NABH 3rd edition presentation (ppt) for training

From today the new revised standards of NABH for hospitals come into effect. This requires the HCOs to gear up for the new requirements posed by the standards and equip themselves to successfully comply with the requirements stated in the NABH 3^rd edition for the hospitals.

Training is an integral part of preparation for the accreditation and complying with the standards. With this view, I updated a presentation which is mostly available for download on the internet. The current edition has 102 standards and 636 objective elements. The presentation contains the standards and the objective elements but not their explanation. The trainers can refer to the standards book for the explanation and remarks.

In case you identify any errors in the ppt, kindly bring it to my notice. 

NABH 3rd Edition Presentation

If you can't download the file from Scribd, you can download the file from Google Docs. Refer to the link: http://bit.ly/N87eId

Upon clicking the link, you would reach the Google Docs page. On the menu bar on the top-left, you would find a tab 'File'. When you click the tab, a drop-down will appear with the 'Download' option at its end.

An interesting case for better patient communication

I happened to visit a hospital XYZ today and went to meet an acquaintance in the Customer Care department of the hospital. As I was speaking to my friend, a patient came to her office. He showed his reports and told that he’s been admitted in the hospital a few days back and wants to show his reports to his consulting doctor for a follow-up. He was visibly anxious considering the health condition he was going through and, he claimed, he had to travel 30 Kms to come to the hospital.

He came to complain that he wanted to meet his consulting doctor but the receptionist is asking him to show the reports to a ‘junior doctor’. He also wanted to consult doctor ‘M’ in another specialty for a different health problem. He had called the previous evening to the reception and was told that he can meet the doctor today (Saturday) at 1 PM. But after coming to the OPD today, he was told that doctor ‘M’ is not there today. He was upset that nobody understood his concern and was made to unnecessarily visit the hospital without any chance of meeting both the consultants.

Upon enquiry by my friend, it was found that all the appointments for his consulting doctor were booked and he could take his chances of meeting the doctor as a ‘walk-in’. Since there were already a lot of patients waiting as walk-in, the reception thought it better to send him to meet the ‘Associate Consultant’ who would be able to give an advice. In the other department, doctor ‘M’ cancelled his plans of coming to the hospital today morning only and communicated to the reception.

In both the cases, the patient held the receptionists responsible for his troubles, whereas the fact was that in both the cases, either the appointments were not available or the doctor himself cancelled his plan at the last moment.

So was there a mistake at the receptionists’ end?

From my own experience of managing the out-patient departments, I have come across such situations time and again. When one enquires, one finds that the receptionists have acted for the benefit of the patients but end up getting the blame from the patients. So where exactly is the problem?

The devil is in the detail. Many patients like their doctors to decide on the course of their treatment on their behalf because of the trust factor and lack of their inherent knowledge. But replace the doctor with the administrative staff and the patients’ attitude change. They like to be informed completely and properly about ‘what is happening in the back’. Rather than simply giving one line instructions to the patients, administrative teams are expected to provide more details to the patients for them to decide for themselves what their best options are. Patients generally don’t trust administrative staff to decide on their behalf, whatever may be the intention. So the more you communicate, the more your avoid patient complaints.

In the first case, the receptionist should have clarified the context to the patient by telling him that there are no appointments available. While the patient believed he has been asked to meet a ‘junior doctor’, the receptionist should have explained to him clearly that he’s meeting an equally qualified consultant because his own consultant is not available and that she’s trying to simplify his problem. If the associate consultant finds any problem with his reports, he would definitely refer him to meet the consultant immediately.

In the second case, rather than only telling that doctor ‘M’ will not be available today, the receptionist should have first apologized for the inconvenience caused to the patient (of course she is apologizing on behalf of the doctor). Next, she should have explained that his information is correct and it was provided by the reception only. But due to some unforeseen circumstances, the doctor cancelled his OPD visit today, which they came to know in the morning. This should be followed by offering a few options to the patient, like a consultation with another doctor or an appointment for another day with an assurance to give a confirmation call to him on the morning of the appointment day.

Will falling rupee give fillip to medical tourism?

Last few months have not been good for Indian currency and it has seen constant beating. At over 57 for each dollar, it has lost its glory of the past years. India’s oil imports are also adding fuel to the fire of rising inflation. However, many pundits believe a weaker rupee is good for India’s exports as our companies and Indian products and services become attractive again to the western buyers.

In this context, it should also be a good news of Indian healthcare businesses because the affordability for the foreign patients would increase for getting treated in India. I am particularly not sure whether currency plays any role in a foreign national’s decision in taking treatment in low-cost medical destinations. There may be other factors too, like the perception of the country, local support for the foreign citizens, language support, expertise in the health domain for the hospitals etc. But if at all someone is price-conscious and have a favourable outlook towards India, I think it is a good time for that patient to look at getting treated here.

Another aspect is the turmoil in the Euro-zone. Given the fact that many European countries are struggling bankruptcy and jobs are at risk, affordability of healthcare would also become a major concern for some countries. I think there also the scope of medical tourism can be explored. One website claims that the medical tourists stand to save up to 75% of the cost of similar care in their own countries because of the weak Indian currency.

What are your views on this matter? Do you think currency and exchange rate matter when a patient decides on taking treatment? Have you experienced an increase in inflow of foreign patients in your hospital in the recent times because of the currency fluctuations? Does a weaker currency also benefit Indian healthcare providers in another domain?

New added objective elements in NABH 3rd Edition (Revised) with self-assessment toolkit

As I discussed in an earlier post, from July 1st, hospitals are required to comply to the revised NABH standards covered under 3rd edition. The quality professionals can download the new self-assessment toolkit or checklist from NABH website itself using the following link: http://bit.ly/MZngaC

The revised edition has come up with new requirements and you would like to have a quick glance on the new objective elements. So we have done a comparison of the 2nd and the 3rd edition and identified the new objective elements.

