NABH guidelines on OT air-conditioning: NABH HIC 2-J

The updated guidelines on OT design are available on NABH website and readers can refer to the following link to apprise themselves of the requirements.

http://qcin.org/nabh/documents/OperationTheatre/Operation-Theatre-Guidelines.pdf

Hope this is of use to the Quality professionals.

NABH Chapter 5 – Hospital Infection Control (HIC): Some references for making the Infection Control Manual

As part of NABH chapter HIC standard 2, there is a requirement for Infection Control Manual and the standard gives detailed guidelines on the components of the manual through its various objective elements. It also suggests CDC’s guidelines as good reference material for various infection control practices and areas.

Centre for Disease Control and Prevention (CDC) has specific guidelines for each kind of high-risk area to prevent Healthcare-associated Infections, or HAIs. Get CDC’s definition for HAIs here: http://www.cdc.gov/hai/

Get all the information about CDC guidelines for Infection control by visiting the following page: http://bit.ly/OaRTqZ 

More specifically, CSSD related guidelines, as suggested in NABH HIC 2F, are available in the CDC guidelines for Disinfection and Sterilization in Healthcare Facilities, 2008 at the following link: http://bit.ly/OQD64S

If you have time, you can also watch this 2 minute video in which Dr. Denise Cardo, Director of the Division of Healthcare Quality Promotion, CDC, speaks about HAIs as a threat to Patient Safety and how we can respond to this challenge.

WHO ‘Safe Surgery Saves Lives’ Checklist: NABH COP 14

While dealing with care of patients who are undergoing surgical procedures, NABH recommends hospitals to refer to WHO ‘Safe Surgery Saves Lives’ Initiative. In this post, I bring to you a complete detail around the initiative and the checklist. This is also an important example that Dr. Atul Gawande quotes in his book – ‘The Checklist Manifesto: How to get things right’ and is one of my favourite books.

All the references are from the WHO’s website.

You can read an overview of the checklist on this page: http://bit.ly/OgsVIH

You can have a look at this 19 pointer checklist on the 20^th page of the pdf available on this link: http://bit.ly/NStgEM

I am sure you will have a lot of questions on what this checklist is all about and how to use it and is it applicable in your hospital. Don’t worry, WHO provides answers here: http://bit.ly/MtqbcY

And if you want to get a feel of how to do this checklist, watch the video below:

I’ve shown this video to 2 different audiences and both agreed that this checklist is short and crisp and can take care of a lot of elementary goof-ups that happen in their OTs and enhance patient safety. If you noticed, it doesn’t take more than 2 minutes each time you do the checklist. I think that’s time worth spent in protecting our patients.

Update on 30/08/2013
Based on a viewer comment, I felt there have to be other illustrations and videos for Safe Surgery Checklist which helps in better understanding of its implementation.

Below is a video from a hospital in Australia where a patient is undergoing Hip Replacement procedure. This one has the Pre-Incision (Time-Out) and Post-Procedure (Sign-Out) shoot only, but in a better detail.

This is another video from St. John of God Hospital in Australia. This one has two-part, the first one about how to do the Safe Surgery Checklist, and the second one about how not to do the checklist.

NABH COP-5: The new standard on nursing care

NABH 3^rd edition has brought with it a host of new requirements and probably gives a hint on what to expect in the years ahead for quality accreditation and Indian healthcare. There’s this new standard COP-5 on nursing care and I found one objective element, i.e. COP 5G, of particular interest. The statement of the objective elements is “Nurses are empowered to take nursing-related decisions to ensure timely care of patients”. The interpretation says “Self-explanatory”. And I always thought that nurses are required to only follow orders!!

This standard requires nurses to prepare their own ‘Nursing care plan’ for each patient. I wonder whether we have adequate teaching standards in our nursing schools and colleges where they can teach clinical discretion to the new generation of nurses because most nursing superintendents I meet always crib about the quality of new nursing workforce.

I guess this ‘nursing care plan’ requirement will increase the expectations and work load on the already overloaded nurses in our hospitals. And can anyone please explain to me, what is the scope of ‘nursing-related decisions’ in COP 5G, and if these decisions are anyways related to nursing, why do we need to empower them?

My personal knowledge is limited in this aspect of patient care and I have no idea about the nursing protocols. But whatever I have observed, I think nurses are supposed to follow the orders of the doctors as well as manage the care plan for the patient developed by the doctor (in his absence). When we speak of empowering nurses in nursing-related decision making, how can I make sense of it? Knowledgeable people on this topic, please guide me with your comments.

