Environmental and Social Assessment and Management Systems:
In 2017, Nyaho undertook a SafeCare Assessment (a quality improvement methodology and standards accredited by the International Society for Quality in Healthcare) of its facilities and operations and attained Level 4. In the accreditation journey, such Level 4 means that the facility has strong quality systems and is regularly monitoring the implementation of treatment guidelines and standard operating procedures through internal record reviews and clinical audits.
The SafeCare Assessment was done as a baseline external evaluation, in preparation for the Joint Commission International (JCI) https://www.jointcommissioninternational.org/en/ surveys that are on-going and seeking accreditation to JCI standards for ambulatory care (recognized as a global leader for healthcare, quality of care and patient safety). In addition, the company undertakes annual environmental assessment or audit of its facilities and maintains current environmental licenses.
Policy
Nyaho has an Occupational Health and Safety (OHS) Policy and manual that guides health, safety, E&S performance of its operations. The policy covers all inherent risk areas such as infection prevention and control in the context of health workers safety; management of occupational exposures to HIV and recommendations for post-exposure prophylaxis; safety for health workers in laboratories and radiology; healthcare waste management; electrical safety for health workers; use of chemicals in a hospital and fire safety. The policy covers all workers and staff are trained on the policy and related operational procedures. Nyaho will continue with sensitization activities on the policy for the newly recruited workers. In seeking compliance with JCI standards, the company is developing additional policies such as Care of Patient Policy, Policy on Point of care testing and Patient Identification Policy among others.
Identification of Risks and Impacts
The company has developed a corporate risk management policy that is under review by the Board of Directors. Nyaho undertakes risk based internal audit reviews of all its operations and submits the reports to the Board’s Finance, Audit and Risk Committee. External strategic risk assessments of Nyaho operations have been done by reputable international audit firms over the past two years. The company has conducted an operations risk assessment of the main hospital and the Octagon outpatient facility, and developed risk registers whose implementation is overseen by the various departmental directors. The risk assessment is guided by the business objectives and priorities. Identified risks are documented and addressed on site, while major risks are escalated for management interventions, especially where additional resources are needed to address those.
Management Programs
Nyaho’s risk management program includes; the development and implementation of risk registers, development and implementation of annual Quality Improvement Plans (QIPs), and on-going risk management training and monitoring. In addition, the company has developed and implements: an infection prevention and control program; occupational health and safety (OHS) program, healthcare waste management program, handwashing and sanitizing program and a fire safety program.
For the satellite facilities, the company has developed a Satellite Clinic Blueprint manual to guide the project teams in planning, design, execution, construction management and operations in a consistent standardized manner. The company’s strategy is to lease or rent spaces from commercial buildings to establish the satellite clinics as opposed to greenfield or own real estate projects. According to ESAP 1, the Satellite Clinics Blueprint manual will be updated to include environmental and safety risks and issues to be considered throughout the project cycle. This will include E&S criteria for site selection; E&S checklists for procurement of materials and construction; checklists for life and fire safety for the satellite facilities especially the urgent care centers and E&S checklists for operation phase of the clinics including waste management.
Organizational Capacity and Competency
Nyaho is in the process of recruiting a Quality Director who will be responsible for overseeing the implementation of the Quality Management System (QMS), including coordinating quality audits and implementation of Quality Improvement Plans (QIPs). In addition, a patient safety committee is in place, which is responsible for the mitigation of risks in the clinical areas. As per ESAP 2, Nyaho will designate a quality, health, safety and environment (QHSE) officer to co-ordinate the day to day implementation of the quality, health, safety and environment related matters with the main hospital and satellite clinics’ operations officers and report to the Quality Director. The designated officer will need training on EHS.
The Human Resource (HR) department develops and implements a training plan annually for all its employees. In addition, Nyaho has partnered with Ubora Quality Institute to develop, implement and institutionalize their own Quality Improvement initiatives through a Quality Management Mentors Professional Development Programme (QMMPDP). So far, 25 staff have undergone training in quality improvement. Training topics for staff in various departments include infection prevention and control, needle stick injuries, basic life support, health and safety, ergonomics, healthcare waste management, fire safety, quality improvement among other on the job trainings and refresher courses.
Emergency Preparedness and Response
The OHS Policy manual outlines general information on chemical safety, electrical safety and fire prevention measures. The main hospital and the Octagon satellite facility has some emergency fire suppression equipment and signage posted strategically around the facilities. Fire alarms have been provided at the main hospital’s new mother and child unit. The emergency assembly point is located and marked near the hospital exit. According to ESAP 3, the company will conduct a Life and Fire Safety Audit of the main hospital and develop a documented site-specific Emergency Response and Evacuation Procedures for the hospital and satellite clinics considering all possible emergencies that may occur at each site. The emergency procedures will include site-specific decision-making procedures, communication plan to staff and patients, evacuation procedures and provisions for care for inpatients (including back-up facilities, medication, transport etc.) to ensure safe continuity of care, training plans for staff, frequency of emergency drills, locations of fire equipment, inspection and maintenance procedures and records of the emergency equipment at each site.
Monitoring and Review
Nyaho monitors, reviews and tracks the implementation of issues raised in the risk registers and departmental key performance indicators (KPIs) through the Balanced Scorecard System®. The KPIs and risks identified in each department is reviewed and tracked by senior management on a quarterly basis. Internal monitoring and annual audits are done by the incident committees at each department. External monitoring is done by external firms who monitor the implementation of the improvement plans. According to ESAP 4, Nyaho will update the monitoring procedure for KPIs to include monitoring of energy usage, water usage, waste disposal, staff injuries and hazardous materials stored at each facility.