Readers are advised to follow the link below to download another version of the self-assessment toolkit where we have marked 'Yes' against the new objective elements. You can reach the download page by clicking here.

Upon clicking the link, you would reach the Google Docs page. On the menu bar on the top-left, you would find a tab 'File'. When you click the tab, a drop-down will appear with the 'Download' option at its end. 

HospiArch comes home in Bangalore in August

Are we serious about Performance Appraisals?

In the upcoming conference PeopleHosp on the issues pertaining to human resource management in healthcare industry, one of the topics for discussion is performance appraisals. Having spent couple of years in IT and healthcare industry, I belong to the category of cynics for the relevance of performance appraisals. This is not to mean that I do not believe in performance appraisals. My disappointment is with the way appraisals are carried out. In our corporate scenario, both appraiser and appraisee are clueless about the concept of performance measurement and performance management. Appraisals are thought to be an activity which has to be performed during April-May and are seen as a burden and not as a performance improvement exercise. Most people would agree with me that, as employees, we have lost trust in the appraisal process because our managers never set performance goals on time, they are not clear about how to measure the performance itself, ratings are seen as a subjective indicator of the satisfaction or dissatisfaction of the manager with his juniors and favouritism is a norm rather than being an exception.

So what can be done to respond positively to this situation? Can something be done to transform performance appraisals as an employee motivation exercise?

As you would have noticed, primarily the organizations need to drill down the concept of performance linked to organization’s goals at every level. For doing that, the company leadership should have goal-setting exercises during February-March of the year so that it sets the direction for goal-setting for the individuals down the hierarchy.

Another important aspect here is for the managers to understand the job description and scope of the work of their subordinates. The performance goals have to be set ultimately in the scope of the work of the subordinates. This is where the HR comes into sharp focus. Each year the HR should engage the managers in a discussion to re-emphasize the concept of job descriptions. The scope helps the manager and the subordinate to understand whether the performance was as per the expectations or not and in which aspect did the subordinate performance outstandingly. No work outside the purview of job description can be seen as exceeding expectations because it may not be useful to company goals. For example, if person X does person Y’s job, it can’t be said that person X did more work, rather it was the inability of the manager to get the work done from Y. in the instance that Y was not able to function, say because of medical leave or pregnancy, then one can appreciate X for taking the burden of her colleague.

Most organizations follow the bell-curve (normal distribution) or the forced ranking method for rating their employees. Again, most employees don’t understand how it works and even HR people lack confidence in explaining the functioning of the method. Forced ranking method requires that each individual in a unit/department be compared to each other (forced comparison) and then a descending list of performance is prepared. So if there are 20 employees in a department and all happen to be great performers, still the manager has to arrange their performances in a descending order. How you do it is the trick. The manager and the HR have to carefully develop metrics that can objectively measure the performance of these set of people and arrive at a score. These scores can then be sorted in a descending order.

The normal distribution concept of appraisals relies on the fact that the organization has a pre-set budget to award compensation and increments to their staff. So the quartiles are identified and linked to increments. Therefore the 25^th percentile may get the lowest increments and the 75^th quartile may get the highest increments. The organization may also be using the concept of percentiles. So the 10^th or the 20^th percentiles get the lowest increments and the 80^th or the 90^th percentiles get the highest increments. Since the performances have been converted into a score and ranked in a descending order, identifying the employees who fall in which quartile or percentile is easy. What is difficult is to explain to a well-performing employee on why he has to be in a lower percentile even when his/her performance was very good. Probably that is where the HR needs to take efforts in explaining to the employees in advance how the forced ranking system works and what is the company policy in deciding the percentiles, the rationale behind it and the method of computing the same.

If we look at the situation from the NABH standards perspective, HRM 5 (Chapter 9, Human Resource Management, 3rd edition) also deals with performance appraisals in detail, requiring that such a system exists in the organization, employees should be aware of this system, pre-determined criteria for performance evaluation should exist and the evaluation should be carried out at pre-defined intervals and should be documented. Therefore, performance appraisals are linked to quality healthcare set-up in hospitals as well.

From my own experience, I have found that a communication in advance with the employees on performance goals, measurement technique and percentiles linked to company’s increment policy can reduce the heart-burning to a large extent when certain good performers have to be pushed down the percentiles because of the forced ranking.

We would be attending PeopleHosp in Bangalore on July 4^th, 2012. Hope to see you there. Talk to us and we’ll be happy to get you discount for attending PeopleHosp in Bangalore.

Statutory compliances as required under NABH

In an earlier blog titled 'The impetus on statutory compliances in NABH accreditation', I had discussed briefly about the categories of regulatory and statutory compliances required under NABH accreditation for a hospital. If you refer to the page 12 and 13 of the NABH Application Form for hospitals (item 19), you would find a list of applicable statutory / regulatory requirements for a hospital. The same list is regenerated here as:

You can download the source file by clicking here.

AMEN presents PeopleHosp - a Conference series on Strategic Human Resource Management for Hospitals

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. 

@DirectNABH - Follow NABH's Director on Twitter!

Recently I came across an interesting entity on Twitter. It happened to be the Director NABH's twitter page. The page has been active since February this year and 40 tweets have been posted on the page. While the tweet messages are 'textually' short, they are great words of wisdom for quality professionals.

Whenever you have time, do visit their page https://twitter.com/#!/DirectNABH and if you happen to be active on twitter, make it a point to follow it. You can tag him using @DirectNABH.

The latest tweet reads "Patient safety should be a top priority even with excellent care programs, state-of-the-art diagnostic equipment, and dedicated physicians." This surely is a useful advice!