COHSASA Panel calls for total quality management in South Africa’s public hospitals

SOUTH AFRICA—The COHSASA Conference has emphasised the importance of strong leadership, effective governance, and transparent reporting to improve healthcare quality across South Africa’s public sector.

Speaking at the Hospital Show Conference in Sandton, experts from regulation, academia, and hospital management examined persistent challenges and practical opportunities for reform.

Moderated by COHSASA CEO Jacqui Stewart, the panel emphasized that healthcare outcomes vary widely between facilities, often reflecting the strength of internal leadership structures.

Professor Sibusiso Zuma of UNISA explained that collaboration among departmental heads plays a decisive role.

He noted that nursing, pharmacy, and clinical leaders must work as a unified team to identify and resolve problems while maintaining a visible presence on the ground.

Leadership and infrastructure challenges

Dr Siphiwe Mndaweni, CEO of the Office of Health Standards Compliance (OHSC), reinforced the link between leadership and care quality.

Drawing from inspection findings, she stated that weak or absent leadership directly undermines service delivery.

At the same time, aging infrastructure and poorly managed maintenance budgets continue to strain facilities.

She pointed out that even basic supplies remain inconsistent, making infection prevention difficult.

Furthermore, gaps in clinical governance have contributed to rising litigation, as oversight structures often exist only on paper, with little active engagement.

In addition, poor community involvement, security concerns, and underused strategic plans further weaken healthcare delivery.

However, Dr Mndaweni highlighted that facilities with engaged leadership—where managers actively interact with staff and patients—consistently report better outcomes.

Beyond compliance to continuous improvement

Dr. Arthur Manning, CEO of Rahima Moosa Mother and Child Hospital, argued that regulatory compliance should serve as a baseline rather than a final goal.

He stressed that while standards define minimum care levels, hospitals must strive to exceed them.

Professor Zuma supported this view, warning against a short-term compliance mindset.

He observed that many facilities intensify efforts only during inspections, then lose momentum afterward.

To address this, he recommended broader staff training in Total Quality Management and regular six-month audits involving all departments to sustain continuous improvement.

Addressing cultural barriers in reporting

Professor Sabelile Tenza of North-West University identified deeper cultural challenges, particularly performative compliance.

She cited cases where hospitals temporarily borrowed equipment to pass inspections, revealing a disconnect between policy and practice.

Moreover, she described a culture of fear that discourages staff from reporting shortages or failures. According to her, healthcare workers often hesitate to report adverse events due to a lack of feedback and concerns about blame.

She stressed that effective “Just Culture” frameworks must protect confidentiality and focus on incidents rather than individuals.

Although the National Department of Health has introduced free online reporting tools, adoption remains low.

Professor Tenza called for more user-friendly, mobile-accessible systems with reduced duplication between paper and digital processes.

Meanwhile, Dr Mndaweni clarified that while regulation may seem punitive, enforcement remains a last resort.

She noted that the OHSC increasingly aims to support improvement, although persistent non-compliance may still lead to licence revocation.