Image: Butterfly Palliative Home: Patience, Sr Nelly, Dina, Warren Oxford-Huggett, and Tarryn Bell with patients Hope and Lulu When CHoiCe Trust received a five-star rating from the Association of Palliative Care Centres (APCC), it became the first member organisation in Limpopo to reach that level. Director Nikki Stuart-Thompson is pleased with the recognition, but she credits the people around her for getting there. The team reviewed policies together and made sure the procedures they wrote would help them in their daily work. “It is just not possible to get to where we are now without all members of our team pulling together,” she says. The work has not stopped with the award. CHoiCe Trust is already identifying areas it can strengthen. A picture across South Africa The APCC uses its Standards for Palliative Healthcare Services to guide quality improvement among members across South Africa. Developed with the Council for Health Service Accreditation of Southern Africa (COHSASA), the fifth edition addresses both patient care and the organisational systems that support it. The Standards are freely available, giving palliative care services a practical framework to review their work and identify areas for improvement. APCC’s wider quality framework also looks at the care delivered and the experiences of patients and families. The fifth edition’s accredited status was celebrated at the 41st International ISQua Conference in São Paulo. The recognition brought work by the APCC, COHSASA and South African palliative care services before an international audience focused on healthcare quality. The APCC’s latest accreditation figures show 16 members at one star, 10 at two stars, 16 at three stars and 18 at four stars. CHoiCe Trust and South Coast Hospice hold five-star APCC ratings. Seven members, including Overstrand Hospice, have achieved external COHSASA accreditation. The APCC star ratings and COHSASA accreditation are separate stages; each organisation works from its own starting point. Recent milestones include Zazen Respite Care in Gauteng and Hospice Bloemfontein, both of which have moved to three stars. Helderberg Society for the Aged in the Western Cape has also moved from one to three stars. From the Standards to daily care At Helderberg Society for the Aged, the self-assessment initially felt daunting. Staff divided it into smaller tasks, gathered evidence across departments and looked closely at what was already working. The exercise gave them a way to plan improvements while continuing to care for residents. Nelspruit Hospice had spent considerable time updating policies before its August visit. The assessors discussed strengths and areas for improvement, then held a session with staff on patient care plans. CEO Landi Bezuidenhout says the team came away encouraged to keep learning. She had already seen the policy work take hold: “This work is no longer a once-off project. It has become part of daily practice.” At Overstrand Hospice, preparation for the external COHSASA survey led staff to standardise documentation, medication safety practices and adverse-event reporting. Patient Care Manager Sister Esme Potgieter says colleagues in clinical and non-clinical roles became more accountable to one another. General Manager Fran Tong credits the preparation provided by APCC surveyors for helping the team approach the external assessment.   After a review, members can turn to mentors for help interpreting the Standards and working through the findings, and a development plan sets out where to focus next. To extend this support, the APCC began training apprentice surveyors in 2025, drawing on experienced people within the palliative care sector. An assessment can show where an organisation needs to improve. Making those changes while continuing to care for patients takes time and support, and some teams need guidance before they reach the assessment stage. In KwaZulu-Natal, a separate, grant-funded programme is helping ten APCC members work through that preparation together. Dedicated support in KwaZulu-Natal The KwaZulu-Natal Accreditation Support Programme began with workshops in Estcourt and Verulam in July. Participants worked through the Standards together before mentors began visiting individual organisations to help teams apply what they had learned to their own policies and self-assessments. At Midlands Hospice on 27 August, APCC Accreditation Manager Warren Oxford-Huggett and Karin Warman, a mentor from South Coast Hospice, met General Manager Chantal Hathorn and Case Manager Nola Poole. They reviewed sample policies and worked through questions that had emerged since the workshop. Warren called the discussions “intense but illuminating”. Mentors have since visited Zululand Hospice, Butterfly Palliative Home, Blessed Gérard Hospice, Estcourt Hospice and Ladysmith Hospice. The ten organisations are preparing updated self-assessments for the end of November. Peer review is planned for December and January, with outcomes expected at the end of January 2027. Once the KwaZulu-Natal programme has been evaluated, the APCC plans to offer the workshop virtually to members in other provinces.