Do Accredited Hospitals Deliver Better Quality Care?

“Accreditation cannot be made mandatory and it should happen through voluntary compliance to make it more acceptable and sustainable,” says U K Ananthapadmanabhan, President (Operations & Projects), Kauvery Hospitals Group, Trichy and Member, CII National Healthcare Committee

Indian healthcare industry has done considerably well after independence despite several inadequacies. Maternal and infant mortality rates have gone down and average life expectancy has gone up from 40 to 65 years. Waiting time and cost for even complicated heart surgeries and neurosurgeries is much less than in United States of America or many western countries. On the demand side, 75  percent of outpatient care and 60 percent of inpatient care are availed in the private sector.

Both these observations point to the presence of a thriving private sector in the state as well as the increasing preference of the public towards private providers. Hence there is a need for the private sector to perform well and provide quality and affordable services to achieve universal healthcare. Our healthcare system has come of age and it is time that we start critically evaluating the quality of care provided in the private hospitals and government hospitals.

Does accreditation ensure quality healthcare? It does. Accreditation by definition is a self-assessment and external peer assessment process used by healthcare organisations to accurately assess their level of performance in relation to established standards.” In developed countries the clinical outcomes did not significantly improve because of accreditation indicating that accreditation is ‘a’ means and not the ‘only’ means for quality improvement (QI). In America a recent survey showed that 70 percent of the people felt that accreditation improves the quality  of care in hospitals. Thus accreditation is a wonderful tool in the overall armoury required to ensure patient safety and quality care. It is not the only tool required to attain excellence in quality. It is unfair to compare the Indian healthcare scenario to theAmerican healthcare system which is a very well organised and self-regulated system. Therefore  accreditation cannot be made mandatory and it should happen through voluntary compliance to make it more acceptable and sustainable.

National Accreditation Board for Hospital & Healthcare Providers, under Quality Council of India (NABH), which comes with 102 standards in 10 chapters, is the only set of guidelines. These standards have not been deliberately made prescriptive to provide enough opportunities for the healthcare organisations to excel in their quality standards, comply with the laws of the land and meet standards provided by professional bodies in clinical and non-clinical areas. Sharing of knowledge and expertise among the healthcare organisations which have been accredited and which are awaiting accreditation is acceptable practice in all developed countries, but hospitals should follow all ethical principles and norms and should not resort to‘cut and paste culture’particularly while developing standard operating procedures which will  curb the innovative sprit in the Indian health care system.

Hospitals seeking accreditation should adhere to the NABH standards in letter and spirit and use them for bench marking their performance and misusing certificate of accreditation just as a marketing edge. NABH on it part, has been constantly reviewing the standards and in November 2011 has released latest and the 3rd Edition. This standard has been recognised by International Society  for Quality in Healthcare (ISQua). All the ten chapters in the standard reflect two major aspects of healthcare  delivery i.e. patient centered functions and healthcare organisation centred functions.

Senior hospital administrators participating in the TN Health Summit 2012 held on 14th July on the theme ‘New Frontiers in Healthcare: Opportunities and Challenges’ at Chennai ,organised by CII –Tamil Nadu Healthcare panel felt that in practice hospital accreditation in India has definitely contributed to the  improvement of quality of care in the hospitals, especially in the Indian healthcare sector. The process of accreditation is as relevant and appropriate for healthcare institutions in India as in the hotel industry and higher education. However, the existing hospitals which are attempting for accreditation are finding it quite difficult because the NABH requirements require some structural and cultural changes which needs total top management commitment, financial resources and complete involvement of all the members in the organisation from housekeeping boy to the top medical consultant.

Many existing hospitals which require considerable amount of funding to effect changes in the system are obviously not attempting to seek accreditation. It is heartening to note that all new hospitals and in hospital expansion projects, hospital authorities seem to be working for accreditation at the planning and  design stage itself. In the new hospital projects, architects are developing their plans based on the SOPs given by the clients at the design stage itself. The process of accreditation seems to have got its required momentum, thanks to the constant awareness campaigns organised by the NABH and emerging trend of large corporate organisations, MNCs and insurance companies looking for NABH accredited hospitals for corporate tie ups and insurance payments. There is general agreement that in course of time market forces will drive the accreditation process.

Focus on patient safety and patient rights
During the last five years accreditation process focused on various aspects of patient safety and patient rights which the patients rightly deserve. Medical errors and negligence reporting, incident and sentinel event reporting and action taken reports, medical audits seem to have greatly improved leading to better quality care in accredited hospitals. Qualified and trained NABH auditors, during their pre and final audit do a meticulous and a fair evaluation which has won the appreciation of the hospital management  professionals around the country.

Hospitals working towards NABH accreditation perceive that the inspection by NABH authorities is a learning and course correction exercise to improve quality of care instead of doubting it as fault finding mission. According to NABH sources there are 138 hospitals accredited for a three-year cycle and there are 478 hospitals waiting in the wings at different stages for approval. This is a clear sign that accreditation of hospitals is catching up faster than expected.

Accreditation may not be a panacea for all ills in the Indian healthcare industry but as stated by Wendy Nicklin, President and CEO, Accreditation Canada ‘Accreditation is a risk mitigation strategy, a performance measurement tool, a management tool for diagnosing  strengths and areas for improvement and provides key stakeholders with an unbiased third-party review.’



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