Internal governance structures
Our board is comprised of a cross section of community and business partners who have the best interest of DPH at heart. Their main function is strategic and financial oversight. The Board of directors meet on a quarterly basis and the executive committee on as need basis to deal with decisions that may impact on the functioning of DPH.
Nathan Ramailane: Businessman (Chairman)
Marlo Laubscher: Lawyer (Vice Chairman)
Adriaan Venter: Businessman
Deon Erasmus: Rotary Representative
Maria von Backstrom: Community Developer
Harlan Cloete: Governance expert
Steven Tekana: Anglican Minister
QRA (Quality Improvement and Risk Management Activities)
The QRA committee monitors and evaluates the Quality Improvement and Risk Management Activities on a monthly basis. Each department (Finance, Patient Care, Administration, Management, Fundraising and Marketing etc.) develops audits in the beginning of the year based on the strategic plan, the environment, high risk, high volume and high cost and experience and this is approved by the Board. If audits, accidents or incidents indicate a concern a QAPI (Quality Assurance with Performance Indicators) programme is developed to proactively manage the concern. The QAPI programme describes the objective, indicators, activities, analysis, what is learned and how monitoring and evaluation is done to oversee how effective the change management process has been. If not, the QAPI may need to be redeveloped and a new approach is implemented. If the process has been successful, the QAPI programme will be terminated and monitored through audits as necessary.
The Risk Management Plan
The Risk Management Plan is developed with the senior managers and quantifies risk and possible impact and the development of a plan with activities to mitigate high risks. This plan is approved by the Board and addresses Financial, Physical, Operational, Environmental and Medico-legal Risks. The plan is monitored at the QRA (Quality Improvement and Risk Management Activities) meetings held on a monthly basis.
Health and Safety
We work in high risk environments with some of the most vulnerable members of our community. Health and Safety remains a top priority for us which are addressed at our a weekly palliative care team co-ordination meeting and is part of the monthly QRA (Quality Improvement and Risk Management Activities) meeting. A team is approinted by the CEO who on a 3-mthly basis who does an inspection.
Sustainabilityof DPH is addressed on a yearly basis as part of the audited financial statements and development, acceptance and monitoring of the financial budget, a constant focus on succession planning, remaining relevant, adapting to changes in the health environment, adapting to funding opportunities, focussing on COHSASA accreditation and remaining focused on the DPH mission and vision.
Impact Assessment Measures
Our COHSASA accreditation and HPCA 5-star status is proof of our commitment to quality palliative care provision.
We have a comprehensive record keeping and data collection system which includes the following:
Recording and evaluating palliative care patient interventions with a focus on medical symptom management (pain, constipation, physical care etc.), psychosocial support provided, home care visits and nursing procedures performed (see patient intervention statistics)
Patient numbers: New patients and deaths and types of illnesses referred provides information on scope of work and the perception of referral institutions.
Clinical audits: The severe symptom management form monitors that the quality of patient symptom interventions are inline with the palliative care clinical guidelines.
The APCA POS (African Palliative Care Positive Outcome Scale) audit is done every 6 months to assess the patients' experience of the care received. The annual patient satisfaction and staff satisfaction questionnaires informs training needs, staff patient ratio requirement, the patient experience and the areas of developmental needs.
Quality Improvement and Risk Management Activities (QRA) consist of regular audits based on high cost, high volume and high risk activities and an analysis of accident, incidents and near misses are done. If the audits, risk assessment, accidents or incidents are a concern a Quality Assurance Programme with Performance Indicators (QAPI) plan is developed to change or improve an event or address a situation. This is monitored monthly at the QRA meeting and reported to the Board if indicated.
The Interdisciplinary Care Plan, weekly IDT review and planning and record keeping monitor the impact of our work.
External governance structures
Good Governance and Accountability
The Independent Code consists of a set of principles, values and responsibilities intended to guide and inform the way that organisations are managed and conduct their affairs. DPH has committed to comply with and give full effect to the principles, values and guidelines which constitute the independent code of governance for NPO’s South Africa.
DPH is COHSASA accredited. COHSASA is the only internationally accredited quality improvement and accreditation body for healthcare facilities based in Africa. In the past 22 years over 600 facilities throughout the continent have entered the COHSASA programme to improve the quality and safety of the healthcare services provided to patients.
DPH is a 5-star HPCA member hospice. The mission of HPCA is to promote quality in life, dignity in death and support in bereavement for all living with a life-threatening illness by supporting member hospices and partner organisations.
WC-HPCA is an association of HPCA member hospices in the Western Cape. WC-HPCA is a NPC which focuses on 5 specific areas in support of palliative care in the province. These are Monitoring Evaluation and Reporting, Accreditation and quality care support, Training and Education, Resource Development and Advocacy. All HPCA WC membership is approved by the WC-HPCA Board in line with membership criteria.
Yearly audits are conducted by LDP which is structured around LDP Incorporated, a well-known and long-established practice of public accountants and auditors in South Africa.
HPCA Palliative Care Code of Ethics
Palliative care promotes the alleviation of suffering and does not support euthanasia. There is always an appropriate care plan for every person.
All Palliative Care personnel should practice compassion and respect for the dignity, worth, and uniqueness of every individual without discrimination.
Palliative Care supports Universal Health Coverage ensuring that all people can access quality palliative care services whilst ensuring the use of these services does not expose the patient or family to financial hardship.
Palliative Care personnel should owe the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
MEDICAL ETHICAL PRINCIPLES
These principles guide the development of the interdisciplinary care plan, the ongoing assessment, action plan and treatment.