December 2012

Quality, Standards and Patient Safety


How India is rising up to the challenge?

Patient safety is improving the system by learning where people fail and not by holding people accountable for failure-John R Clarke Patient safety in the operating room has long been a concern for hospitals. Numerous initiatives to improve OR care have had some impact, but problems persist. Wrong-site surgery, for example, has received a great deal of focus. A closer look!


Patient safety lacks system

Dr Annie Stanley

Hospital Administrator,
CARE Hospitals


When we talk about patient safety and quality, we mean prevention of harm to patients while receiving healthcare. It is about eliminating preventable medical mistakes, guarding against the impact of human errors, establishing systems to safeguard patients. Quality means continuous improvement. NABH accreditation plays a major role in healthcare delivery systems in India.
World Alliance for Patient Safety (WAPS) was formed in 2004 and its a great initiative. Momentum to this movement came only after initiative was taken to include Patient Safety in July 2007. Jakarta Declaration was made for our Southeast Asia Region, which highlighted the role of involvement of Patient for Patient Safety. The Foundation urges member states to engage patients, consumer associations, healthcare workers, and professional associations, hospital associations, healthcare accreditation bodies and policy makers in building safer healthcare systems and creating a culture of safety within the healthcare institutions. Our challenges in patient safety is lack of systems in our hospitals and other healthcare institutions, lack of awareness/ realisation of its importance even among the healthcare providers, no scientific data base is available and lack of dedicating funding for promoting patient safety.

Demand for accreditation has created awareness

Dr Girdhar J Gyani
Member Governing Board,
NABH and Member Governing Body,

Quality in healthcare has been very recent phenomenon in our country. I always kept saying that when I was involved in the development of the accreditation programme for the NABL, for medical laboratories, I knew that the quality in healthcare was very different. The quality in healthcare means saving life of the patient.
Today we have got NABH which is internationally acclaimed society for quality in healthcare and both the aspects, one is the standard and another is an organisation that means the hospital accredited by NABH today have got the global acceptance. I will say accreditation relies on establishing technical competence of healthcare organisations in terms of accreditation standards in delivering services with respect to its scope. It focuses on learning, self-development, improved performance and reducing risk. Accreditation is based on optimum standards, professional accountability and encourages healthcare organisation to pursue continual excellence.
Why quality in healthcare is still a farfetched concept, because the demand supply ratio controls the quality. Demand still is huge and supply is very limited and with these circumstances you cant build quality. This is a very simple market phenomena but I think todays 83 percent expenditure in healthcare is coming from the private sector. So hopefully in the next five years the demand and supply issue should be appropriate when supply of quality healthcare will increase.
NABH has done something wonderful. A framework is available from NABH but see in five years only 160 hospitals got accredited. It is to see if the demand for accreditation gets increase in the years to come so that more and more healthcare providers go for accreditation.

Corporatisation of hospitals is the trend

U K Ananthapadmanabhan
President (Operations and Projects),
Kauvery Hospitals Group,

India needs a healthcare system that can meet the demand of over a billion people. Each year 39 million people are pushed into poverty because of their inability to meet healthcare costs. India leads the world in terms of maternal deaths.5,70,00 maternal deaths in 2010, MMR 212 as against 109 of MDG in 2015. Dearth of qualified medical professionals in rural areas is observed. Health insurance covers only about a fifth of the population. Unorganised private sector accounts for almost 80 percent of outpatient healthcare. This is the canvas on which we are talking
about the quality standards, patient safety and improvement. There has been a paradigm shift in healthcare delivery mechanism. Today from large public sector hospitals, we have corporatisation happening with a chain of clinics, day care centres and primary health centres coming up in places such as Podukota, Trichhy and Madhurai. In Trichy hospital qualified pharmacists are working, which I feel is good improvement has happened. When you say a particular hospital is approved or recognised by any insurance company, they also look for some standards requirement and that is indeed very basic requirement. Insurance company, whether it is private or public, also introduces some kind of standardisation and quality parameters. I have seen some standard developed by NABH and I feel NABH standard should be more precise.

Need to redesign the safety mechanism

Dr Pervez Ahmad
Vice Chairman & Lead Director,
General Manager, Modi Hospital &
Research Center

Quality is an attitude, if you dont have that attitude you will never have Quality. Accreditation is very important, Its like passing a test; you get to have a degree but that is only a degree, it does not give
you a stamp of high quality. We have 1.2 billion peoples views taken on that. There should be quality healthcare for all. We heard about health infrastructure which is improving, we heard about quality accreditation which provides NABH, NABL, etc. We have a lot of data that needs to be transferred to intelligence which then is useded for all quality standard, etc.
Indian hospitals are gaining reputation as high quality service providers, several new projects with world-class infrastructure, quality driven organisations are investing in latest equipment, IT, SOPs and patient-centric delivery systems. Medical service excellence is achieved to ensure best patient experience and clinical outcomes. There is a programme in the US which is called WINGS. It is supported by an insurance company, which creates the same concept which is used in plane. As per the initiative, when you get into the
plane whether the pilots have flown the aircraft 50,000 times or one time, they all need to go through the check-list. That check list is regardless of who the person is. The checklist is verified by five or ten people before the plane flies. Same thing needs to be replicated in healthcare. Issues that lead to medical errors are majorly due to four most important things. These are-communication, orientation/ training, patient assessment and staffing ratios. If you address just four of these, youll actually take care of very significant reduction of lots of these events which happen. So there are a lot of factors which need to be addressed when we talk about quality and standard.
I particularly like occupational safety. People dont talk about occupational safety. I am very particular about the people who work in healthcare organisation and in nursing jobs. Nursing job environment is the most dangerous job. We have problem about exposures to blood-borne pathogens which is very significant for people who work in healthcare environment. At the end I can say that patient and staff safety is a global concern. All our efforts need to be made to reduce the risks of error, not devising quickfix solutions. The mantra is: redesign, transform and innovate.

Emergency medical services

Dr Ramana Rao GV
utive Partner,
Emergency Medicine Learning Center (EMLC) & Research

This particular discussion on quality standard and patient safety are very important and I am sure my experience will also add value. Vision of GVK EMRI is to respond to 30 million emergencies and save 1 million lives annually, to deliver services at global standards through leadership, innovation, technology and research and training. And for that these factors of safety are very important. Quality care is very important standard. The organisation thought that we need to be proactive by creating a leadership liverish technology. Do not be complacent about yesterdays glory but ensure that there is a significance innovation & refinements on continuous spaces and capacity building research so that the efficiency and effectiveness can also be enhanced.
This organisation has attempted in the pre-hospital care by an ambulance based emergency response services. Developed detailed process understanding and well-defined responsibilities throughout the organisation. We have started very unique process where the patient use three digit numbers- 108. We have established an emergency response centre; only with a focus that we can quickly identify the exact location. We also realised that the medical emergency should also have in addition to that, police and medical emergency should have the integration.
The technology is being provided by Mahindra Satyam. The technology solution takes care of the person who is free to take the calls and unique Id comes easily, safety gets ensured and goes to the next process, the voice process can also be transferred to a place where a dispatch decision of ambulances can also be taken. PPP is a very useful learning for us, where we understood the priority of the government that we need to bring a lot of process, performances measures and the right kind of people, so it would become a good PPP model.

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