Hospital Data Analytics: Abundance of Data, Dearth of Creativity!

Consider this: A new patient comes to a hospital. He gets registered by providing his demographic data and other occupational details. During the course of time, say a time frame of 4-5 years, he visits various medical specialties for medical consultations, visits diagnostics and buys medicine from the pharmacy. If the health condition is bad, he gets admitted as well. In certain conditions, he may require admission more than once in a 5 year period. He chooses shared or single occupancy rooms for his hospital stay. There is an ‘X’ amount that this patient pays during these 5 years.

Now imagine the actual scenario of a hospital. So many patients visit a hospital and they go through a process mentioned above. Through each and every interaction with the hospital, patients are participating in a data generation process. And here I am not even touching the dust on clinical data. This one is operational and business data. Unfortunately, most hospitals lack the creativity to use this data for any purpose – be it business performance management, process optimization or service improvements. Let us look at some ways in which operational or business data can be leveraged by a hospital.

Loyalty Program: Every person needs acknowledgement, especially when he pays for a service. There are some patients who spend more money on treatments in your hospital than other patients. Unfortunately the disease-burden on such patients is much higher, yet they stay loyal to your hospital and seek costly treatments from you for a prolonged period and pay a substantial amount. What could be a better way than recognizing such individual patients and reducing their burden by offering loyalty discounts? Firstly, such a patient would be extremely happy that your hospital acknowledged his disease burden. Secondly, he will be pleasantly surprised at the reduction in cost offered to him. While the health is compromised, such patients would gain some psychological relaxation that the hospital pays attention to them and helps them in a small way. Over a period of time, this should improve the Net Promoter Score (NPS) of your healthcare services, since the word-of-mouth would indicate to other patients that it’s better to take treatment for chronic diseases at your hospitals since in the longer run, this would bring down their cost of treatment.

Preventive Health-checkups: You have got the demographic details of the patient and you know his occupation profile, age and even health history. A simple database query will get you the names of the patients who underwent certain treatments in a particular order (X-Y-Z) or visited some specialties in a particular order (A-B-C). Doctors keep talking about the new trends in ailments linked to health profile and past disease history. The same knowledge can be used to detect such trends of patient movement or treatments among patients. In such identified cases, it would be appropriate to offer customized preventive health-checkups from time-to-time. Through the preventive action, the hospital can help reduce the risk of further aggravation of the disease condition of the patients (from the known risks). This is especially true in the cases of patients at the risk of diabetes, or the diabetic patients running the risk of further complications (like cardio, dermat, ophthal etc.), or old people suffering from orthopedic problems etc.

Second Opinions: There is now-a-days a new trend in hospital marketing where hospitals are promoting second opinions. But these are specialized chains and multi-specialty hospitals haven’t really jumped into the train. But data can definitely tell which consultants are frequently visited by patients for second opinion. Special marketing programs which reduce the cost of second consultation with these consultants will bring-in more patients and predictably more conversions for that specialty.

There are many interesting ways in which operational and business data can be analysed to generate such insights for a hospital. We specialize in data analytics offerings for healthcare facilities. In hospitals where the data is not in proper shape, our experts also advise hospitals on data design to meet business requirements. With a sound data design and analysis, we enable hospitals to form better business strategies for present and future. 

The language of signs: How sufficient and effective sign-boards take you one step closer to NABH accreditation

Hospitals are a public place and attract a diversity of mankind who come to the facility to get healed. As hospital administrators, we spend enormous time building a credible clinical team and a functional hospital structure. But one area which constantly misses the attention of administrators is the sign-boards inside the hospital.

Since we work in a hospital, we are used to its many departments and we are aware of their locations. But can we expect a first-time patient to know what all facilities our hospitals offer and where are they all located? Also, all kinds of patients who speak various languages visit the hospitals and there is a decent chance that some patients might not know English, Hindi and even the local language of the city/state in which the hospital is set up (for example, medical tourists from other countries or Indian patients who travel from one part of the nation to another part for treatment). So language can be a big barrier in communication as well apart from lack of sign-boards.

NABH team felt that most hospitals lack this ability to provide sound directions to their patients. This probably is the reason why there is a lot of focus on signages in NABH quality standards and it forms as one of the assessment criteria.

