Auditing in health care has been recommended by many national organisations to improve patient safety and quality of care, despite inconclusive evidence to support its effectiveness. In South Africa, the National Core Standards for health establishments in South Africa (NCS) was published in 2011. The NCS recognises that staff are vital to ensuring that the health system delivers quality health care and therefore require protection against the risk of injury, infection and other occupational hazards, consistent with the South African Occupational Health and Safety act of 1993. The aim of this study was to determine: (a) the compliance of public sector primary healthcare (PHC) facilities with the NCS for occupational health and safety (OHS) and infection prevention and control (IPC), (b) the impact of the audits three years after baseline audits, at follow up self-assessment audits and (c) the reliability of self-assessment audits when compared to external audit results. This dissertation is divided in three parts. Part A is the study protocol which received ethics approval in March 2015. Part B is a structured literature review covering standards for health care, the impact and effectiveness of accreditation/certification/auditing in health care, interrater reliability and factors associated with OHS/IPC compliance. Previous studies have failed to address whether evaluating occupational health and safety or infection prevention and control standards using accreditation/certification in a primary healthcare, low and middle income setting is effective or reliable. Part C is the journal ready manuscript presenting the results of the study in the form of a manuscript for an article for a named peer reviewed journal. This was a cross-sectional study of NCS OHS/IPC audit data, with a longitudinal component, of a sample of public sector PHC facilities in the Western Cape province of South Africa between 2011 and 2015. Baseline PHC facility compliance with OHS/IPC measures was low. There was no significant improvement in compliance after three years. Poor inter-rater reliability indicates a large degree of measurement error. Practical implications of these results are the need to improve reliability of assessments and a process to convert low compliance scores into implemented improvement actions.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/22763 |
| Date | January 2016 |
| Creators | Cloete, Brynt Lindsay |
| Contributors | Ehrlich, Rodney, Yassi, annalee |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Public Health and Family Medicine |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Master Thesis, Masters, MMed |
| Format | application/pdf |
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