21 April 2019


Bokone Bophirima reduces medical negligence claims  

by: Tebogo Lekgethwane   date: 06 july 2018

Intervention plans and strategies to reduce cases of medical negligence are beginning to bear fruits, with a recorded decrease in these incidents in Bokone Bophirima. 
Health MEC, Dr Magome Masike, has commended positive progress on the work the province has done so far on the matter. Masike said the province would continue building on this good work in order to bring the numbers down even further.
Medical negligence cases have decreased from 46 between January and June 2017 to 37 for January to June 2018. While in 2017 these cases saw claims amounting to R378.8 million (R378 868 540) against the provincial health department, only R147,6 million (R147 673 733) was demanded in the same period this year. 
Dr Masike has attributed the decline to various intervention strategies that he has introduced since he began paying more attention to this issue. One such intervention strategy is to review all maternal and infant mortality cases at the Provincial Mother, Child and Women Health (MCWH) Forum - a platform chaired by the MEC himself. 
“I am pleased with the progress we are making, though I believe an opportunity still exists to do more. Since we began to deal with these cases directly at the MCHW Forum, we are beginning to see the difference. The Forum affords healthcare practitioners and managers an opportunity to discuss and review causes of deaths, missed opportunities, avoidable factors and recommendations to prevent and avoid future occurrence and each of them accounts on the spot,” said the MEC.
Some of the plans that are being implemented to mitigate maternal and infant mortality, which are major contributors to medical negligence cases, include the following: 
Emergency blood of a minimum of two units must be available at all hospitals conducting baby deliveries.
All obstetric and gynaecological (O&G) specialists should refrain from telephonic orders and must respond immediately when called to see a patient.
All obstetric and gynaecological specialists must undergo the Essential Steps on Management of Obstetric Emergencies (ESMOE) training to acquire more skills.
Junior doctors are monitored and coached when performing Caesarean Section and trained on Caesarean Section monograph.
High Risk patients are managed at an appropriate level of care.
There has also been considerable initiatives and programmes aimed at improving services at public health institutions, in order to reduce the number of medical negligence claims that include - among others - introducing quality improvement projects. These include dealing with identified problems immediately. For example, prior to anesthesia all patients must get a pre-op examination by an anesthetist and also have X-rays taken. The health department has also ensured that all health facilities have clinical guidelines which the nurses and doctors should adhere to as a preventative measure. Doctors and nurses are trained on adverse events management and the department ensures that there is competency testing and certification for doctors and nurses that is done before performing clinical procedures.
A policy on Health Adverse Incidents Management has been developed, which focuses on proactive management of patient safety by identifying causes and strategies for prevention. It also proposes redesigning organizational systems and behavioural choices based on learning through analysis of adverse incidents. This implies that when an adverse incident has occurred, the department will look for ways in which its healthcare system can be improved, and managerial and staff behavioural choices adapted, so that the likelihood of a recurrence of the same event is significantly reduced.
Clinical guidelines have since been distributed to all health facilities across the province and orientation of health professionals is continuing. These guidelines go to an extent of encouraging re-training where necessary.
“We are doing the best possible to attend to all factors contributing to medical negligence claims,” said MEC Masike.
“It is important to note that not all cases reported are concluded as cases of negligence. However, even if a case is concluded as a case of no negligence, the client may still be complaining that the service did not meet his/her expectations. Therefore a case may be a case of no negligence and at the same time be a case of poor quality service rendered, e.g. when the desired clinical outcome was not realized, or when the waiting time was far too long,” he said.