ceo

I am sincerely grateful for what I believe is the best response I have ever seen in an SAOA initiative since I joined the organization. I had conditioned my mind to accept about 100 responses as ideal and instead we received about 398 completed questionnaires and a further 482 questionnaires incomplete due to the last four or five questions not being completed for various reasons and with network failure accounting for most of these incomplete questionnaires. The next surveyconsists of two domains with the last domain only partially included. This is aimed at completed more domains per questionnaire which will help us to complete the survey quicker. We have also started developing some of the policies which the survey referred to such as infection control and first aid policy. These will be made available on the website as soon as the relevant subcommittees have sighted and approved the documents. Please continue participating in the next surveys to assist the association in its fefort to support quality improvement in the profession.

ombudsman

 

This month’s article focuses on rule 27 A insertedGN R68/2009 of the Health Professions Council of South Africa.

Rule 27 A. Main Responsibilities Of Health Practitioners

States that a practitioner shall at all times:

1.Act in the best interests of his or her patients

2.Respect patient confidentiality, privacy, choices and dignity

3.Maintain the highest standards of personal conduct and integrity

4.Provide adequate information about the patient’s diagnosis, treatment options and alternatives, costs associated with each such alternative and any other pertinent information to enable the patient to exercise a choice in terms of treatment and informed decision making pertaining to his or health and that of others

5.Keep his or her professional knowledge and skill up to date

6.Maintain proper and effective communication with his or her patients and other professionals

7.Except in an emergency, obtain informed consent from a patient or , in the event that the patient is unable to provide consent for treatment himself or herself from his or her next of kin

8 .Keep accurate patient records The past month complaints are mostly related with the above rules being violated by our registered optometrist.

1.A patient consulted with optometrist, after a month no one had contacted the patient. Patient called optometrist repeatedly, inquiring about the spectacles. The patient was given all kinds of excuses by the staff ranging from computer being stolen and all sorts.

Eventually the spectacles were ready for collection and the patient took delivery of the specs and wore them for two weeks but, experienced blur, headache, dizziness and painful red eyes . The patient was not the first time wearer of spectacles . The patient brought back the spectacles and notified the optometrist of the complaint and who then admitted to the incorrect refractive error but suggested an eye drop instead . The patient left the spectacles with the optometrist and requested remedy of the situation .

The patient brought the matter to my attention. I pleaded with the patient to go back to her optometrist for re-examination and she refused and cited unprofessional behavior by the optometrist during their conversation and telephone message exchanges. The patient requested that her claim be reversed less the eye examination. The optometrist is contesting . The matter was brought to the attention of the HPCSA by the patients daughter .

2. An optometrist listed a patient with the credit bureau who refused to take delivery of spectacles because they were not according to the specification as requested by the patient. Patient requested single vision and the optometrist ordered multi focal. After a heated verbal exchange the optometrist dismantled the spectacles and lenses were placed in an envelope for the patient to come and collect. The matter was referred to the credit regulator ombudsman .

In all of the above matters, the interest of the patient was not taken into consideration. Mobile practice complaints are reported almost every month and the wellness screening are on the increase .The HPCSA must really have the political will to act against these matters .

Nkosi Lucky

(SAOA Ombudsperson)

0715258733 or 0726171124

legal

 

 

The HPCSA – The Optometrist’s Exposure To HPCSA Complaints

As a member of the SAOA, you may sometimeswonder about the need to obtain and maintain medical malpractice insurance. It is true that we do not see many claims againstoptometrists for medical malpractice, i.e., injury toyour patient which the patient alleges was caused by your negligence. As a practicing optometrist, your main exposure is not a claim against you for medical malpractice. Your major exposure is that someone will lodge a complaint against you or your practice with theHPCSA. If we have a look at the HPCSA’s booklet titled, “How to lodge a complaint against a healthcare

practitioner”, which is available to the public on their website at , you will see that the public is advised that they have the right to, “complain about healthcare services that either violate your rights to good health or breach ethical standards, to have your complaint investigated and to receive a full response thereafter.” Further in HPCSA booklet, the HPCSA advises that the member of the public is entitled, and even

encouraged, to lodge a complaint with the HPCSA regarding the conduct of any HPCSA-registered

practitioner that involves any of the following:

1.Unauthorised advertising

2.Incompetence in treating patients

3.Over-servicing patients

4.Charging excessive fees

5.Criminal convictions

6.Insufficient care towards patients

7.Improper relationships

8.Racial discrimination

9.Improper conduct

10.Rude behaviour toward patients

11.Performing surgical procedures without the patient’s consent

http://www.hpcsa.co.za/conduct_complaint.php

12.Prescription of specific medicine to maintain the dependency of a patient

13.Disclosing information regarding the patient without his/her permission.

