Understanding quality systems in the South African prehospital emergency medical services: a multiple exploratory case study

Abstract

IntroductionIn South Africa (SA), prehospital emergency care is delivered by emergency medical services (EMS) across the country. Within these services, quality systems are in their infancy, and issues regarding transparency, reliability and contextual relevance have been cited as common concerns, exacerbated by poor communication, and ineffective leadership. As a result, we undertook a study to assess the current state of quality systems in EMS in SA, so as to determine priorities for initial focus regarding their development.MethodsA multiple exploratory case study design was used that employed the Institute for Healthcare Improvement’s 18-point Quality Program Assessment Tool as both a formative assessment and semistructured interview guide using four provincial government EMS and one national private service.ResultsServices generally scored higher for structure and planning. Measurement and improvement were found to be more dependent on utilisation and perceived mandate. There was a relatively strong focus on clinical quality assessment within the private service, whereas in the provincial systems, measures were exclusively restricted to call times with little focus on clinical care. Staff engagement and programme evaluation were generally among the lowest scores. A multitude of contextual factors were identified that affected the effectiveness of quality systems, centred around leadership, vision and mission, and quality system infrastructure and capacity, guided by the need for comprehensive yet pragmatic strategic policies and standards.ConclusionUnderstanding and accounting for these factors will be key to ensuring both successful implementation and ongoing utilisation of healthcare quality systems in emergency care. The result will not only provide a more efficient and effective service, but also positively impact patient safety and quality of care of the services delivered.

A resuscitation systems analysis for South Africa: A narrative review

“…Common concerns include transparency, reliability, and contextual relevance, which are exacerbated by poor communication and ineffective leadership. 51 Culture of excellence and improvement seem to vary across the public and private sector, with private EMS often investing more into quality improvement. 51 In contrast, quality in the public sector mostly focus on metrics such as response time targets, versus assessing quality of care.…”

“… 51 Culture of excellence and improvement seem to vary across the public and private sector, with private EMS often investing more into quality improvement. 51 In contrast, quality in the public sector mostly focus on metrics such as response time targets, versus assessing quality of care. 51 In general, South African EMS lack knowledge of quality management systems, but do acknowledge its importance.…”

“… 51 In contrast, quality in the public sector mostly focus on metrics such as response time targets, versus assessing quality of care. 51 In general, South African EMS lack knowledge of quality management systems, but do acknowledge its importance. 52 A set of clinical quality indicators for South African EMS has also been developed, including for OHCA 53 but the extent to which this has been adopted or implemented is not known.…”

“…A lack of leadership and quality system infrastructure and capacity have all been cited as barriers to improving clinical care in South African EMS. 51 This is being addressed systematically, as more EMS are implementing digital systems which may support quality improvement.…”

Refining circumstances of mortality categories (COMCAT): a verbal autopsy model connecting circumstances of deaths with outcomes for public health decision-making

“…NCDs predominated in the 50–69 and 70+ years age groups where most deaths were attributed to CVD and ‘emergencies’ and ‘inevitable’ COMCATs. This reflects an exponentially increasing NCD burden in South Africa and a lack of emergency and preventative health system responsiveness, which threatens achievements in infectious disease control and maternal and child health [ 58 , 59 ]. As in many settings, the authorities often have neither reliable data on the population burden nor its determinants, and thus are unable to plan and organize services responding to local needs, and particularly the needs of vulnerable and excluded groups.…”