eNABHle: Achieving NABH accreditation

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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.