Access to Safe Care in Developing Countries

Author(s): Stuart Whittaker1
Affiliation(s): 1Research and Information, The Council for Health Service Accreditation of Southern Africa, Pinelands, South Africa
Key issues:

Recognising the inevitability of unsafe outcomes due to high-risk processes in hospitals, this presentation introduces the concept of the Wedge Model for improving access to safe healthcare. The model comprises two separate, parallel but interdependent processes converging on unsafe care. The model has been developed in response to current events in South Africa. Rarely does a week pass without some minor or major adverse event in a hospital or healthcare facility in this country being reported in the country's media. Post-apartheid hospitals are struggling to deliver quality care to some 43 million people, particularly in the poorer, rural areas. This struggle is even more intense, given resource constraints, the impact of HIV/AIDS, a brain-drain of doctors and nurses and poor performance in both clinical and non-clinical areas. However, evidence is emerging that all countries experience the paradox of healthcare facilities providing some excellent curative care and yet posing a high risk to patients, staff and the community.

Meeting challenges:

The Wedge Model approach offers a mechanism to reduce the risk to patient, staff and community safety and at the same time improve patient care. One side of the wedge is COHSASA's standard improvement programme that aims at improving facility, clinical, management, clinical and non-clinical support and technical systems so that ultimately high levels of excellence are achieved. Work to date shows that services can be improved using QI methods based on standards compliance provided management support and essential resources are available. Clinical standards, however, show a resistance to improvement and adverse events remain a threat. The other side of the wedge is the adverse event monitoring, improving and preventing arm that aims at identifying and improving systems failures that impact on patient safety while they are being improved by the standard improvement arm.

Conclusion (max 400 words):

In this two-pronged approach, serious system failures are identified and interventions prioritised to ensure that patient safety is maximised at any given point during the ongoing quality improvement cycle, which is being implemented simultaneously. The aim is to achieve safe and effective patient care through the Wedge Model by improving systems through incremental standard compliance improvements, on one hand, and regular monitoring and improvement of serious system failures through AE monitoring, route-cause analysis and solutions, on the other hand.

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