Investigating quality management in the context of the National Core Standards : evaluating the evidence base and policymaking process
Healthcare is no different to any other service industry in its endeavor to achieve the highest quality service at the lowest cost. South Africa is currently in the midst of introducing regulatory reforms to address major quality gaps in the health care system. The National Core Standards (NCS) for all healthcare establishments is one of the main policy levers proposed to attain higher quality standards and the Office of Health Standards Compliance (OHSC) has been created as the regulatory body to enforce these standards. This study evaluates the evidence base and policy making process that has resulted in the NCS paying particular attention to the dynamics between regulation, Quality Improvement (QI) and Quality Control (QC). The purpose of this study was to evaluate the underlying assumptions of the NCS in relation to discourses on QM. The methodology of the study was qualitative in design using a documentary review and semi-structured interviews with policy makers, Quality Management (QM) experts, private healthcare and health professionals working in facilities. Analytical techniques included secondary analysis of NCS background documents and thematic analysis. Findings from the documentary review were that the NCS is a strongly QC and regulatory oriented policy and the evidence base for the NCS does not reflect the full spectrum of QM literature. The main finding of the study is that the QC and regulatory focus of the NCS is explained as an effort to counteract political patronage that has resulted in a lack of accountability within the South African health system. The implications of a strongly QC oriented policy could be positive for accountability but could also result in lack of QI skills among healthcare professionals and the risk that health professionals will not engage with the policy as they do not feel part of the problem solving process.
Health services administration , Total quality management -- South Africa