Quality Improvement Governance: Audit Compliance with Health Norms and Standards, A Comparative Study

Abstract

This comparative qualitative research explored how the governance structure responded to audit recommendations concerning quality improvement by comparing Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and Groote Schuur Hospital (GSH). It aimed to understand the quality improvement processes and systems in place, the structure, and how the institutions differ in terms of systems for quality improvement. Audit reports and quality improvement plans from 2019 to 2023 were obtained from both hospitals; however, CMJAH only had one quality improvement plan for 2023/2024. Semi- structured interviews were conducted with managers and coordinators involved in quality improvement at the institutions. The main findings observed from the research were inadequate adherence to standard operating procedures, limited human resources to ensure that quality improvement activities are implemented, and inadequate monitoring and evaluation tools to monitor progress. Furthermore, the assessment reports indicated that there was no implementation of the remedial actions for external audit findings, risk escalation and mitigation, financial findings, and human resource management. Austerity measures and quality activities funding were also highlighted during participant interviews at both institutions. Even though both institutions are meeting compliance requirements with health norms and standards, a robust governance structure is required to ensure that all quality improvement activities are conducted as planned and objectives are met. Furthermore, limited human resources have been noted as an impeding factor at both institutio