Below is a whitepaper I had submitted for publication during a conference on Quality accreditation held in Pune.
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Till a decade back, hospital
accreditation was unheard of. National Accreditation Board for Hospitals and
Healthcare Providers (NABH) was established in 2006 to bridge this huge gap
between what the patients demanded and what the healthcare providers were
offering. NABH standards for hospitals (1st edition) began with 504
objective elements spread over 10 chapters and 100 standards and in its latest
revision (3rd edition) the NABH standards for hospitals have grown
to 102 standards with 636 objective elements. Accreditation requires a
healthcare provider to demonstrate its compliance to standards and after a
stringent assessment process they are given the accredited status. This assumes
significance in the light of the fact that till date only 138 hospitals4
in India have been able to achieve accreditation from NABH. According to one
estimate, India has about 40,000 hospitals of small, medium and large scale5.
Therefore, as per this estimate, not even 1 percent of hospitals in India have
NABH accreditation.
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We live in exciting times in
India. As an emerging market, India is at the centre of attraction of the world
and everyone is talking about India as the land of opportunity. Indian
Healthcare industry is one of the sectors of the economy which is leading this
exuberance. All major consulting companies, be it KPMG or PwC, estimate
double-digit growth figures for the healthcare industry for the next decade. An
IBEF (India Brand Equity Foundation) report of November 2011 estimates
healthcare industry size at US $280 Billion1, bolstered by rising income
levels, expanding middle class, an increasing appetite for premium services and
conducive policy environment.
In all this hoopla, it is easy
for anyone to miss the reality. The fact is that most investment in healthcare
in India is by private sources and a lot of money in flowing into building new
hospitals and adding more beds, given the low bed availability in our nation.
According to World Health Statistics, India has 0.9 beds per 1000 population,
way below the global average of 2.92. But most of this
infrastructure is getting built in the metros and tier-I cities of the country
leading to over-penetration in many areas. Most of this infrastructure is being
built at a high capex. The mushrooming of hospitals in urban centres has led to
an increasing competition among the various players. So on one hand, hospitals
are grappling with higher costs, on the other hand they also need to fight
tooth and nail with their peers to achieve moderate bed occupancy.
Indian healthcare also suffers
from systemic flaws which haven’t been fixed due to misplaced priorities by
both government and healthcare businesses. Even when the size of the industry
has become US $50 Billion3, standardization of quality of care still
remains a dream in our country. The pricing patterns even for common surgeries
vary extremely in the country. Not many patients would agree that they could
understand the processes or policies followed in the hospitals from which they
received care. Most hospitals do not provide clarity on the services rendered
by them and one can easily find examples of misrepresentation of services by
hospitals in most of the Indian cities. Indian doctors have also been blamed
for following unethical practices like prescribing over-medication and
unnecessary diagnostic tests to pocket commissions from pharma companies and
diagnostic centres respectively.
Visiting a hospital in India is a
pain of its own kind. One can easily observe poor inter-departmental
coordination and may even face eccentric rules and policies in a hospital. Most
hospitals, for the sake of saving money, compromise on patient safety. While in
the West, people are obsessed about preventing Healthcare-associated Infections
(HAI) and there are elaborate studies on the risks to patients because of them,
Indian hospitals are still sleeping over the issue. The biggest risk to
patients arises from the inexperienced doctors and untrained medical
professionals providing their services in our hospitals. Industry’s standard
excuse has been the high rate of attrition and the huge demand pressures
leading to compromises on quality of medical professionals. One can go on and
on in identifying the problems that the industry faces. Finally, it is the
trust of the patients that takes the beating because of these problems.
However, there has been a
paradigm shift in how patients today consume healthcare services. In the
internet age, patients are using social media to voice their opinions about the
quality of care they receive at the hospitals. The present day patients question
the treatment options offered to them by their doctors and many of them switch
doctors easily if they are not satisfied. Gone are the days when patients
trusted their doctors and hospitals with their eyes closed. The modern day
patients demand healthcare providers to demonstrate quality in their services
and deliver clinical excellence which is measurable and comparable.
In this scenario, accreditation
presents a unique opportunity to healthcare providers. Quality accreditation
can provide a sustainable competitive advantage to healthcare businesses if
they build their strategy around creating NABH standards compliant
infrastructure, policies and processes. A closer look at NABH standards
indicate that the standards promote adherence to global best practices of
healthcare delivery and there are detailed guidelines on measuring performance
of hospitals on pre-defined quality indicators. Through a systematic approach,
any healthcare business can achieve compliance to these standards. But it is
easier said than done. Accreditation requires an organizational culture change
which needs to be sustained for a longer period of time. A culture developed on
the bedrock of quality care and patient safety will provide utmost quality
assurance to patients and the community at large. Recent trends also indicate
that patients have become more aware about accreditation and they are basing
their choice of hospital on whether the hospital has any kind of accreditation
or not.
Given the fact that only
quality-focused hospitals will be able to achieve accreditation, it would
ensure that those hospitals will always remain on top of the preference list of
the patients. While the competing unaccredited hospitals may boast of great
infrastructure, good doctors and affordable pricing, patients will not risk
their lives with such institutions when an accredited facility is available in
their city. It is a commonly known fact that in the matters of health, patients
do not take their decisions based on the price of the treatment. Rather, they
base their decisions on the treatment style of the doctor and assurance of
better clinical outcomes. An accredited hospital would definitely enjoy an edge
over its unaccredited peers. Since achieving accreditation is not an easy thing
and an applicant may take couple of years to pass the NABH audit, this would
ensure that an accredited facility stands out from the crowd.
In conclusion, it can be seen
that there is a paradigm shift in healthcare industry in India. Accreditation
bodies like NABH will play a vital role in ensuring delivery of quality care
through the hospitals which are accredited by them. While there is an intense
competition among hospitals, ones which have received accreditation will be
able to provide greater assurance to patients about the quality of their care
delivery system, something which their unaccredited peers cannot provide.
Healthcare businesses need to have a strategy on leveraging accreditation to
convey their superior care system to the patients. Since not even 1% of hospitals
in India have received accreditation, this situation presents an opportunity
for healthcare businesses to establish sustainable leadership position in their
target markets by aligning their organizational culture and infrastructure to
comply with quality accreditation standards.
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Sources:
1. Healthcare Report by IBEF, November 2011, URL: http://www.ibef.org/download/Healthcare50112.pdf,
last accessed on August 8, 2012
2. The Times on India Online Article titled “India doesn't
have even 1 hospital bed per 1,000 persons”, October 2011, URL: http://articles.timesofindia.indiatimes.com/2011-10-10/india/30262811_1_beds-tertiary-care-aiims,
last accessed on August 8, 2012
3. The Economic Times Online Article titled “Indian
Healthcare to double size to $100 bn by 2015”, January 2011, URL: http://articles.economictimes.indiatimes.com/2011-01-28/news/28428766_1_healthcare-sector-private-equity-indian-healthcare,
last accessed on August 11, 2012
4. NABH, URL: www.nabh.co/main/hospitals/accredited.asp,
last accessed on August 15, 2012
5. Views on Healthcare Quality Blog titled “eNABHle:
Achieving NABH accreditation”, May 2012, URL:
http://ikureknowledge.blogspot.com/2012/05/enabhle-acheiving-nabh-accreditation.html,
last accessed on August 15, 2012
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