After reflecting on this event, I've realized that therapy is just one part of receiving quality healthcare. It's really about feeling informed, acknowledged, and valued throughout the entire process. I felt overlooked and frustrated after waiting over an hour for a scheduled appointment, having my consultation rushed without explanation, and leaving without clear instructions on my prescription. This experience highlighted the importance of viewing healthcare through a systems-thinking lens. Even small actions, like greeting a patient warmly or taking a few extra minutes to explain a diagnosis, can make a significant difference. As someone eager to contribute to change, this has shown me the type of care we should strive for and where we need to improve.

Reflecting on the resources and challenges in enhancing the quality of South Africa's healthcare system, I've come to appreciate how interconnected the various components of a health system are. This session taught me that a single issue, like a shortage of staff or poor data systems, often represents a larger, systemic problem. It helped me adopt a more holistic or "systems thinking" approach, allowing me to see how leadership, infrastructure, human resources, financial investment, and community engagement all work together to either enhance or undermine care quality. What struck me most was that quality improvement is about understanding the bigger picture and developing integrated, sustainable solutions that can truly effect change, rather than just addressing one issue at a time. This reflection has reinforced my belief that leadership and policy are essential tools for achieving better outcomes, especially in a complex and unequal environment like South Africa.

From this workshop, I've learned that a Quality Improvement (QI) policy serves as a crucial roadmap for guiding healthcare systems toward better service delivery. I now understand that a strong QI strategy outlines clear goals, roles, and accountability measures to ensure that healthcare is not only safe and effective but also fair and accessible an essential factor in South Africa. Learning about initiatives like the National Health Insurance (NHI) QI policy has shown me how quality improvement can be used to bridge service gaps, particularly in vulnerable and marginalized communities. This session has deepened my understanding of how policy and practice must align to ensure that everyone, regardless of their location or financial situation, receives high-quality care.

Before attending this workshop and participating in the annotating exercise, I viewed quality improvement policy mainly as an administrative or technical guideline important, but not entirely connected to everyday healthcare challenges. However, after reviewing and annotating the policy, I recognized how crucial these documents are in shaping the actual functioning of the health system and its core values. Through this exercise, I identified key elements that remain relevant, such as the emphasis on patient-centered care and equitable access, but I also noticed significant gaps, particularly in the policy's responsiveness to contemporary issues like non-communicable diseases, digital health integration, and the evolving needs of the health workforce. This process taught me the importance of policies being adaptable and dynamic. It also helped me develop a more critical viewpoint, realizing that policies are tools that require ongoing evaluation and adjustment to foster meaningful and lasting improvements in healthcare quality. Overall, I now see policy not as a static document but as a dynamic framework that must evolve to meet the needs of the system it aims to serve.

One of the most valuable skills I gained from this exercise was applying the Lean Healthcare framework to a real-world healthcare issue. This approach allowed me to look beyond surface-level problems and identify "waste" and inefficiencies through a systematic, data-driven lens. Learning to use process mapping enabled me to visualize patient flow and pinpoint bottlenecks, a skill I believe is vital for anyone aspiring to work in healthcare administration or policy. While there were challenges in working as a group, there were also significant lessons to be learned. One of the main difficulties was coordinating everyone's contributions and reaching a consensus, especially when we had differing goals and interpretations of the data. Ironically, communication sometimes became a bottleneck itself, reflecting one of the very issues we identified in the referral process. However, this experience taught me the importance of diverse perspectives, active listening, and teamwork when tackling complex problems. Each group member brought unique strengths whether technical knowledge, policy expertise, or empathy for patient experiences that greatly enriched our final outcome.

Initially, I viewed public health primarily through a lens of deficiency focusing on what is lacking or not functioning. However, I've come to see it as a realm full of potential, where even small changes in procedure or perspective can lead to significant impacts. This shift made me realize how easy it is to concentrate solely on what isn't working while overlooking the small victories that deserve recognition. These stories of success, resilience, and creativity are equally important, and acknowledging them is just as crucial as identifying problems. My perspective has evolved from being problem-focused to being solution- and people-oriented, which I believe will influence my approach to healthcare in the future.

After watching Chimamanda Adichie's powerful TED Talk, "The Danger of the Single Story," I found myself reflecting on how I perceive and discuss the South African health system. In my earlier analysis of the referral system, I focused on issues like long wait times, poor handovers, inadequate transport, and staff shortages. While these problems are indeed pressing and valid, I now recognize that my perspective was shaped by a dominant narrative the one portraying the public health sector as a failure. Adichie's talk reminded me that, despite the challenges, they do not represent the entire picture. By concentrating solely on what is broken, I inadvertently reinforced negative stereotypes often associated with health in Africa: tales of inefficiency, suffering, and loss. I overlooked the stories of resilience, innovation, and compassion that also exist within the same system. I failed to acknowledge the dedicated healthcare workers who tirelessly strive to save lives and provide quality care, often with limited resources. I've learned that to truly understand the complexities of our healthcare system, we must listen to a variety of stories not just the loudest or most distressing ones. As aspiring healthcare leaders or advocates, it is our responsibility to highlight the voices and successes that often go unnoticed, alongside the issues that need addressing. Ultimately, it is this well-rounded narrative that fosters empathy, drives meaningful change, and deepens our understanding of the realities of our healthcare system.

I've experienced a slight shift in perspective that has challenged my traditional approach to problem-solving in healthcare. Previously, I believed that significant change could only come from identifying flaws and fixing them. My understanding of systems was more linear: problem then solution then outcome. However, incorporating the concepts of Systems Redesign and Appreciative Inquiry has greatly broadened my viewpoint. I was particularly impressed by how Appreciative Inquiry reframes the conversation. Instead of seeking out failures, it encourages us to focus on what is working well and use that as a foundation for change. I now view healthcare systems as dynamic ecosystems that nurture what is already thriving rather than as rigid structures. Since resilience and creativity stem from strengths rather than just repairs, I plan to apply this perspective to any quality improvement initiatives I undertake in the future.

As I’ve reflected on Standard Operating Procedures (SOPs), I’ve recognized their critical role in maintaining efficiency, safety, and quality in healthcare. SOPs serve as safeguards that ensure everyone is aligned, especially in high-pressure environments where even minor mistakes can have serious consequences (WHO, 2021). They are more than just checklists. A real-life incident from Tamil Nadu, India, in 2018 highlighted this for me. Although I didn’t experience it firsthand, it resonated with me regarding the importance of SOPs. A pregnant woman received an HIV-positive blood transfusion because the SOPs for blood screening were not followed. The blood was incorrectly labeled as safe, and the donor was unaware of their HIV status. This lapse led to the woman contracting HIV, a situation that could have been entirely avoided had the proper procedures been adhered to (DT Next, 2018). This incident taught me how catastrophic it can be to overlook SOPs. It made me consider how quickly a single mistake can lead to preventable harm in complex systems like healthcare. I now understand that SOPs not only promote efficiency but also foster a culture of safety, consistency, and trust. I will carry this insight with me as I progress in my healthcare career, recognizing that adhering to protocols is fundamentally about advocating for patients rather than merely following bureaucratic rules.