Hospitals and healthcare facility, new or old, can begin by thinking through the various facilities they offer and developing sign boards on them. Care should be taken to prefer signs over text-based signages or a hybrid can be used.

For the sake of creating cleaner environment, you could place dust-bins at various places and could use following sign –

Toilets are another facility that most visitors would like to use. Rather than placing a sticker on the toilet door/wall, it would be better to use signages at an angle to the wall, like the following example –

Also notice the use of the image for physically-challenged visitors. A common requirement of visitors is to locate lift or staircases to move to various sections of the hospital building. Sign-boards could come handy here too –

But a sign board with text, sign and direction would be much appreciated by the visitors.

Since hospital is a public place and certain visitors who intentionally or unintentionally smoke inside your premises can create disturbance for other people, having signs to discourage smoking can be a good idea –

Letting patients know the services offered in a particular part of the building will also avoid patients to unnecessarily waste their waiting time in areas where they are not supposed to be –

NABH puts a lot of focus on patient safety and this requires administrators to create fire-safe buildings and provide enough information signs to visitors in the event of a fire disaster. One area to help visitors/staff is to extinguish fire through prompt action is to provide fire extinguishers at various places and put requisite signages –

Here again, a sign-board at an angle to the wall should be a preferred option –

In many hospitals, basic signs for escape/exit routes are not provided which can be a major risk to patients’ safety. Simple signs like below can enhance the safety of your patients/visitors/staff –

Informing visitors and staff to stay away from lifts during a fire emergency can also save lives –

More than anything, it requires your common sense to design a patient-friendly hospital building and a visitor-friendly signage system. 

What’s new in NABH 3rd Edition for Hospitals? [Chapter 1: Access, Assessment and Continuity of Care]

The 3^rd edition is an attempt to bring specificity to certain aspects of patient care covered in various chapters. There is also a bit more clarity introduced in certain standards. So let’s look at what’s new in the first chapter, i.e. Access, Assessment and Continuity of Care.

Many of the objective elements of AAC in 2^nd edition began with the phrases “The policies and procedures guide….” or “Policies  guide….” and in the 3^rd edition, the word ‘Documented’ has been added in the beginning of these sentences. So AAC-2a would read as “Documented policies and procedures are used for registering and admitting patients.” or AAC-3d now reads as “The documented procedures identify staff responsible during transfer/referral.” Clearly NABH wants HCOs to document their process, policies and procedures very clearly and not to leave things to the imagination of the employees. Even unwritten policies followed consistently in the organization should now get documented so that there is a visible evidence to establish compliance.

AAC-2 has a new objective element added to the list – “A unique identification number is generated at the end of registration.” In relation to this, the standard on discharge summary (previously AAC-15, now AAC-14) also has a new objective element – “Discharge summary contains the patient's name, unique identification number, date of admission and date of discharge.” This new addition hints towards NABH’s advice to hospitals to go for computerization, i.e. implement a hospital information system (HIS) or hospital management system (HMS).

In 2^nd edition, AAC-3 began with the following objective element – “Policies guide the transfer of unstable patients to another facility in an appropriate manner.” AAC-3 missed out on covering patients who would get transferred into a hospital. So a new objective element AAC-3a – “Documented policies and procedures guide the transfer-in of patients to the organization” tries to address this issue. AAC-3b becomes more specific with the text – “Documented policies and procedures guide the transfer-out/referral of unstable patients to another facility in an appropriate manner.”

Standard AAC-4 from 2^nd edition (During admission the patient and/ or family members are educated to make informed decision) has been scrapped because the chapter on Patient Rights and Education (PRE) deals with this issue adequately.

The standard on ‘initial assessment’ deals about content of assessment, person responsible for this activity, time frame of this activity and other contents of the initial assessment. In edition 3, standard AAC-4 (earlier AAC-5) comes up with 3 new objective elements: “Initial assessment of in-patients includes nursing assessment which is done at the time of admission and documented”, “The plan of care is countersigned by the clinician in-charge of the patient within 24 hours” and “The plan of care includes goals or desired results of the treatment, care or service” to include the roles of nurses and clinicians in initial assessment.

