Barriers and enablers for implementation of Trauma Society Accreditation in Western Cape Private Hospitals
Klette, Amanada Mary-Jane
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In 2011 the Trauma Society of South Africa (TSSA) published recommendations for accrediting hospitals with emergency departments (EDs) in the South African Medical Journal (SAMJ). These guidelines were drafted for South Africa following international evidence that an improvement was seen in patient outcomes following the implementation of accreditation. Emergency medical services (EMS) personnel have little to help them decide where to take a patient, other than “the closest, most appropriate facility”. TSSA accreditation is intended to provide an objective grading of expertise and resource availability at a specific facility that would assist the EMS community in making informed decisions. However, few facilities have subsequently sought or achieved TSSA accreditation. This research aimed to explore the rationale behind the lack of implementation of accreditation in private hospitals in the Western Cape, despite ample international evidence relating trauma accreditation with better patient outcomes. The research details the barriers and enablers for the implementation of the TSSA accreditation in the Western Cape private hospitals. The Western Cape has the highest trauma prevalence in South Africa, yet only two private hospitals and no public hospitals in the province have been accredited according to the TSSA accreditation tool. The research was qualitative, interpretive descriptive, and contextual in nature. All five private hospital groups in the Western Cape were invited to participate after ethical approval and permissions were obtained. Through purposive quota sampling and predetermined inclusion criteria, three different categories of participants were recruited from each hospital group, namely emergency department unit managers, hospital general managers, and doctors from the emergency department practice. Sixteen semi-structured, individual interviews were conducted with an equal distribution between all three categories. Data collection continued until data saturation was reached (n=16). A first-order thematic analysis followed by a second-order interpretive analysis was concluded with a consensus discussion with a co-coder. Field notes were kept. Five themes, twenty-one categories and sixty-nine sub-categories emanated from the data analysis. The themes highlighted the contextual realities of EDs within the private health system and that TSSA accreditation cannot be seamlessly applied to this system, without transformation by overcoming identified barriers and implementation of effective enablers. EDs need to be affiliated with tertiary training institutions and should be actively involved in the research. Participants held different understandings of TSSA accreditation, presented different rationales for accreditation, and suggested how accreditation could be facilitated. Enablers were based on organisational strengths whilst barriers highlighted private health system realities and the geographical determinants of trauma care. It was recommended to contextualise the TSSA accreditation tool, and process, to the private hospital environment within the Western Cape. A collaborative approach to tool contextualisation can be used to obtain buy-in. Effective communication informing hospitals that the TSSA has no conflict of interest, may address perceptions about the TSSA accreditation being associated with only a specific hospital group. Whereas implementing a TSSA accreditation roadshow, presenting the propositional value thereof, with evidence of positive patient outcomes associated with the TSSA accreditation process would promote buy-in. Promoting the fact that TSSA accreditation could strengthen public-private collaborations within the eminent National Health Insurance (NHI) system, including enhanced trauma training opportunities to ensure continuous professional development which is a critical component of the TSSA accreditation process.
- Health Sciences