includes a capacity-building element, which empowers staff to understand the standards and the fundamental principles on which they are based. This means that health facilities have a clear vision of what systems and processes need to be in place for them to fulfil their particular mission statements.

In addition, the FAP aims to equip staff with quality assurance/improvement skills to enable them to implement and maintain the standards necessary for the best care of patients and the best use of resources.

Facilities may elect to contract with COHSASA’s Facilitated Accreditation Programme (FAP) or choose to implement the facilitation themselves in a conventional way. No facilitation is provided for alternate site facilities and psychiatric programmes unless it is requested, but many facilities opt to build COHSASA’s facilitation component into the accreditation programme.

COHSASA’s accreditation programmes differ slightly according to client requirements (with or without facilitation) and the type of facility being accredited, but the basic principles and the progression of the programme are the same.

COHSASA Accreditation Criteria                                                                                

1. On first entry into the COHSASA accreditation programme, a facility that

substantially complies with the accreditation requirements will be awarded a two-year accreditation.

2.1 A facility that re-enters the programme within two years after the expiry of its accreditation certificate will be awarded a three-year accreditation on condition that:

2.2 Should the facility substantially comply with the standards, but not meet the above requirements, a two-year accreditation will be awarded, with the option of undergoing a validation visit by COHSASA within 15 to 18 months after accreditation in order to:

Should any deficiencies indeed be identified, the facility would then have the opportunity to rectify these and to apply for another validation visit, which could still result in the extension of the award for another year to three years.

3. Should a facility re-enter the COHSASA programme more than two years after the expiry of its accreditation certificate, substantial compliance with standards will result in the award of a two-year accreditation. This could be extended to three years if a validation visit conducted by COHSASA 15 to 18 months after accreditation shows that standards are being maintained and that the facility’s quality improvement programme is not only being sustained but also improved. Should any deficiencies be identified at the validation visit, the facility will have the opportunity to correct these and to apply for another validation visit, which, if successful, would result in the extension of the award for another year to three years.

You can find more information on COHSASA website.