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Policy Regulation Need of the Hour

Dr K K Kalra

Dr K K KalraDr K K Kalra, CEO, NABH

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National Accreditation Board for Hopspital (NABH) is the hallmark of quality care in hospitals in India. Dr K K Kalra,CEO, NABH, in conversation with Ekta Srivastava, ENN, speaks on the importance of getting NABH accreditation countrywide.

Accreditation benefits all stake holders and getting accreditation for any hospital either private or government is both difficult and hard to sustain its policies. Accreditation results in high quality of care and patient safety. The patients get services by credential medical staff. Rights of patients are respected and protected. Patient satisfaction is regularly uated.

As of today, there are just 200 NABH accreditated hospitals. It requires a lot of commitment and continuous improvement. Just getting an accreditation is not enough. Sustaining it is very difficult as the board keeps a serious surveillance on those accreditated for renewal. In the first go, accreditation is given for just three years, said Dr K K Kalra, NABH CEO.

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 The staff in an accredited health care organisation are a satisfied lot as it provides for continuous learning, good working environment, leadership and above all ownership of clinical processes.

Accreditation Important for Patients
Patients are the biggest beneficiaries of the accredited hospitals. Accreditation to a health care organisation stimulates continuous improvement. It enables the organisation in demonstrating commitment to quality care. It raises community confidence in the services provided by the health care organisation. It also provides opportunity to healthcare unit to benchmark with the best.

Dr Kalra said the biggest beneficiaries of accreditation were patients as the certification ensured best quality services to them. Although there are 19 major criteria to be followed by any hospital seeking accreditation, there are 150 minor objectives that the unit should fulfill, he informed. NABH accreditation was not mandatory yet but it was also not an easy affair. The process involved many pre-assessment procedures and inspections but was mainly patient centric.

It is aimed at providing the best possible care to patients. Beginning from small things like hand washing to post operative care, everything has a definite protocol monitored extensively. We conduct even surprise inspections, said Dr Kalra. Patient safety and care were the biggest pillars of certification process, he added.

Wake up Call!
There was a time when people were not exactly aware of the functioning of the hospitals, neither in the government section nor in the private, which ultimately ended them with empty pockets and huge debt. In regard to the role of NABH as waking up the patients and passing on the awareness , Dr Kalra said, When I studied the whole market and discussed with various people, there was awareness among the communities as well as with the hospital administrator also. There was a need to little motivate them and we had come out with some other solutions. It was said that quality was ducting there was no limitations to the improvement. Even in a full accredited hospital, there is still a chance for further growth in excellence. Quality is a journey, we had in troduced two more stages. Hospitals which had and which wanted to come here due to legal or regulatory problem or some other reasons, straight away could apply there, i.e, pre- entry level. So that once some basic culture of the quality sets here then they would enjoy this level and can progress to higher levels. Today, there are just 200 hospitals accredited out of 50-60 000, be due to this some will get motivated and come forward.

Also read: NABH goes global

New Certificates
Further he added that beside that they had introduced two new systems Safe I certificate and Nursing Excellence. The certificate was awarded under the NABH Safe-I hospital infection control programme, which acts as the first stepping-stone towards NABH accreditation for those hospitals that lack the resources and managerial bandwidth to achieve the full NABH accreditation.

Under the Safe-I programme, NABH recommends safe injection and infusion practices, biomedical waste management, healthcare workers safety, and sterilization and disinfection. NABH and BD had signed an agreement in August 2011 to support hospitals in attaining quality-ofcare standards for infection control in three phases. During Phase One, initial workshops were carried out across hospitals in India to ensure the Safe-I programme is adopted by hospitals as a stepping-stone towards achieving quality.

There is a need for increased awareness among the healthcare facilities so that more healthcare organisations start participating in quality initiatives

The second phase will offer Centres of Excellence and Health Economic models to be developed for the benefit of Indian healthcare after dissemination of Safe-I programme. The last phase will augment national capability of standards dissemination by developing additional Centres of Excellence.

On speaking about the second certification Dr Kalra mentioned, we are coming up with new programme of Nursing Excellence, we improve the nursing care the whole scenario will change. Major role is the nursing care; outcome depends upon the nursing care. What kind of nursing care is in the hospital is very important. So hospitals which otherwise are not fully complied cannot go for this at different level of this start. There is A improvement in the hospital gradually.

Governments loopholes
In India, there are many states which are deprived of facilities including healthcare including healthcare. Though there is a huge budget that goes across from the central government, the state government lacks in providing all the basic facilities to the people. As Dr Kalra said, Everybody says that health is a priority, but there is always minimum three to four percent of gross domestic product (GDP)  on health sector. in the world .In India there is just one percent, now they have targeted for three but I am not able to see any priority here. Out of the pocket expenses in the world India is having maximum, which is around 71 percent. Health insurance today is aprox 10-12 percent, who will then afford to go to the private hospital. Though there is some awakening but still for the poor people they have to sell their every property to afford even the cheapest health facility. Today government is not bothered about anything, everything is on paper. There was a time when government hospitals are trusted with closed eyes  but now government itself is discouraging them by not providing any infrastructure or facility.

NABH is a constituent board of the Quality Council of India under the ministry of commerce set up to establish and operate accreditation programme for healthcare organizations. The International Society for Quality in Healthcare ( ISQua) had accreditated the standards for hospitals laid down by NABH India which meant that the standards were at par with internationals norms, Dr Kalra said.

Blood banks, pathology laboratories, dental hospitals and single specialty hospitals were added to NABH only in the last few years. Finally, accreditation provides an objective system of empanelment by insurance and other third parties. Accreditation provides access to reliable and certified information on facilities, infrastructure and level of care

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