The standard “Patients cared for by the organization undergo a regular reassessment” (AAC-6 in 2^nd edition) was silent about whether it covered OP patients, IP patients or both. Standard AAC-5 in 3^rd edition takes care of this confusion with the inclusion of two new objective elements – “Out-patients are informed of their next follow-up, where appropriate” and “For in-patients during reassessment the plan of care is monitored and modified, where found necessary”.

The standards dealing with laboratory and imaging services (AAC-7 and AAC-10 in edition 2) defined scope of their services in terms of “requirements of the patients”. Of course this was very ambiguous. So the edition 3 has aligned these to the documented scope of services of the hospital. The new standards AAC-6 and AAC-9 read as “Laboratory services are provided as per the scope of services of the organization” and “Imaging services are provided as per the scope of services of the organization” respectively. In each of these standards, 2 new objective elements have also been introduced. “The infrastructure (physical and manpower) is adequate to provide for its defined scope of services” and “Results are reported in a standardized manner” expand the scope of these standards.

Since the chapter Facility Management and Safety (FMS) contains standards on safety, edition 3 has done away with the objective element “Policies and procedures guide the safe use of radioactive isotopes for imaging services” (AAC-12h in 2^nd edition).

AAC-12 of 2^nd edition also defined objective element AAC-12c as “Written policies and procedures guide the handling and disposal of radio-active and hazardous materials”, so there was some scope left for HCOs to follow their own policies which may be in conflict with or non-compliance of statutory guidelines. The new standard AAC-11c removes this conflict by stating the element as “Handling, usage and disposal of radio-active and hazardous materials are as per statutory requirements.”

A new aspect was added to the standard “Patient care is continuous and multidisciplinary in nature” with the inclusion of the objective element “Transfers between departments/units are done in a safe manner” (AAC-12e in 3^rd edition).

In all, compared to 2^nd edition, 3^rd edition has scrapped 5 objective elements and 1 standard (which had 4 of the 5 scrapped objective elements). The new edition has also introduced 13 new objective elements. Therefore chapter AAC in 3^rd edition has 14 standards and 90 objective elements.

What's new in NABH Third Edition: Chapter 2 - Care of Patients (Part 1)
What's new in NABH Third Edition: Chapter 2 - Care of Patients (Part 2)

The Scandal in Patient Satisfaction Surveys

I do not have experience in more than 3 industries, so I can’t make a generic observation. But one thing that never missed my observation was the poorly framed customer/patient satisfaction survey in healthcare industry compared to other industries. In couple of healthcare facilities where I had the opportunity to put my hands onto these so-called feedback forms, or the now popularized satisfaction surveys, I could not imagine the reason why would so many people in so many hospitals do such a lousy job. In one clinic, what I witnessed was even more shocking. In place of sentences as questions, there were phrases. So it left it upto the patient to first create question in her mind, then its meaning and then reply to it suitably.

What this points to is the lack of our seriousness in getting a proper and genuine feedback from our customers, i.e. patients. This practice, unfortunately, also points to our unwillingness to change.

A hospital has lots of departments – OPDs, reception, admission, registration, billing, laboratory, radiology, pharmacy and many more. One common feature of the feedback form is that it tries to assimilate the feedback from the patients on all these departments in one form. Consequently, there is this tendency to form questions like these – What was your satisfaction with the reception? (Options: Highly Satisfied, Satisfied, Dissatisfied, Highly Dissatisfied). I would like to ask the person who formed this question, what would you understand, if the respondent replied that he was dissatisfied with the reception? Yes, the respondent was dissatisfied with the reception, but what was it that led to the dissatisfaction? Was it the waiting time, was it the receptionist’s behaviour, was it the poor air-conditioning or was it the painting put behind the receptionists? Year after year and month after month, hospital employees have been very religiously getting patient feedback on questions like these. I guess that’s the reason this industry is so very backward in its management practices. Somehow it never cares for the reasonable feedback from its customers. That is why this post begins with the title – the scandal in P.S. surveys.

So what is the solution?

