World Quality Month – November

This is the time of the year when global quality community across industries comes together to assess its journey in quality and to discuss the new milestones needed to be achieved in the future. We in Indian Healthcare are also on our journey, backed by the Quality Council of India and NABH, to improve the quality standards and improve the experience of care delivered to our patients.

The challenge that we face looks insurmountable: India is a vast geography, with about 40,000 hospitals of varied sizes and there are no common standards of care or practice followed in all these centres. The industry also has been blamed for many malpractices and this has strained the doctor-patient relationship to some extent and created a dent in the trust that the patients put in their doctor’s ability to heal them. Yet there is a silver lining in the clouds.

Industry has accepted to self-regulate itself and has shown commitment and enthusiasm in accepting the accreditation and NABH standards as a means to re-establish the faith of the patients in our hospitals. There are wider discussions now on the ills plaguing the industry and many inner voices are coming out to question the practices and find an acceptable solution for a sustainable future. The govt. is also playing an active role in positively regulating the industry so as to identify the black sheep from the herd. Then there are awareness mediums online which are enabling patients to take appropriate decisions about their health.

As hospital quality professionals, it is our responsibility to define our role in the broader context of our organizations and partner with the internal stakeholders in building consensus on implementing quality standards and continuously improving them as a means to achieving enhanced patient care as an end.

Let me also state here that NABH is one point of view on healthcare quality in India, and there is a scope of further opinions to co-exist with it. I remember talking to the CEO of a famous ophthalmic hospital in Bangalore and he was complaining that the NABH standards are not suitable for single specialty hospitals like his' who delivery community-care to the masses. Then there are other administrator friends of mine who manage smaller hospitals built 20-30 years back when the current building bye-laws were not there and there was no QCI. They find it challenging to comply with the contemporary accreditation standards.

My idea is simple. NABH accreditation is also a voluntary accreditation standard for hospitals and is based on the mutually agreed upon standards. There is a scope for similar such initiatives by various segments of the industry who might find it difficult to comply with the infrastructure requirements, but they can formulate standards which would guide and regulate their clinical processes. I must admit here that the care processes and infrastructure go hand-in-hand, but it is also true that many hospitals are not going the NABH-way because some of the standards are unacceptable to them or put their operations at risk. In such circumstances, a separate set of standards which are inclusive of this community’s requirements, yet firm on the clinical standards, would go a long way in main-streaming quality standards.

We are living in changing times as the healthcare industry embraces practices such as lean, six sigma etc. from other industries. There are some centres of excellence who have taken a lead in such newer practices, but a majority remains out of the network. The reason for this is that the success stories of a few have not been replicated in others and we lack professionals with implementation skills. We also have not ventured on peer-benchmarking to explore the opportunities for healthy competition.

I believe the future looks optimistic and our journey is going to be long and arduous. Therefore, we need to continuously work together and build bigger and more inclusive networks of healthcare quality professionals to bring innovation in quality standards and implementation strategies and also to award and appreciate thought-leaders in this field.