âAccreditation cannot be made mandatory and itÂ should happen through voluntary compliance to makeÂ it more acceptable and sustainable,â saysÂ U K Ananthapadmanabhan, President (OperationsÂ & Projects), Kauvery Hospitals Group, Trichy andÂ Member, CII National Healthcare Committee
Indian healthcare industry has done considerably well afterÂ independence despite several inadequacies. Maternal andÂ infant mortality rates have gone down and average life expectancyÂ has gone up from 40 to 65 years. Waiting time andÂ cost for even complicated heart surgeries and neurosurgeriesÂ is much less than in United States of America or many westernÂ countries. On the demand side, 75 Â percent of outpatientÂ care and 60 percent of inpatient care are availed in the privateÂ sector.
Both these observations point to the presence of a thriving privateÂ sector in the state as well as the increasing preference of theÂ public towards private providers. Hence there is a need for theÂ private sector to perform well and provide quality and affordableÂ services to achieve universal healthcare. Our healthcare systemÂ has come of age and it is time that we start critically evaluatingÂ the quality of care provided in the private hospitals and governmentÂ hospitals.
Does accreditation ensure quality healthcare? It does. AccreditationÂ by definition is a self-assessment and external peerÂ assessment process used by healthcare organisations to accuratelyÂ assess their level of performance in relation to establishedÂ standards.â In developed countries the clinical outcomes did notÂ significantly improve because of accreditation indicating thatÂ accreditation is âaâ means and not the âonlyâ means for qualityÂ improvement (QI). In America a recent survey showed that 70Â percent of the people felt that accreditation improves the quality Â of care in hospitals. Thus accreditation is a wonderful tool inÂ the overall armoury required to ensure patient safety and qualityÂ care. It is not the only tool required to attain excellence in quality.Â It is unfair to compare the Indian healthcare scenario to theAmerican healthcare system which is a very well organised andÂ self-regulated system. Therefore Â accreditation cannot be madeÂ mandatory and it should happen through voluntary complianceÂ to make it more acceptable and sustainable.
National Accreditation Board for Hospital & Healthcare Providers,Â under Quality Council of India (NABH), which comesÂ with 102 standards in 10 chapters, is the only set of guidelines.Â These standards have not been deliberately made prescriptiveÂ to provide enough opportunities for the healthcareÂ organisations to excel in their quality standards, comply withÂ the laws of the land and meet standards provided by professionalÂ bodies in clinical and non-clinical areas. SharingÂ of knowledge and expertise among the healthcare organisationsÂ which have been accredited and which are awaiting accreditationÂ is acceptable practice in all developed countries,Â but hospitals should follow all ethical principles and normsÂ and should not resort toâcut and paste cultureâparticularlyÂ while developing standard operating procedures which will Â curb the innovative sprit in the Indian health care system.
Hospitals seeking accreditation should adhere to the NABHÂ standards in letter and spirit and use them for bench markingÂ their performance and misusing certificate of accreditation justÂ as a marketing edge. NABH on it part, has been constantlyÂ reviewing the standards and in November 2011 has releasedÂ latest and the 3rd Edition. This standard has been recognisedÂ by International Society Â for Quality in Healthcare (ISQua). All theÂ ten chapters in the standard reflect two major aspects of healthcare Â delivery i.e. patient centered functions and healthcare organisationÂ centred functions.
Senior hospital administrators participating in the TN HealthÂ Summit 2012 held on 14th July on the theme âNew Frontiers inÂ Healthcare: Opportunities and Challengesâ at Chennai ,organisedÂ by CII âTamil Nadu Healthcare panel felt that in practiceÂ hospital accreditation in India has definitely contributed to the Â improvement of quality of care in the hospitals, especially inÂ the Indian healthcare sector. The process of accreditation is asÂ relevant and appropriate for healthcare institutions in India asÂ in the hotel industry and higher education. However, the existingÂ hospitals which are attempting for accreditation are findingÂ it quite difficult because the NABH requirements require someÂ structural and cultural changes which needs total top managementÂ commitment, financial resources and complete involvementÂ of all the members in the organisation from housekeepingÂ boy to the top medical consultant.
Many existing hospitals which require considerable amountÂ of funding to effect changes in the system are obviously not attemptingÂ to seek accreditation. It is heartening to note that allÂ new hospitals and in hospital expansion projects, hospital authoritiesÂ seem to be working for accreditation at the planning and Â design stage itself. In the new hospital projects, architects areÂ developing their plans based on the SOPs given by the clientsÂ at the design stage itself. The process of accreditation seems toÂ have got its required momentum, thanks to the constant awarenessÂ campaigns organised by the NABH and emerging trend ofÂ large corporate organisations, MNCs and insurance companiesÂ looking for NABH accredited hospitals for corporate tie ups andÂ insurance payments. There is general agreement that in courseÂ of time market forces will drive the accreditation process.
Focus on patient safety and patient rights
During the last five years accreditation process focused onÂ various aspects of patient safety and patient rights whichÂ the patients rightly deserve. Medical errors and negligenceÂ reporting, incident and sentinel event reporting and actionÂ taken reports, medical audits seem to have greatly improvedÂ leading to better quality care in accredited hospitals. QualifiedÂ and trained NABH auditors, during their pre and finalÂ audit do a meticulous and a fair evaluation which has wonÂ the appreciation of the hospital management Â professionalsÂ around the country.
Hospitals working towards NABH accreditation perceive thatÂ the inspection by NABH authorities is a learning and course correctionÂ exercise to improve quality of care instead of doubting itÂ as fault finding mission. According to NABH sources there areÂ 138 hospitals accredited for a three-year cycle and there areÂ 478 hospitals waiting in the wings at different stages for approval.Â This is a clear sign that accreditation of hospitals is catchingÂ up faster than expected.
Accreditation may not be a panacea for all ills in the IndianÂ healthcare industry but as stated by Wendy Nicklin, President and CEO, Accreditation Canada âAccreditation is aÂ risk mitigation strategy, a performance measurement tool, aÂ management tool for diagnosing Â strengths and areas for improvementÂ and provides key stakeholders with an unbiasedÂ third-party review.â