I believe it’s not about the inability to create the right feedback form. It’s just the absolute absence of intention to improve our systems as a response to poor feedback from the patients. So what we need first is the willingness to learn from our patients and capture what they feel about our services in a meaningful way. Patient satisfaction surveys, or PSS, have to be designed keep the specific objective in mind. Do not play a generalist here. Be very specific in seeking feedback. For example, the question could look like this: “If you were dissatisfied with our reception service, what contributed to your dissatisfaction?” (Options: 1. Behaviour of the receptionist, waiting time at the reception, ambience of the reception, seating arrangement, any other ___ ).

Revised NABH Accreditation standards, the 3rd Edition, comes in effect from July 1st

The NABH standards for accreditation for hospitals being currently used are part of 2^nd Edition. NABH has revised these standards and the 3^rd Edition is now available. http://nabh.co/main/hospitals/Letter-3rd-ed.pdf

In another 1 month’s time, i.e. July 1^st onwards, all the accreditated hospitals and those in the process of seeking accreditation will be required to comply with the 3^rd Edition of standards. The second edition had 10 chapters and 514 objective elements, while the third edition has raised the bar with 10 chapters and 636 objective elements.

We have released a blog where you can find link to the revised NABH standards 3rd edition and we have identified the new added objective elements (out of 636) in the revised edition. Kindly visit:
New added objective elements in NABH 3rd Edition (Revised)

You can also read about the comparison between 2nd and the 3rd edition in the following posts:
What’s new in NABH 3rd Edition for Hospitals? [Chapter 1: Access, Assessment and Continuity of Care]

What’s new in NABH 3rd Edition for Hospitals? [Chapter 2: Care of Patients] – Part 1

What’s new in NABH 3rd Edition for Hospitals? [Chapter 2: Care of Patients] – Part 2

What is the cost of NABH Accreditation for a hospital?

During a conversation with a hospital administrator friend of mine, I was posed with this question by him – “Apart from a consultant’s fee, am I supposed to incur any other cost to get an NABH accreditation for my hospital”?

This was indeed an interesting and thought-provoking question. This question has relevance to all the hospitals undergoing and planning for accreditation in the future.

As per my understanding, there are two kinds of cost involved in accreditation. One is the ‘cost of compliance’ (CoC) and the second is the ‘cost of the accreditation program’ (CoAP). When a hospital decides to go for an NABH accreditation, one of the first things they can do is conduct a self-assessment using the freely available self-assessment toolkit on NABH’s website. You can find the same here:

http://www.nabh.co/main/hospitals/documents.asp

The self-assessment will tell you the gap between your current processes & infrastructure and the NABH-compliant processes & infrastructure. To close this gap, you may need to invest in equipments, OT infra, personnel, signboards, civil structures, renovation, statutory compliances, safety devices, IT systems, trainings, printing information material and a few other things. So this CoC depends on the gap and will vary from one hospital to another. It can fairly be assumed that CoC for a newly setup hospital will be relatively lesser than an existing old hospital (say 10 or more years old).

Some of these components of the CoC can be recurrent in nature, for example the cost of training. Since healthcare is prone to severe attrition, the new hires would need to be trained on documented policies and procedures apart from the regular technical trainings.

The CoAP is a onetime expenditure that a hospital has to incur. If you are hiring a consultant organization to help you in your accreditation program, then you have to pay for their fee, travel and stay of their consultants. Apart from these, you may like to invest in some internal marketing where you develop promotional material to inform the staff about the new changes happening in the hospital processes because of NABH implementation, motivational messages or even other kinds of reminder signages. You might also be giving them educational materials or handy notes. Some hospitals also create incentive programs in which those employees who champion the accreditation program are incentivized financially. One another expenditure which is often overlooked is the fee to be paid to NABH for the accreditation. It has following components:

1. The Application fee and Annual fee for accreditation may vary between 1.25 to 2.5 lakhs per annum depending on the bed capacity of the hospital, as provided on NABH website.
2. There is also a one-time application fee that varies between 30 to 70 thousands depending on the bed capacity of the hospital, as provided on NABH website.
3. The hospital also has to bear the cost of travel and boarding/lodging of NABH assessors when they visit your facility.

You can find information on these costs in the NABH Application form here: http://www.nabh.co/main/hospitals/ApplicationForm.asp

NABH accreditation is based on the sound principles of patient safety and quality of care. Whatever be the cost, these principles can never be compromised. If we cut corners and try to save money using unethical ways, we end up reducing the quality of our care and putting the lives of our patients in danger.

