First experiences of accrediting district hospitals for excellence in newborn care in KwaZulu-Natal, South Africa: Successes and challenges

Haskins, Lyn; Nyasulu, Dolly; Davidge, Ruth; McKerrow, Neil; Horwood, Christiane

doi:10.5430/jha.v7n3p25

Cited by 2 publications

(4 citation statements)

References 15 publications

(18 reference statements)

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“…Preparation for accreditation in the final year of the project further reinforced these messages, as hospital managers were informed of the standards against which they would be assessed. During accreditation, each hospital was visited and assessed by a group of senior managers and clinicians, this served to strongly motivate hospital managers to comply with recommendations for their hospital to achieve a good accreditation score [10].…”

Section: Discussionmentioning

confidence: 99%

“…Alternative approaches could be to select several critical indicators and weight these within the scoring system, or penalise hospitals who fail to comply with them. Such an approach worked well in the accreditation process undertaken during this project which is described elsewhere [10].…”

Section: Discussionmentioning

confidence: 99%

“…On completion of the intervention, accreditation visits were conducted to all district hospitals by a team of senior clinicians and managers to assess the hospital’s performance, and to determine whether each hospital had achieved accreditation status for excellence in newborn care. Activities included in the accreditation assessment and accreditation outcomes for district hospitals, are described elsewhere [10].…”

Section: Methodsmentioning

confidence: 99%

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A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa

et al. 2019

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BackgroundMany newborn infants die from preventable causes in South Africa, often these deaths occur in district hospitals. A multipronged intervention aiming to improve quality of newborn care in district hospitals was implemented comprising training in clinical care for sick and small newborns, skills development for health managers, on-site mentoring, and hospital accreditation. We present the results of the project evaluation.MethodsWe conducted three sequential cross-sectional surveys in 39 participating district hospitals at baseline, midpoint and endpoint of the three-year intervention period. Data were collected by a trained midwife using a series of checklists including: availability of trained staff, drugs and equipment; newborn care practices; perinatal mortality audits; neonatal unit staff skills; quality of record keeping. A scoring system was developed for three domains: resources; care practices; resuscitation equipment, and a composite score that included all variables measured. Health worker (HW) knowledge was assessed at midpoint and endpoint.ResultsThe average score for resources increased from 13.5 at baseline to 22.6 at endpoint (maximum score 34), for care practices from 17.7 to 22.6 (maximum score 29), and for resuscitation equipment from 10.8 to 16.1 (maximum 25). Average composite score improved significantly from 42.0 at baseline to 55.7 at midpoint to 60.7 at endpoint (maximum score 88) (p = 0.0012). Among 39 participating hospitals, 38 achieved higher scores at endpoint compared to baseline. Knowledge was higher among HWs trained during the project at midpoint and endpoint. Gaps that remained included poor infrastructure, lack of resuscitation equipment in some areas, poor postnatal care and lack of a dedicated doctor.ConclusionsThis intervention achieved measurable improvements in many important elements contributing to newborn care. A scoring system was used to track progress, compare facilities’ performance, and identify areas for improvement. Various methods were used to generate the quality of care score, including skills assessment and record reviews. However, measuring quality of clinical care and outcomes was challenging, and we were unable to determine whether the intervention improved clinical care and lead directly to improved outcomes for babies. In developing a future score for quality of care, a stronger focus should be placed on assessing clinical care and outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa

et al. 2019

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“…This study forms a component of a multipronged initiative to improve QoC in neonatal units in district hospitals in KwaZulu-Natal (KZN), known as the KZN Initiative for Newborn Care (KINC) [28]. The KINC intervention is described in detail elsewhere [29, 30]. We report the findings of an in-depth qualitative study which aimed to explore mothers and HWs experiences of care provided in neonatal units in district hospitals in order to identify opportunities to improve QoC.…”

Section: Introductionmentioning

confidence: 99%

Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa

et al. 2019

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BackgroundThere is a high global burden of neonatal mortality, with many newborn babies dying of preventable and treatable conditions, particularly in low and middle-income countries. Improving quality of newborn care could save the lives of many thousands of babies. Quality of care (QoC) is a complex and multifaceted construct that is difficult to measure, but patients’ experiences of care are an important component in any measurement of QoC. We report the findings of a qualitative study exploring observations and experiences of health workers (HWs) and mothers of babies in neonatal units in South Africa.MethodsA qualitative case study approach was adopted to explore care of newborn babies admitted to neonatal units in district hospitals. Observation data were collected by a registered nurse during working hours over a continuous five-day period. Doctors and nurses working in the neonatal unit and mothers of babies admitted during the observation period were interviewed using a semi-structured interview guide. All interviews were audio recorded. Observation data were transcribed from hand written notes. Audiotapes of interviews were transcribed verbatim and, where necessary, translated into English. A thematic content analysis was used to analyse the data.ResultsObservations and interviews were conducted in seven participating hospitals between November 2015 and May 2016. Our findings highlight the importance of information sharing between HWs and mothers of babies, contrasting the positive communication reported by many mothers which led to them feeling empowered and participating actively in the care of their babies, with incidents of poor communication. Poor communication, rudeness and disrespectful behaviour of HWs was frequently described by mothers, and led to mothers feeling anxious, unwilling to ask questions and excluded from their baby’s care. In some cases poor communication and misunderstandings led to serious mismanagement of babies with HWs delaying or withholding care, or to mothers putting their babies at risk by not following instructions.ConclusionGood communication between mothers and HWs is critical for building mothers’ confidence, promoting bonding and participation of mothers in the care of their baby and may have long term benefits for the health and well-being of the mother and her baby.

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First experiences of accrediting district hospitals for excellence in newborn care in KwaZulu-Natal, South Africa: Successes and challenges

Cited by 2 publications

References 15 publications

A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa

A health systems strengthening intervention to improve quality of care for sick and small newborn infants: results from an evaluation in district hospitals in KwaZulu-Natal, South Africa

Communication between mothers and health workers is important for quality of newborn care: a qualitative study in neonatal units in district hospitals in South Africa

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