Quality in service establishments has to be ensured more by emphasis on ‘processes’ rather than on the final ‘output’. This is all the more true of hospitals since medicine is not only a science but also an art, writes Dr Swati Pawar, Deputy Medical Superintendent, Mahatma Gandhi Medical College & Research Institute, Puducherry.
Though relevant in every sector, quality is vitally important in the field of hospital management for it determines what, when and how much will be the sum effort of care. Unlike the manufacturing industry where output is easily definable, the input-output relationship well known, and quality of output measurable in absolute and relative terms, the same is not true of the service industry.
Quality in service establishments has to be ensured more by emphasis on ‘processes’ rather than on the final ‘output’. This is all the more true of hospitals since medicine is not only a science but also an art, heavily dependent on human judgment and labour.
The most effective means of ensuring quality care – and thereby outcome of service – is thus to guarantee that particular processes, shown to deliver good outcomes are always used. Monitoring and improving the process factors of care and Quality Mananagment (QM), therefore, assume importance as a means of regulating the outcome of hospitalisation.
In India, quality management is not as yet a mandatory requirement mainly because there is no statutory body that lays down standards for hospitals, inspects adherence to these standards and accredits hospitals that fulfill these standards in terms of infrastructural requirements, process factors and final outcome of care.
Government hospitals are assured of their annual revenue and so there is no compulsion to meet targets in terms of quantity and quality of services provided. Private hospitals, however, have to compete for clientele, which makes quality management a mandatory requirement.
With regard to the traditional tools of QA, there is no question that techniques such as setting and monitoring of clear standards, systematic statistical review of quality linked date, retrospective medical audit, peer review, credentialing and accreditation, mortality and morbidity audits, risk management, nursing audit, utilisation review, monitoring of nosocomial infection, appraisal of provider profiles, etc have indeed resulted in improved patient care processes, higher standards, and improvement in the final outcome of care.
Even if clinical outcomes are satisfactory, the long wait, the impersonal treatment, the cost and just about everything else about the experience can be and often is negative if service quality is poor. Patient satisfaction is all the more important in a private enterprise, for it is the perception of quality by regular clients that determines the continues patronage of managed care programmes and becomes the determining factor for market share, profitability, return on investment – in fact the basis for survival of the hospital.
There is an understandable reluctance on the part of doctors in defining parameters and standards within which they will render care and, traditionally, no doctor likes to sit in judgment over his colleagues. If healthcare providers have to play a role in ensuring a higher quality of care, the responsibility rests on the hospital administrators. It is the administrators who generally have to face the consequences of malpractice in terms of poor reputation of the hospital, loss of clientele, legal expenses, compensation and higher hospital cost.
Hospital administrators and their professional forums must strive towards bringing about the needed changes: adoption of quality assurance programs, laying down minimum standards for hospitals and professionals instituting an accrediting process and regulating the quality of hospital care in India.
There have been many an obstacles to implement quality in hospitals. Confronted with the trade-off between improving patient outcomes and maximising short-term revenues, many organisations routinely choose the former.
Often absent from the debate about how to increase access and contain costs is an appreciation of the root cause of the upheaval in healthcare. In any industry in which tacit knowledge becomes explicit, new production systems, organisational forms, and roles must be developed. Healthcare is no different.
Even governments are expanding their gamut in healthcare from accessibility to quality. The government of Tamil Nadu will be soon making it mandatory for all those hospitals approved for TNCM Scheme to have or meet the basic minimum criteria defined by NABH, National Accreditation Board for Hospitals in India.