After this discussion, my administrator friend started having second thoughts about NABH accreditation. I told him only one thing. India has close to 35-40 thousand hospitals (of all sizes) while only 131 have received NABH accreditation till date. It is a privilege that only a few hospitals enjoy. If you want to be part of the Ivy League, never think twice about the costs. After all, you are investing in quality.

Experiences from the meeting with Director, NABL and NABL Accreditation Officers on Sunday May 27 at St. John’s Hospital Bangalore

I was fortunate to be present at the 2^nd Medical Assessors Conclave organized by NABL at St’ John’s Hospital Bangalore today. It was a conclave of NABL Lead Assessors as well as an opportunity for the laboratory representatives and consultants to have an interaction with NABL Director Dr. Anil Relia and other officers from NABL. Some of the highlights were:

Dr. Anil Relia, Director of NABL, gave a brief overview of NABL accreditation, the progress so far and the plans for future. According to him, about 400 laboratories in India have received NABL accreditation. Since NABL follows ISO 15189, the test results of an NABL accreditated laboratory are internally acceptable. He also gave an introduction to NABL 112 revised standards to the audience.

The talk by Dr. Anita Borges, Chairperson of Accreditation Committees, Clinical Labs, focused on the role of Accreditation Committee as part of NABL. 

According to her, some of the common problems that the accreditation committee has identified from the assessors’ report of lab audits are:

• Biosafety issues
• Biomedical Waste Management
• When & what corrective actions to be taken on poor IQC and EQA performance
• Harmonization of instruments
• Validation/verification of reagents
• Regulatory requirements for HIV testing

Other laboratory-related concerns of accreditation committee are:

• The impact of analyte stability on the quality of test results of samples transported over long distances
• The continuation of testing after withdrawal of a test from the scope especially when the withdrawal is due to an inability to meet quality requirements during an audit
• Complacency of accreditated labs leading in some cases to deterioration of quality performance

She also hinted that there is a possibility that NABL will make it mandatory that a lab will only get accreditation when it meets quality requirements for each and every test which is part of its scope because an accreditated lab gets to use NABL identifiers like logo to market itself, without letting the patients know that certain tests are not covered under the accreditation.

Dr. Prasad Sawant made an elaborate presentation on validation and verification requirement in medical testing. Dr. Jayaram from Anand Diagnostic Lab discussed the topic of Inter-Lab exchange of samples as an alternative to EQA when it is not feasible for a lab to undertake the EQA or Proficiency Test program.

The Chief Guest for the conclave, Sh. SV Ranganath, Chief Secretary, Govt. of Karnataka, spoke about the quality journey and his personal experience of working with the NABH leadership team for the accreditation of govt. hospitals and assured support to NABL for the accreditation of govt. labs. Of the challenges faced by him, he found resistance to change to be the biggest. Towards the end of his talk, he put forward 5 propositions, i.e.

1. Accreditation is a journey, not the destination.
2. Accreditation will improve the quality of Indian hospitals.
3. While accreditation is a wonderful tool to ensure quality, it does not guarantee outcomes.
4. Equal focus should be given to the accreditation of blood banks, taluk-level hospitals, diagnostic centres, dental facilities and ayurvedic clinics.
5. Focus should also be given to teaching hospitals as they produce doctors of tomorrow.

Dr. Thuppil Venkatesh, Professor Emeritus, St. John’s Medical College and Principal Advisor to Quality Council of India gave a talk on Ethics in laboratory medicine and proposed ten commandments for labs. 

He stressed on the fact that healthcare providers have responsibility towards the patients who put blind trust in them and spoke for the need for the audit of ethical system of the labs. Of course this is out of the scope of an accreditation body like NABL, but ethics and business virtues are equally important to ensure quality service.