It has been our experience over the past 11 years that we have been handling HPCSA complaints against insured practitioners that even the most ethical of practitioners may at some stage end up with a complaint against them at the HPCSA. Receiving a complaint from the HPCSA can be incredibly stressful to the practitioner involved.

Our experience has shown the 9 out of 10 complaints against optometrists involve billing issues. It is essential that in the event that someone threatens to report you or you actually receive a complaint from the HPCSA that you notify us as soon as possible so that we can assist you with it. It is a condition of your insurance that you report any

incident or circumstance that could give rise to a claim or a complaint against you as soon as you become aware of it. Therefore you should not wait until you receive the actual complaint before notifying us as the insurers will reject that claim/complaint if it is determined that you knew about the incident giving rise to the complaint against you and did not notify it at the time youbecame aware of it.

 Assistance with HPCSA complaints is one of themany benefits that is provided by your SAOA membership if you have taken up the medical malpractice insurance offered through the Association.

Some of you may have investigated taking outmedical malpractice insurance individually rather than through your membership of the Association. It is very important where you look at obtaining cover anywhere else that you ensure that that cover you obtain will assist you with complaints involving billing which may be made against you to the HPCSA.

President’s Message

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Dear Colleagues

I’m traveling in the United States, where the news focuses on Oscar, horsemeat in lasagne and the ever-awful economy, in that order, which suggests that the economy can’t be that bad, after all. By the end of this trip, I shall have traveled through 6 American airports, but already the ubiquitous Apple is obvious. In 2010, Apple doubled its revenue with the iPad while the rest of the country floundered in a recession. Last year the iPhone 5 was launched and sales had doubled again. This year, a more pedestrian 25% increase is projected. No, I’m not a total convert, but who can help admiring such success? And what can we learn from a company that went huge just as the (financial) world came to an end? Three things: Three years ago, tablet computers did not exist. Today half of Americans own one. Security queues at airports certainly seem to confirm that they are ubiquitous! Optometry needs to create an offering that is universally appealing. If we could increase our reach to half of our population, we would each see more than double our current patients. Hemisphere, United Airlines’ inflight magazine, calls Apple the computer company that became a lifestyle arbiter. Likewise, optometry should be about your quality of life with (or without) eye-care. 84% of the tablet computer market is held by iPad. We must hold on to eye-care. Expanding our scope is fine, but we should not lose expertise in the fields of low vision, vision therapy and contact lenses. Already we see lay people encroaching on our scope in these areas, and perhaps we are to blame for not owning and preserving them. Only a third of iPad users own an iPhone as well, but a whopping 91% of them will buy an iPhone again the next time their contract comes up for renewal. An iPad costs about R5000, an iPhone nearly double that. Apple has made sure that they have something at every price point. Car companies do the same: Think A Class Mercedes for the young buyer, through to the ML and then the G class for the preposterously wealthy. BMW steps through from the 1 series to the 3, 5 and 7 series. Once a person buys a brand, they tend to stick with the brand, provided that they are satisfied, of course. We can gain patients from other practices, but ideally we should grow the group of people who access eye-care. Otherwise it’s like a pyramid scheme: A dead end. Our country’s average age is 14, so start with the children. We need to reach patients young and keep them satisfied. This month, ask every mother when her child/ children last had an eye exam. Most of them won’t even have thought of bringing their children in. Those children could be your patients for a loooooong time, certainly longer than the moms. Life expectancy for women in SA has dropped from 68 years when I qualified, to 55 years (in 2009.) Meanwhile, India’s life expectancy has increased from 55 in 1980 to 65 in 2010. An interesting story in Nature suggests that having sons has a negative impact on a woman’s life expectancy. There was certainly one little boy on my flight to Houston that was threatening not only his mother’s chances for a long and happy life but also that of the other passengers. By the time you read this, the SAOA’s KZN/ Gauteng Business course will have been completed and the Western Cape Business course around the corner. You can still register at http://www.saoa.co.za. Later in the year, our paediatric courses will prepare you for the children of those moms that you are going to be talking to this month. Regards,Nina

 

Business Tip-Inventory/Stock Management

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Business Tip

This month’s Business tip is on Inventory/Stock Management.

