Author - Gareth Kantor

SA and Brazil: the C-section Champions League 

Caesarean section (C-section) rates are higher in SA private hospitals than in American “celebrity hospitals”. But Brazil’s are even higher. Why so high and what can be done? The caesarean section (C-section) rate just published in Discovery Health’s 2017-18 Healthcare Claims Tracker has prompted media comparisons with US hospitals where celebrity moms like Gwyneth Paltrow, Kim Kardashian and Victoria Beckham deliver their celebrity offspring. Cedars-Sinai (Los Angeles) (24.3%) and Mount Sinai Hospital in New York (21.5%) lag behind Discovery’s reported [...]

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Six key themes for improving patient safety at a national level – lessons from Uganda

South Africans sometimes imagine our country’s development to be far ahead of other African states but the truth is we have much to learn from our neighbours. Image source: https://wwwnc.cdc.gov/travel/destinations/traveler/none/uganda A national stakeholder symposium on health care rights and patient safety practice was held in Kampala in September 2018. The symposium identified 6 key themes for structuring the development of safety interventions in Uganda that may well be useful here. A national system for collecting, monitoring, sharing and learning from patient safety [...]

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(Why) is SA the sickest nation on the planet?

South Africa came last in a survey of 150 countries and was named the world’s unhealthiest nation! Canada first, SA last Canada is said to be the healthiest country, though they are fatter than us, and equally depressed. Having personally survived the cold, dark night of several Canadian winters fortified by doughnuts this bit seems real to me. Highest and lowest scores: Canada vs South Africa (source: http://global-perspectives.org.uk/volume-three/infographics) People love a score People love to compare, so they love scores and rankings. But I’m not [...]

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The Kindness Bundle: compassion and caring make a difference – to outcomes!

In their joint keynote session titled “I have changed my mind” at the IHI International Forum in Glasgow, both Don Berwick and Maureen Bisognano focused on compassion as an issue they have changed their way of thinking about. One example was the white board of information maintained by a long stay facility for the elderly. The white board displays, for staff, not only the patient/resident’s picture, age, resuscitation status, and medical issues, but also “what matters to you” for each person: “2 [...]

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If you can’t measure it you can’t manage it – WRONG!?

“If you can’t measure it you can’t manage it.” How many times have we heard this said – and accepted it as a truism? At last week’s IHI International Forum in Glasgow, Don Berwick asserted, with his characteristic mix of eloquence, humility, humor, and passion, that “all measurements are wrong”. In measuring we create a construct that’s a faulty representative of what matters. How many dinners we share is a mere shadow of the quality of a relationship or ultimately of [...]

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Is there a simple formula for sustainable quality improvement?

Answer: no! Almost any process in health care can be improved but sustained improvement is much more elusive. Part of the problem is the prevalence of discontinuous and non-integrated quality initiatives attempting to tackle, for example, safety, value, staff satisfaction, and culture change. A recent report from IHI published in NEJM Catalyst (March 6, 2019) argues that what’s missing for sustainability is not care model redesign, incentive payments, IT systems, or policy change but management structure and practice that changes the organisational [...]

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Explaining Patient Safety – cultural models as barriers, and how to overcome them

Many of us think of patient safety as a high priority for the health system but misconceptions about patient safety are common. We need to bridge the gap between the messages people hear and what the patient safety community understands. Experts know that most medical harm can be traced to systemic problems but the public sees sensational stories about individuals and the mistakes they have made. A recent WIHI podcast explores how to better communicate patient safety issues, based on new [...]

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What are South Africa’s health care Quality Improvement needs?

To help assess interest in reviving the Best Care Always campaign we polled the BCA database and asked “what are your QI needs?” More than 50% of respondents indicated the need for training in QI methods, for connecting with others doing similar work, for help with data and measurement and access to scientific evidence in journals. No surprises there? Of this limited survey sample (n=51), the majority are based in the South African public health sector – either exclusively (45.8%) [...]

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2 Billion Peripheral IV Catheters – and Most Of Them Fail!

Globally, 2 billion peripheral IV catheters (PIVCs) are placed each year. Most patients admitted to hospital for treatment require one. Surprisingly, 50% or more[1-4] have their PIVC removed because it stops working (becomes dislodged or occluded) or because of a complication, such as infiltration, phlebitis or infection. This leads to substantial waste, discomfort, cost, and harm. Despite how common this simple but important procedure is, and how unsatisfactory the outcomes are, the problem of premature PIVC failure is little studied. There [...]

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