Ideas for improving patient services in hospitals - 2

Ask a hospital employee, dealing with cashless hospitalization and undertaking pre-authorization formalities or involved with billing for the medical insurance patients, about a recurrent problem they face and you would get one common issue – Patients think ‘cashless hospitalization’ means they are not supposed to pay any cash and the insurance company will pay every penny of the medical bill. The moment the insurance company rejects a claim, or it takes longer to process the claim, or they ask patient to partly pay the expenses not covered by the insurance, the patient and their attenders start shouting at the poor staff. The situation gets worse when some of these visitors turn abusive, create ‘scene’ in the public or go to the hospital administrator to complain against the employee.

In most genuine cases, the hospital is not at all at fault. The insurance is a contract between the individual and her insurer, but since hospitals become the intermediary at the time of bill settlement, patients end up holding hospitals accountable and not the insurer. Also, because of the alleged ‘mis-selling’ of health insurance plans, the insurance agents also do not completely educate their customers on what to expect when they actually visit a hospital. The situation in presented as if cashless hospitalization is the ultimate comfort in settling the hospital bill. What they hide is the fact that at the time of discharge, the patients have to wait a long time (sometimes 8-10 hours) for their medical bills to get finally settled. Even this wait doesn’t guarantee that the insurer will pay completely.

Now in all this chaos, it is the hospital which has to face the patient/customer’s wrath. What I’m going to suggest is that the hospital has to partner with the insurance firms in educating the patients and there is enough scope to do that. Most patients visit the hospital’s OPDs and in-house diagnostic centres and pharmacy a couple of time before some of them get admitted. During all these visits, they have to spend some time waiting to meet doctor for consultation or get tests done. The hospitals should smartly leverage this waiting time and should display messages which educate the patients about what to expect when they get admitted using cashless hospitalization. This is basically to orient them on the actual cashless hospitalization process. With the increase in medical insurance sales, more and more patients are taking up this service and whenever they get admitted, they are bound to wait longer than the patients who pay their dues by cash.

So if you mentally prepare your patients about the ‘other’ aspects of cashless hospitalization during their OPD visits through communication materials like pamphlets, posters or even other attractive mediums, you will face far less issues when insurance patients undergo treatment at your facility. Don’t you think it will improve your patient satisfaction?

Invitation for exclusive interaction with Director NABL, NABL Accreditation Officers and Lead Assessors at St. John's Hospital Bangalore on May 27th

Source link: http://bit.ly/KrKXaf
Details:
NABL is pleased to invite two representatives of your medical laboratories for an exclusive interaction with Director NABL, NABL Accreditation Officers & Lead Assessors (ISO 15189) from across the country on the occasion of 1st NABL Conclave on 27th May 2012 at Annex III, St. John’s Medical College Campus, Kormangala, Bangalore - 34. NABL 112 latest version will also be released. During the pre-lunch session special lectures from distinguished speakers are arranged: Session I: Verification and Quality Assurance Session II: Interlaboratory Comparison to Ensure Quality Session III: Ethics in Laboratory Medicine The special course and the ever first interaction with Lead assessors from across India for which fees is subsidised by NABL to Rs 500/-(Five Hundred Rupees Only)

The Three-Legged Technology Stool of hospital operations

Let’s do an exercise first. You have to make a guess on the probability of the following events:

a. What is the probability that a hospital will have the latest medical equipment and machines, yet you can find someone in the same hospital using a P3, 256 MB RAM computer?

b. How high are the chances that you will find medical equipments in a hospital which do not communicate data with each other?

c. What is the probability that someone would have spent 50 crores in building a nice swanky hospital, yet would be using an HIS (Hospital Information System) bought for, say 1 lakh?

d. What is the chance that you will visit a hospital and would find a dot-matrix printer installed at the front-desk?

e. What probability you would assign to the situation where you will find that the network of a hospital has not been upgraded for years?

Most people would agree that there is a very probability of any or all of the situations happening in our hospitals. The question is, is there a problem with this kind of a situation?

Hospital operations stand on a three-legged technology stool. The three legs are formed by:

• Medical Technology (eg. CT, MRI, X-Ray machines etc.)
• IT Software Technology (eg. HIS, LIS, Tally etc.)
• IT Infrastructure Technology (eg. Computers, Printers, Networking etc.)

For stable operations, all the three legs have to be equally strong and should match each other’s length. If you have one set of technology which is very advanced and the other set of technology is primitive, the stool will lose its balance. The consequences of such a situation have to be faced by your patients and your employees.