Inventory management is generally a balancing act between product availability/demand or customer service and the costs associated with that inventory. In other words a practice manager must ensure that certain products (consumables and/or stock items) are available at all times in order to fulfill a patient’s demand.

One of the most effective methods of managing inventory is the ABC-XYZ analysis. The ABC analysis is a method used on the principle that only a few products are responsible for the majority of the profits of the sales and the other products only contribute marginally. This analysis is used to distinguish those products that are responsible for the majority of the profits (80%) from those that are generating only minimal profits (20%). Products that are responsible for majority of the profits are regarded as important products or A items, followed by those that are in between which are regarded as B items then lastly the C items which are regarded as non-important items. The rationale behind this analysis is to know which inventory items to focus on and to know which items to prioritize in inventory and perhaps which items to consider discarding in the future. As such businesses are trying to avoid spending 80% of their resources on products that will only bring 20% of the income.

The classification normally is done in two dimensions whereby the value of the item and the amount brought in by that stock item is evaluated and then later the demand of that particular item. To illustrate this point consider the following example:

Suppose a practice sells branded frames Xo, Yo, and Zo. The brand Xo cost the practice R1000/ frame and can be sold for R3000/frame. The brand Yo cost the company R700/frame can be sold for R2000/frame and the brand Zo cost the company R500/frame and can be sold for R1000/frame.  In the first step of the ABC analysis the following conclusion will be made:

Item Ranking Product
A Xo
B Yo
C Zo

Brand Xo would rated important and brand Zo least important. However if we now assume that an average the demand for brand Xo is 10 frames per week, for brand Yo is 1 frames and demand for Zo is 5 frames per week the second dimension of the ABC would be to classify these brands according to their importance with regards to demand. As such the analysis would be as follows:

Item ranking A B C
Product Xo Zo Yo

Combining the classification we would have a classification that is as follows:

Item Ranking A B C
A Xo
B Yo
C Zo

Following this analysis it becomes evident that brand Xo is the cash cow in this practice followed by product Zo as it has shorter shelf life thus lower holding costs. Therefore this practice should spend 80% of its resources looking at brand Xo and Zo and only 20% of the resources should be allocated to product Yo. This allocation can be in terms of shelf space, position, promotions etc. This classification will also help the practice in knowing which brand to reorder next time in that brand Yo can be discarded because even though its potential income is slightly higher than that of brand Zo, its holding cost are higher as such it might cost the company in the future.

It is evident from the discussion above that the ABC analysis provides a good starting point to identify the cash cows from the inventory and use them to the best advantage of the business.

For more on this tip or other tips, send a comment on our blog or forum and send me an email on maemo@saoa.co.za

Till next month.

Maemo

omburdsman

The office has received and dealt with numerous complaints, queries and some clarity seeking questions on the scope and practice of the optometric and dispensing profession.

Key amongst the complaints are listed here-under

  1. Mobile complaints
  2. Advertising misleading
  3. Practice Ownership
  4. Consumer Act  ( understanding consumer rights )
  5. Unprofessional conduct

Mobile Practice

Complaint: An optometrist that is conducting an unapproved mobile, travelling and visiting areas were optometric services are readily available and that optometrist’s practice is not in the area

The company employee touts and canvasses on the optometrist behalf by inviting employees and setting up appointments. Acting on the complaint the optometrist sighted ignorance of the requirements to conduct a mobile practice.

The complaint was referred t o the HPCSA legal department for sanctioning .

This is the norm amongst all mobile operators they claim ignorance of the Ethical rules of conduct set by the PBODO (HPCSA) on conducting mobile practice.

Wellness days become a fertile ground for unregistered mobiles to take advantage of the ignorance of human resource managers on the requirements of screening participation by Optometrist.I would like the PBODO (HPCSA) to publish the list of all approved mobiles and the areas of operations and be able to monitor them.

