Accreditation: The Same Worldwide

     I have mentioned in the past that my hospital, University Teaching Hospital of Butare (CHUB) is going through the accreditation process. I love it (in direct contrast with how I felt about it stateside). Basically, accreditation has allowed me to make changes, while removing the blame and fault from myself. It's fantastic, plus it has really forced the hospital staff to take responsibility for the changes. I help, but I by no means lecture them every day on each and every little tiny thing. They have to make and enforce the changes themselves because I won't be here forever.
    Many of the hospitals here in Rwanda are making this leap with The Council for Health Service Accreditation of Southern Africa, also known as, COHSASA. In the United States hospitals are accredited through the Joint Commission (JC). Now as my healthcare friends know, there are many, many, MANY rules and regulations that the JC have, that during the normal year may or may not be strictly followed. Rules such as no material can be X inches from the ceiling, the width of your hallway has to be such and such, all sorts of documentation requirements, and so on. I had the great pleasure of being interrogated by a JC surveyor one year I was employed at GW. Of course it happened to be during the phasing out of physicians writing notes in the charts, but not all of course. It was lots of fun finding all the documentation (and reading out loud some very illegible handwriting) requested.
     Anyhoo... starting Monday COHSASA will be conducting a survey of CHUB. Let me tell you a secret: accreditation is the same worldwide. There is a vibe of absolute hysteria and panic racing through the hospital. I ALMOST feel at home. But the changes that have happened the past two weeks have been really inspirational. All of a sudden last week squirt bottles of alcohol for hand hygiene appeared at every ICU bedside.

  

Then the emergency trolley (aka code cart) checklist was actually being used and a hand washing station appeared outside of the ICU for visitors (we still have no running water).

  Yesterday I walked into this:

Cécile and the "mess"

Which looks pretty disastrous, but the end result was this:

 August 2014                          December 2014

I didn't say anything about the reorganization nor about checking every medication and material for an expiration date, which is what my In-Charge Cécile took upon herself to do yesterday. She has really stepped up and I am so immensely proud of her developing leadership skills. Meanwhile, I hung the newly revised assessment guides that Jessie and I had worked on together. It's amazing how excited I get over color printing and lamination. Maybe I missed my calling as a teacher.

      Meanwhile, we (the nurse educators) have been working with the Rwandan staff to certify 120 staff members in BLS. First, the other educators (I was still in Italy) put 12 staff members through an instructor training course. Then we essentially let them loose. It is amazing what they have done. While the powerpoint slides were provided by us, they have done all of the lectures, skills practice sessions, and only used us for the exam portion of the day and basically just for the sake of time. While we failed miserably at 120 people, we did certify 51 people in the last few weeks prior to the survey.

Newly appointed BLS instructor Emmanuel teaching

     Next week should be interesting. In 2012 when CHUB started the accreditation process the hospital scored a 40%. ICU scored 43%. Both of these scores are considered (marginally) partially compliant. I am so interested to see how they have hopefully improved over the last two years. Wish us luck!

Lessons Learned:
1) Sometimes people will surprise you with their courage and leadership.
2) Sometimes you will be surprised at how similar things are in completely different cultural settings.