Ideas for improving patient services in hospitals - 1

Hospitals and clinics should be synonymous with good hygiene. Patients come to a healthcare facility with an expectation to gain better health and hygiene is an important aspect of good health. It also forms a part of the impression that a healthcare organization creates in the minds of its patients. A facility with the best of the doctors but with filthy toilets reflects on the organization’s lack of commitment to ensuring hygiene in its internal environment.

Agreed that hospitals are public places and a multitude of visitors use the toilets. But it is also true that even airports face such visitor traffic. Yet anyone can make a guess which of the two maintains better level of hygiene in the toilets. I guess the problem here is not the scale of traffic, what most hospitals lack is the will to make their washrooms usable with a certain degree of hygiene.

So if you really want to impress your patients, do that where it matters the most!

What is Patient Centricity?

Many of us in the healthcare would have come across this term called as Patient Centricity. It means different to different people. One big multinational IT firm looks at it from a technology point of view where technology is weaved around this concept. Another view of patient centricity revolves around the concept of coordinated care. Yet another hospital chain takes this term as part of its core values, thereby elevating patient centricity from an action orientation to the level of a belief system.

But at the heart of all this discussion is the patient. She is the one who puts trust in our capabilities to cure her of her illness. She carries the belief that her well being is our business. She hopes that behind her back, all our actions and decisions are being taken to ensure her good care. Such is the relationship we enjoy with our patients. To me, patient centricity is a guiding light, a sense of direction, to design our healthcare organizations. The design could be of systems and processes, infrastructure, hierarchy, medical and IT technologies or any other thing that has the potential to participate in patient care.

It is true, such a vision is not an easy task to achieve because our organizations are always in a state of flux. Who says that we need to be there? But we must make every attempt to be there.

eNABHle: Achieving NABH accreditation

The content of this post has been referred from the following link: http://bit.ly/KiH5YB

This interesting piece of information and article has been created by Mr. Koushik Sekhar. Here's the article:

Achieving NABH Accreditation

There are about 40000 and odd small (<50 bedded) and large health care organisations (> 50 bedded) (HCO) in India. 127 Large HCOs and 12 small HCOs are already accredited by National Accreditation Board for Hospitals & Healthcare Providers (NABH). 440 large HCOs and 131 small HCOs are listed as applicants and are in the process of accreditation. This means that less than 1.5% of HCOs are either accredited or in the process of getting accreditation.

Why is this so?

There may be several reasons for this sorry state of affairs.

The first reason may be that NABH accreditation is a voluntary process. There is no compulsion for hospitals (HCOs) to opt for it. The HCOs may not perceive it as a value addition. There is no evidence available that has proved that NABH accreditation has improved the business angle of HCOs and made them more profitable. Hence the HCOs may perceive this painful journey to be a path of ‘no returns’.

The second reason may be due to the fact that HCOs perceive NABH accreditation to be difficult. This is more so for well established locally well known and generally profitable HCOs. Most HCOs have a flavour of their own, a method of working of their own and may be driven entirely by an owner cum administrator who has his own style of functioning. Many of these chairmen/CEOs may have inherited their post and HCO or have created their unit right from scratch. The units tend to have their own style of management and may feel that their style may not match that of NABH. Many such HCOs are very set in their ways and the older they are it is more difficult for them to unlearn their ‘bad’ ways and relearn ‘good’ ways. Many HCOs do not want to start on their accreditation journey because of this simple fact that they feel it is a difficult journey not worth embarking on.

The third reason may be that HCOs perceive accreditation as an expensive process.  Though the actual money paid to NABH is about Rs 1.55 lakhs per annum for a less than 100 bedded hospital and may not cross Rs 3.25 lakhs for 301 or more bedded hospital for the initial accreditation, the HCOs may land up spending more money on accreditation. Most of the expenditure incurred will go into facility improvement, achieving legal compliance and in documentation, recruitment and training. HCOs who do not have a robust quality management department may also recruit an NABH approved consultant for hand holding them during this journey. HCOs are also required to propose budgetary allotments for infection control, quality improvement and safety. It is not enough if the budget gets allotted, since it will be checked whether they spent it on these proposals. Though all the money spent on these angles goes to improve the HCO and to make good a deficit, the top management tends to see it as expenditure for “NABH” accreditation.