Rural areas are not well serviced by Mobile practices and with the roll out of NHI in 2014 we need such mode of optometric services. We need to reduce in equalities in our optometric health services.

Here below are the extracts of ANNEXURE 8 Rules of conduct pertaining the Optometric Profession and Dispensing Optician (HEALTH PROFESSIONS COUNCIL OF SOUTH AFRICA) PBODO

An optometrist may conduct vision screening at an industrial corporate, community or school center provided that

(a) The screening is conducted as an entry investigative procedure to identify individuals in need of referral for a comprehensive eye examination

(b) No definitive diagnosis is made, management is prescribed or prescription is given at the screening center.

(c) The outcome of the screening process including referral notes for the individuals identified as requiring further eye examination and statistical reports for the center concerned are recorded

(d)  No canvassing of or touting for a patient is done by or on behalf of the screening practitioner

(e) Patients are not mislead into believing that the screening is compulsory

Provisions of conducting mobile

(a) An optometrist may conduct a mobile practice in areas whose optometric services are not readily available with a provision that

(b)The practice operates in a defined area only

(c) The equipment used for a comprehensive visual examination in that practice is as defined in the guide lines issued by the board from time to time

(d)  Prior written approved to conduct such mobile practice is obtained from the board

(e)  Optical appliances dispensing is conducted by the practitioner at the site visited

(f) The practitioner operating the practice also has an established practice from which the mobile practice is operated from

(6)Patients are informed of the contact details of the established practice and of the nearest health facility with which the practitioner has made arrangements for emergency ocular health care.

ADVERTISING

Complaint: Optometrist put up an advert calling members of the public to purchase an eye examination and they will get a T-shirt, designer belt, watch and a bag.

The office of the Ombudsperson managed to point out this unethical advertising and the optometrist removed all those non optometric merchandise from the window display.

Some TV adverts violates the ethical rules of conduct and has been referred to the Legal department of the HPCSA for consideration.

PRACTICE OWNERSHIP

A query was raised by a member on the corporate entity owning an optometric practice of which is not registered with the HPCSA.

Employment of optometrist by unregistered persons – Refer to the HPCSA-committee on undesirable business practice for clarification.

CONSUMER ACT

Optometrist should be familiar with the fundamental consumer rights to avoid litigations:

1 Right to fair value, good quality and safety

2. Right to fair just and reasonable terms and conditions

3. Right to fair and honest dealing

4. Right to fair and responsible marketing

5. Right to disclosure

6. Right to choose

7. Right to Privacy

8 Right of Equality

UNPROFESSIONAL CONDUCT –RELATIONSHIP WITH COLLEAGUES

Complaint: Optometrist refused to release a patient prescription to another colleague .The legal department forwarded to the HPCSA Ombudsman for consideration.

Optometrists are urged to foster good relations amongst colleagues for the benefit and interest of patients.

All for the promotion of ethical practice of the Optometric profession

Nkosi Lucky Ombudsperson

0715258733,0726171124

The Issue Of Quality In Optometric Practice

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The issue of quality in optometric practice may be central to the reluctance of legislative authorities and the medical profession to embrace changes in the profession of optometry. The responsibility to assure our stakeholders falls squarely on our door and represents the single biggest challenge we have faced in decades. To this end, the SAOA is preparing survey questionnaires which are to be circulated to members for a response from the end of March.

These questionnaires will deal with different components or factors that are generally accepted to have an impact on the quality of services provided. It is difficult to measure quality of services in any setting because quality is a multi-factorial concept. A patient’s perception of quality could be determined by one of several factors such as the following:
(1) the setting within which the service is offered,
(2) the conduct of frontline staff and the clinical staff,
(3) the type of equipment used in the consultation,
(4) the post consultation information provided and its comprehensiveness,
(5) the accuracy of the diagnosis and the outcomes linked to the clinical management choices,
(6) the efficiency of the administration in dealing with claims and payment related matters and lastly
(7) the confidence of the patient in the facility to cater for any perceived complications or adverse situation should those arise.
It is factors related to the above which the survey will address. I plead with you to take a little bit of your time to respond to the questionnaires. The more responses we get the more comprehensive the outcome will be. We will publish the results online and the process will culminate in an adoptive conference of the norms and standards that we would have supported through this process. Your involvement with this process will help us to change the face of the profession forever. Please do your part.