EARLY WARNING INDICATORS OHSC CONSULTATIVE WORKSHOP ON THE WORK OF THE OHSC AS THE REGULATOR PRESENTATION BY OHSC VENUE: PROTEA HOTEL: POLOKWANE DATE: 08 NOVEMBER 2018

Outline How the OHSC protect and promote the health and safety of users Functions of the OHSC - EWS Purpose Indicators How indicators were developed She does not always take us where we want to as her subordinates, but directs us where ought to be, which in some instances is not where we don’t necessarily want to go. As leader, she leads us from within.

How does the OHSC protect and promote the health and safety of users Advise on the determination of norms and standards to be prescribed Inspect and certify HEs Investigate complaints Monitor indicators of risk Make recommendations for intervention Collect or request information from HEs Promote: Advise on the review of norms and standards Publish information in relation to prescribed norms and standards Recommend quality assurance and management systems for the national health system Issue guidelines for HEs to assist compliance Collect or request information Liaise with other regulatory authorities Public

Functions of the OHSC (a) advise the Minister on matters relating to the determination of norms and standards to be prescribed for the national health system and the review of such norms and standards; (b) inspect and certify health establishments as compliant or noncompliant with prescribed norms and standards or, where appropriate and necessary, withdraw such certification; (c) investigate complaints relating to breaches of prescribed norms and standards; (d) monitor indicators of risk as an Early Warning System relating to serious breaches of norms and standards and report any breaches to the Minister without delay; (e) identify areas and make recommendations for intervention by a national or provincial department of health, a health department of a municipality or health establishment, where it is necessary, to ensure compliance with prescribed norms and standards; ( f ) publish information relating to prescribed norms and standards through the media and, where appropriate, to specific communities; (g) recommend quality assurance and management systems for the national health system to the Minister for approval; (h) keep records of all its activities; and (i) advise the Minister on any matter referred to it by the Minister. Section 79. of the National Health Amendment Act of 2013 states the following Functions of OHSC

PURPOSE OF EWS Proactive in predicting risk for prompt corrective action Contribute to ongoing research on areas of risk to patient safety Identify and prioritise high Risk health establishments Monitor indicators of Risk EWS is technology and associated policies and procedures designed to predict and mitigate the harm and other undesirable events in HEs Apple Watch fall detection works perfectly after Swedish “Gustavo Rodriguez” man collapses The Apple watch has a fall detection which is turned on automatically in the Series 4 for customers aged 65 and older, and you can manually turn it on if you’re younger than that. By analyzing wrist trajectory and impact acceleration, Apple Watch sends the user an alert after a fall, which can be dismissed or used to initiate a call to emergency services. If Apple Watch senses immobility for 60 seconds after the notification, it will automatically call emergency services and send a message along with location to emergency contacts. Other examples are linked to what the discovery car insurance is currently doing where they monitor driver behaviour, acceleration, cornering, use of a cellphone when driving and others. Self reported data (24 hour and monthly reporting) – Reported by HEs Data triangulation of available data (Complaints Call Centre Data, EWS measures linked with inspections, Annual Returns Data, data from the National Department of Health and other available data and information about HEs which is in the form of direct complaints from HEs in the media, civil society groups, researchers, other regulators and other sources. Industrial revolutions have always dominated and changed the world in a big way. The first one happened way back in 18th century, and the second industrial revolution occurred almost two centuries later, in the 20th century. The third one happened only a half-century later, while the fourth one was observed within three decades. By the speed these transformations are occurring, a fifth industrial revolution is already around the corner. Examples - Intelligent and interconnected administrative tools for refrigerators – in this instance; refrigerators warns you when your milk is going off and items you need to replenish. Stores that are not manned. Stores that will remind you. The EWS system is dynamic and data driven in nature and will never remain static.

EWS INDICATORS INDICATORS FREQUENCY OF REPORTING REPORTING MECHANISM 12 Critical indicators Within 24 hours of the incident Online reporting by health establishments 17 Indicators Monthly 19 Measures that are monitored as part of inspections For health establishments that are inspected Generated by inspection database report 15 Indicators that are reported by health establishments as part of the monthly routine from the National Indicator Data Set (NIDS) Sourced from the National Health Information Repository Database (NHIRD)

HOW WERE EWS INDICATORS IDENTIFIED Delphi study was conducted 3 Rounds of discussions were conducted to identify indicators 14 expert panel members consisting of nurses and doctors in medical management Delphi panel reached consensus on 29 Indicators

How should we take you along this journey We shall work with all involved and move towards the end state and equip officials to work in new ways Translate the change vision into reality for all involved across the public and private sectors and define what it means for them Communicate the change vision and case for change and begin to create ownership of EWS monitoring and reporting Explain the objectives, ambition and scale for change relating to EWS monitoring Make it clear Make it known Make it happen Make it Real Make it stick All of you involved will need to ensure there is capability in your organizations to sustain change The concept of UHC means that that “all people and communities can use the promotive, preventive, curative, rehabilitative and palliative health services they need; of sufficient quality to be effective; while also ensuring that the use of these services does not expose the user to financial hardship” According to the words of Prof Mayosi on Health and Health Care in South Africa – 20 years after Mandela, and I quote “ “Working toward the goal of national health insurance to provide more equitable access to high quality individual health services has re-emerged as a popular notion. Health economists have suggested that it would be feasible to raise the additional required funding. However, expectations that equity in health care delivery could be achieved at levels close to current private-sector levels appear to be unrealistic. It is clear from the disparities in funding of the private and public sectors and the very large number of additional health care professionals required that this is unlikely and, if achievable, would take a very long time” un quote – may Prof Mayosi’s Soul Rest in Peace.

Thank you A prominent figure in government twitted the following in October 2018 and I quote "I find the transition from central banking and the private sector to Government very funny. I had forgotten how Government operates! They still print documents and have no electronic board docs," unquote. What the Experts Say According to a study by MIT Sloan Management Review and Capgemini Consulting, the vast majority of managers believe that “achieving digital transformation is critical” to their organizations. However, 63% said the pace of technological change in their workplaces is too slow, primarily due to a “lack of urgency” and poor communication about the strategic benefits of new tools. “Employees need to understand why [the new technology] is an improvement from what they had before,” “The job of a manager is to help people cross the bridge — to get them comfortable with the technology, to get them using it, and to help them understand how it makes their lives better.” Tips - Choose technology wisely, State your case, customize training, get influencers onboard, make it routine, highlight quick wins, make it fun, consider penalties