The fourth reason may be that there are a very few professionals who can guide the HCOs in the accreditation process.  There are a handful of NABH approved consultants who can provide a fee for service. NABH conducts awareness and implementation programmes and specific tailored workshops on medication errors, legal aspects and medical audits.  The HCOs have to resort to training local talent. Larger HCO consortiums are able to tackle this through their own quality management teams and learn as they go.  But smaller HCOS may not be blessed with able quality management people. A few HCOS may have an approved and trained NABH assessor amidst their staff and they would surely utilize their services.

NABH has been in existence for less than a decade and has not yet put in place enabling mechanisms that make the HCOs seek and achieve accreditation. The approved assessors of NABH are strictly required to stay away from offering consultancy for the HCOs seeking accreditation. They can do so only for their own institutions where they work. This is perceived to prevent biased assessment later. There are other instances of accreditation agencies in other countries offering consultancy services along with accreditation services. They strive to keep these two apart and can easily ensure absence of bias based on prior consultancy.  

It is easy to understand that consultants trained by NABH and who assess HCOs will be able to do a better job of guiding HCOs through accreditation. Introduction of such a process may also bring a lot good will and improve the financial aspects of NABH. Many who are now engaged as part time assessors and trainers may be able to devote more time to NABH if they are compensated adequately.  Allowing them to consult under strict supervision is one way NABH has to actively consider.

It is obvious from the forgoing discussion that NABH accreditation has to be made desirable and a value added addition to the HCOs. In addition it is essential to ensure enabling mechanisms are in place to ensure a smooth accreditation process. 

This initiative is to help hospitals and healthcare professionals understand accreditation and work towards accreditation for their hospital.

Relevance of business data for hospitals

Recently there was an article on CNN Money and it aptly highlighted that “physicians are poor businesspeople”. The article can be accessed using this link http://cnnmon.ie/Kb1XTh

You would have noticed that most consulting doctors rely a lot on laboratory and radiology reports to correctly diagnose a patient’s health problem. Once the problem has been identified, they follow a line of treatment, keep a track of patient’s progress and make adjustments in treatment or prescriptions to finally achieve the desired medical outcomes. Isn’t it a very objective way to approach a problem?

Well, the answer is a Yes. What the CNN Money’s article highlights is another aspect to the way physicians run their clinics or hospitals. They are not very smart businesspeople, or in my own definition, they are not very good money managers. But why only doctors, even hospital administrators aren’t any better.

Healthcare facilities create tons of business data every day, but unfortunately they lack the systems and processes to collect and analyze this data to help efficient and effective business decision making. A simple analysis of the monthly revenue per doctor would tell you about the doctors who are not performing upto the expectations of the management. Once the reason for the poor showing is diagnosed, there is a certainty that there will be a positive impact on overall revenue of the healthcare facility. The analysis can be simple or they can be complex, but the point worth noting is that the data is very well available inside the facility. It only takes an effort to create systems to collect data in a systematic fashion and analyze the same to bring out business insights. From our own experience we have seen significant improvements in financial performance of hospitals once they focused on the right data and started analyzing it.

Making NABH standards implementation simpler in your healthcare facility

From the numerous dialogues that our team had with healthcare administrators wishing to achieve the coveted NABH accreditation for their healthcare facilities, we have made a common observation: No one has a clue about the NABH standards. It’s interesting to note that NABH has just 100 standards with 514 objective elements (these will increase to 636 from July 2012 onwards) or requirements and none of the administrator took the time to train herself or atleast someone from their team on these standards. The lack of awareness on the standards is the biggest contributor to the fear that most administrators have regarding NABH accreditation program.

The fact is that NABH accreditation offers best practices in healthcare in Indian context and any hospital achieving compliance to its standards can be assumed to be offering quality healthcare services to its patients. Any administrator who is interested in establishing strong processes in her facility would love to go through the NABH standards because it is the gold standard of healthcare delivery.

The simplest way to implement NABH standards in your healthcare facility is to create awareness about the standards among your team of managers and staff. Make everyone realize their role in implementing NABH-compliant processes and the benefits to them and the patients from these compliances.