OHSC Fraud Hotline

FAQs on certification and enforcement

Q: What does “evidence” mean in the context of a health audit?

A: Evidence is something that you can see, touch or hear. It ensures that there is a real basis for conclusions reached. Evidence can be gathered by:

• Reviewing patient records.
• Observing the state of the facility.
• Interviewing staff and patients.
• Reviewing minutes of meetings.
• Checking other facility records.
The audit tools include questionnaires and checklists for use in the gathering of evidence.

Q: Why should we have the NCS?

A: The standards work. Quality improvement is guaranteed if management and staff follow the standards closely.

The standards compel facility staff to unite to deliver all-round performance.
The standards speak to the soul of our health professions. They reconnect us to the oaths we made to put our patients first.
The standards prepare us for the future when there will be specific laws to control the quality of healthcare.
Standards build teams and managers
Health services are complex and the various components – such as clinical care, clinical support services, and operational management – are inter-connected. Failure to perform in one area affects the other areas. So the standards guide us to improve on all fronts.
Teamwork becomes absolutely necessary. True quality cannot be achieved unless all staff are performing well as individuals and pulling together as a team.
Direction and coordination are absolutely vital. The NCS assist managers to fulfil their leadership responsibilities.
The standards also provide managers and staff with an ideal tool for monitoring and measuring performance and to make improvements where these are needed.

Q: What are the National Core Standards (NCS)?

A: The National Core Standards (NCS) for health care establishments is a tool for those who dream of better healthcare. Not only do the standards tell us what to do to achieve good basic services, but they also require managers and staff of all public hospitals and clinics to take immediate action.

The National Health Council has resolved that the NCS be followed in every province, health district and public health facility. Private health facilities are also encouraged to adopt the NCS, as all health facilities will soon have to meet regulated standards.
All health facilities should be confident that they have the potential to achieve most of the NCS simply by better team work, clearer direction and stronger management. In the case of a few standards, district and provincial help or funding may be needed to overcome obstacles.
Our national goal is to guarantee the public that, no matter which clinic or hospital they attend – anywhere in the country, they will find good standards of basic health care.

All health facilities should be confident that they have the potential to achieve most of the NCS simply by better team work, clearer direction and stronger management. In the case of a few standards, district and provincial help or funding may be needed to overcome obstacles.
Our national goal is to guarantee the public that, no matter which clinic or hospital they attend – anywhere in the country, they will find good standards of basic health care.

Q: What does the auditing of health services involve?

A: Auditing involves checking the actual performance of health care facilities against the required standards and norms in all domains of healthcare.

An audit is simply a way of measuring quality of care. It is not a criticism of the staff, but a valuable instrument to guide quality improvement.
Audits can be done internally by the management and staff of a facility or by a provincial health department as part of a quality improvement programme.
Audits can also be conducted by inspectors of the Office of Health Standards Compliance (OHSC) in order to certify those hospital and clinics that are performing satisfactorily and bring about improvements in those that do not comply.

What is the Minister of Health identified as top priorities?
The Minister of Health has selected six sub-domains for urgent attention by all public hospitals, health centres and clinics. These are:
• Staff values and attitudes.
• Waiting times.
• Cleanliness.
• Patient safety.
• Infection prevention and control.
• Availability of medicines and supplies

Q: How does the OHSC enforce compliance?

A: The OHSC can take further action if a health establishment fails to correct the shortcomings listed in the compliance notice. The nature of the action would depend on how serious the weaknesses are. The OHSC can recommend to provincial or municipal health care departments that action – including disciplinary action – be taken against individuals in charge of sub-standard health establishments. The OHSC can also impose a fine on a health care establishment, refer it to the prosecuting authority for prosecution or (in cases where public health and safety is at risk) recommend to the Minister that the establishment or a section of it be closed temporarily or permanently.

Q: Standards connect to our professional ethics

A:• Standards are not a burdensome add-on to our jobs. They embody the values and ethics of the professions that drive the “business” of healthcare.

• This means they require us to do the jobs that we have signed up for – and that we do our jobs well.
• By helping health professionals and support workers to deliver better care, standards can generate job satisfaction and professional self-respect.

Q: What is the scope of the Core Standards?

A: There are 93 individual standards grouped into seven main categories or domains.

Domain 1 Patient Rights
Domain 2 Clinical Governance and Clinical Care
Domain 3 Clinical Support Services
Domain 4 Health Promotion and Disease Prevention
Domain 5 Leadership and Governance
Domain 6 Operational Management
Domain 7 Facilities and Infrastructure
Six clusters of standards from various domains form the fast track for patient-centred care. This is where every hospital and clinic should start!

Q: What powers does the OHSC have in terms of inspections?

A: The OHSC is tasked with inspecting health establishments to check whether they are meeting the required standards. Most inspections will be routine inspections for the purpose of certifying the health establishment. But inspections can also be conducted as a result of complaints or because the OHSC has detected problems in the course of monitoring information about health services, including media reports and complaints by the public.

Inspectors have powers to enter health establishments for the purposes of checking whether they comply with standards. They can question relevant staff and patients and request access to documents including patient records.
At the end of an inspection, the OHSC has two options:
• To award a certificate stating that the health establishment has met the required standards.
• To issue a compliance notice telling management where the establishment has fallen short, how the weaknesses must be rectified – and by when.

