Thursday, 21 June 2012

Some principles around NABH standards based quality management system

Any system should have some principles around which it is formed and I always wondered about the process by which the NABH standards were designed and put into words. A lot of research went into studying other healthcare quality management systems and this is available on their website. But my point is different. My curiosity was related to the building blocks of the standards. If one were to understand these principles and imbibe these in their hospital operations, one should be able to have a functional quality management system (QMS) in their hospital.

With this thing in my mind, I undertook a research to identify such building blocks or founding principles in the NABH standards for hospitals. The outcome of the research led to eleven points which I intend to share here. This is, of course, my personal observation and based on my limited knowledge of a quality system that has been developed by pooling the knowledge of many experts. However, I shall make my attempt at identifying the principles. According to my research, the building blocks, or principles, of the NABH-QMS are:

1. Professional and ethical governance: The NABH QMS requires the management to be aware of its responsibilities and applicable statutory requirements as well as be ethical in delivering its duties. Professional governance ensures that knowledgeable and competent professionals run the organization which ethical governance ensures that the organization’s leadership always follows the right path.

2. Standardization of administrative and clinical processes: Like any QMS for other industries, NABH also demands that the healthcare organizations should have standard operating procedures for their administrative and clinical operations and these are documented. Standardization is critical to ensure that all patients experience the same level of service and care.

3. Patient awareness: NABH’s QMS focuses on making the patients and their families participants in the care delivery process and in enabling them to take sound decisions about the patient’s treatment. That is why there is a lot of stress on patient information (in language they can understand), consent processes and primary consultant’s role in explaining the medical problem, treatment plan, risks and alternatives.

4. Uniformity of care: Healthcare being a service industry, customer experience is of utmost relevance. Think, for example, about buying a burger at Mc Donalds, calling up the call centre of a bank, booking a flight ticket on any website or watching a film at a multiplex. Every consumer of their services needs a uniformity of experience. In the healthcare set-up, while one may standardize the processes, it is the medical professionals who deliver care. The NABH QMS requires doctors, nurses, technicians etc. to use their skill-sets equally well for all the patients without any differences because of bed category or background of the patients. The uniformity of care is a matter of attitude.

5. Compliance to laws and regulations: Almost all aspects of healthcare delivery are covered by one law/regulation or the other. So many licenses and permissions are required to legally run a healthcare facility. If one or more of these statutory requirements are compromised or are absent, it leaves scope for the organization to follow un-recommended practices which may not be in the interest of the patients. Hence, statutory compliances carry a lot of weightage in NABH QMS.

6. Patient safety: Safety of the patient is paramount and systems and processes have to be built to minimize or eliminate any risk to the patients. If at any point you are confused about more than 1 ways of doing things in a hospital, always ask whether that method can ensure patient safety. If the answer comes ‘no’ for a method, scrap it with no second thoughts.

7. Staff training: When we have talked about standardization and uniformity, it is quite logical that those who deliver care and carry out the various processes should be trained through a common programme that brings about the focus among the employees about following SOPs and their duties and responsibilities. NABH QMS recommends a strong training system for employees to ensure everyone is on the same page.

8. Measure performance: Another characteristic of a QMS is measurability of its performance. NABH achieves this through the clinical and managerial performance indicators. The data or the indicators give a sense of the health of the quality system and the performance over time can be compared.

9. Monitoring mechanism: To create a robust system, we need to have proper checks and balances in place. The corrective and preventive action reporting makes it easier to capture the system’s response to any deviations from the standards.

10. Pro-active risk management: This principle relates to the patient safety and focuses on identification of risks and pro-actively managing them. The standards on prevention of healthcare associated infection and facility management highlight the need for a pro-active action in dealing with these elements of healthcare delivery.

11. Continuous quality improvement: This principle is the sum total of the outcomes of the above mentioned principles. The overall goal of a QMS is not to stop at a particular level of quality. Rather, its goal is to question the status quo and search for better ways of doing things. By continuously training our people, measuring our performance, monitoring our processes, communicating with our patients and following professional standards, we stand to achieve improvements on a regular basis.

As you would have noticed, there is a lot of overlap among these principles and that ensures these are locked together. 


  1. keep up the good work Sir. quite informative.