Recently I was having a
discussion with my fellow quality consultant, Parul, about our experiences in
NABH implementation and some of the regular challenges we face. One of the
things on which we both had the consensus was the fact that the hospitals still have
not realized how quality and accreditation impacts them today and tomorrow.
The journey for accreditation
begins with the organization and its management affirming its faith and
commitment to quality. Quality is a way of life and it requires some difficult
choices to be made on how we will do business and how we plan to serve our
clients, i.e. patients. Quality demands that the compromises that an
organization has been making till date need to be removed. Quality expects each
individual to follow highest standards of professional conduct and comply with
the established policies and procedures. Compliance with quality requirements
ensures the organization also complies with all the statutory and legal
requirements. Quality provides the overall framework for organizational
operations.
At the time of accreditation, a
hospital and its team temporarily gets into an energized state and somehow
achieve the compliance. At times they are backed by skilled quality consultants
who provide appropriate advice to the management, thereby simplifying the
accreditation process. But the real challenge begins after your hospital
receives accreditation.
You would start displaying the
NABH logo in all your brand communication and you would highlight that you have
cracked the tough NABH accreditation in your marketing programs. But if the
necessary culture has not been established and your staff is not actually
committed to quality, slowly but surely non-compliance will set in. The
infatuation with the accreditation will be gone and the hard reality will arrive,
i.e. it is extremely difficult to follow the standards if you do not believe in
them and that you don’t have the necessary culture to support quality
improvement.
The surveillance audit after 18
months from the date of accreditation will be the real test of an
organization's ability to sustainably implement and maintain NABH standards.
Let me also bring another reality
check here. The standards themselves keep undergoing transformation. The NABH standard
for hospitals is in its third edition and other standards are also under
revision. In due course of time, the standards will become stricter and the
quality processes are expected to mature as the standards mature. Again, if the
ownership for quality is missing among the staff, the organization will fall
flat in re-accreditation audits.
Therefore, it is advisable that
an organization should not hurry into its campaign to achieve accreditation. Rather,
it should apply thought on why it needs accreditation and what is its
commitment. Is accreditation just for the show, or is it a business decision? Are
you committed to upgrade your processes when the standards undergo revision? Do
you have the requisite organizational resources to ensure compliance with the
standards in the longer run, or are you in only for a short run?