The compliance notice is only lifted when the establishment achieves the required standards – and then a certificate is awarded.
Management at a health care establishment that feels they have been treated unfairly of prejudiced by the OHSC can appeal against the relevant decision of the Office. The Minister will set up a tribunal to hear such an appeal.

Q: Who is the health sector Ombud?

A: The National Health Amendment Act provides for the Minister of Health to appoint an Ombud – a kind of public protector – for the healthcare sector.

• The Ombud must consider, investigate and settle complaints about poor quality healthcare. He or she must make a recommendation for action at the end of every investigation and the CEO of the OHSC must see this is carried out.
• The Ombud must operate fairly and deal with complaints swiftly. The Ombud is intended to bring about justice without the expense and delay of court action.
In order to protect the independence of the Ombud, the National Health Amendment Act specifies that:
• The Ombud remains in office for seven years and this period cannot be renewed.
• He or she reports directly to the Minister, not to the OHSC. The OHSC must, however, provide the Ombud with the staff needed for effective functioning.
• Funding for the Ombud is voted directly by Parliament and cannot be redirected for other work.
• The Ombud must perform his or her functions “in good faith and without fear, favour, bias or prejudice “.
• The Ombud must report his or her findings and recommendations to the person who laid the complaint and the health care establishment concerned.

Anyone who feels that the Ombud has made an unfair finding or recommendation can appeal to the Minister who will appoint a retired judge or magistrate to reconsider the matter.

Q: How does the OHSC report to the Minister?

A: The Office of Health Standards Compliance (OHSC) functions under control of a Board appointed by the Minister of Health in terms of the National Health Amendment Act of 2013. The Board is the accounting authority of the Office and is responsible for determining the policy of the OHSC and undertaking strategic planning for the functions of the Office.

The Act specifies that the Board should consist of seven to 12 members. Most members are selected on the basis of specific expertise and experience in various areas of healthcare, the law, finance and economics, the private and public healthcare systems, and quality assurance. One member represents organised labour and one is a representative of civil society organisations.

The Minister makes the final selection of members from individuals nominated by institutions of higher learning, civil society organisations, trade unions and other organisations in response to adverts in the Government Gazette and national press.

The Chief Executive Officer and the Chief Financial Officer of the OHSC are ex officio members of the Board.

Q: Who sets standards of service?

A: The Minister of Health has the power to set compulsory norms and standards for health care establishments. He will do this by means of regulations that are made in terms of the National Health Amendment Act of 2013. There will be different standards suited to different types of health care establishments.

• The OHSC must advise the Minister on the setting of these standards and norms.
• Stakeholders and the public will have a chance to comment before regulations on standards are finalised.

Q: How will the OHSC enforce health standards?

A: The OHSC acts with the full authority of the law and it is required to ensure that health care establishments meet the required standards by:

• Monitoring health care establishments through the collection of key information.
• Inspecting health care establishments by deploying teams of specially trained inspectors.
• Awarding certificates to health care establishments that meet the required standards.

Issuing notices to health care establishments that fall below standard, instructing them on mandatory requirements and ensuring these standards are met.

Investigating and settling complaints from the public about sub-standard health services.


Q: Which health services fall under the OHSC?

A: The focus of the OHSC is the “health establishment” not the individual health care professional. Health care establishments include a range of health-related services, both public and private, that provide direct patient care.

The OHSC will focus initially on hospitals and clinics and will broaden its activities gradually to cover other health care establishments.
The conduct of individual health care professionals will continue to be regulated by the Health Professions Council of SA, the SA Nursing Council, the Pharmacy Council, and other relevant professional councils. The OHSC will work synergistically with these bodies toward reaching a common goal.

Q: What is the OHSC and what does it do?

A: The Office of Health Standards Compliance – or OHSC – is a new body, created by a change to the National Health Act, to protect and promote the safety of users of health services by ensuring that:

• Health establishments comply with the required standards.
• Complaints about healthcare are investigated and action is taken where necessary.
Every health worker – from support staff to healthcare professionals and managers – plays a part in ensuring good healthcare. So everyone needs to know about the OHSC and the legal powers this organisation has been given in order to perform its role.

Q: How will members of the public know which establishments have been certified?

A: The OHSC will publish lists of certified institutions on the website once the formal inspection process commences. However, it should be noted that the absence of an establishment from the list will not necessarily mean that it has failed to meet the standards set for compliance. It may also mean that the health establishment has not yet been inspected.

Q: When will the process of certifying establishments begin?

A: All processes of the OHSC depend on the promulgation of regulations prescribing norms and standards for health establishments. The first set of regulations (covering public and private hospitals and primary healthcare clinics) was published for a three-month comment period on 18 February 2015.

Q: In what circumstances could a health establishment that has already been granted a certificate of compliance have this certificate withdrawn?

A: If a health establishment's standards decline and it no longer meets the requirements for certification, it could be issued with a compliance notice. Should it fail to address the issues listed in the compliance notice, the establishment could have its certificate of compliance withdrawn.

The OHSC would most probably be alerted to a drop in standards through the monitoring systems it has or through a pattern of complaints about the establishment registered at its Complaints Centre.

Q: If action is taken because an establishment persistently fails to heed a compliance notice, who would actually be held accountable?

A: Normally the person in charge of the facility or the person in charge of a relevant section of the facility (as defined in relevant regulations) would be held responsible. However, action could also be recommended in relation to the manager of the system that failed to enable the person in charge at the health establishment to comply with regulated norms and standards. In this way, recommendation for action could be directed at officials in district health offices and provincial health departments.

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