Patient Safety – The Johns Hopkins’ Way

One aspect of patient safety is to involve the patients and their family members in the care delivery process. When they are involved in their care delivery, they tend to recover faster and remain safer. This is what Dr. Peter Pronovost of Johns Hopkins Hospital shares with us through a Patient Safety video created by the hospital. The video below fantastically points out ways and means by which patients can be engaged in their care delivery process and how this can help in better clinical outcomes. As you watch this video, you will come across some common, yet powerful, ways of patient safety.

Dr. Peter discusses 4 ways by which the patients can get involved. These are:

• Ask Questions: The patients should ask their care givers questions about their health, treatment plans, day-to-day treatment activities and anything else they need to know.
• Provide Accurate Information: By providing accurate information about their medical history and any kind of medications they have been taking, patients help the care givers ensure that the current medications patient is taking do not interfere with the medicines they are going to prescribe.
• Speak Up: The patients are encouraged to speak up and inform the care givers if they think they are being given the wrong medications or something about their treatment is wrong. They can even ask care givers about whether they are following hand hygiene.
• Follow the Plan: The patients are advised to follow the treatment plan prepared by their care givers and take their help whenever required.

I believe this has a lot of relevance for Patient education in our healthcare facilities. Even from NABH standards perspective, these practices can be usefully implemented for compliance to chapter 4 – Patient Rights and Education. If you find this useful, please share your thoughts.

WHO 5 Moments: Some ideas for NABH Chapter 5 - Hospital Infection Control

While preparing for my training sessions on chapter 5 – Hospital Infection Control, I came across an interesting video on Youtube. The video has been prepared by DebMed Healthcare and covers the WHO ‘5 Moments’. The video focuses on Hand Hygiene and presents the idea in an interesting Rap where you will 5 boys and girls, apparently nurses, dance and enact various situations (5 Moments) where hand hygiene can prevent the spread of infection. Have a look at this short entertaining video!

Notice at 2:15 it is shown that the doctor doesn’t comply with the hand hygiene and the nurse stops him and sends him back to use the sanitizer.

While it may come as a cultural shock to Indian hospitals, the fact is that it is part of NABH compliance too. The latest NABH 3rd edition talks about Infection Prevention and Control. To prevent the infections from spreading, strict hand hygiene is a must. And I think it is a sensible organizational culture to have where each employee can demand compliance from every other employee.

Thinking about NABH implementation in your hospital? First observe the aviation industry.

During a recent NABH training session at one of our client hospitals, we got into an interesting discussion which generally happens in most hospitals that are planning to go for the accreditation. The point of discussion was: While one can get all the hospital staff to comply with the various NABH standards and requirements, it is nearly impossible to get all the doctors to follow the standards and protocols. They have such high egos and they do not listen to anyone. If you try and change their ways, either they blast you or they threaten to leave your hospital. It’s a waste to time to talk to them about quality and accreditation.

I have heard this discussion many times. I have been on the other side, been an administrator and heard such tales from one and all. A closer look at ‘Remarks’ in objective elements of many NABH standards will reflect that those elements require participation from doctors too. So whatever be the problem your hospital faces in convincing doctors, NABH wants you to get them to comply. So how should you tackle this issue?

To this group of audience, I gave the example of aviation industry. Most people in the audience had travelled by air and agreed with me that each one of them had to go through the mandatory physical check, baggage check, ticket check and many such little checks before finally boarding the flight. Even when someone was late for the flight and his/her name was being called, nowhere that individual was allowed to skip any of the security checks. And if you forget to carry your tickets or ID at the airport entrance, you won’t be allowed to enter the airport, forget entering the flight.

Even CEOs, bureaucrats and politicians, whatever may be their status, need to go through these checks. The pilots and the flight crew also have to go through checks and all these procedures are followed to ensure safety of everyone during the flight.

So my point is that if aviation industry can follow strict protocols for every human being involved, why can or should the hospitals not follow strict patient and staff safety protocols? The safety risks are much higher in healthcare because of the infection risks which can affect patients, visitors and the healthcare professionals alike.

I think we need to involve doctors in a dialogue without any pre-conceived notions about their willingness to participate in a quality program. If the benefits of engaging in a quality program are clearly understood, everyone, including doctors, would agree to go through the rigorous process of the accreditation and compliance to the standards thereafter. More than anything, conviction, patience and ability to connect with a varied set of healthcare professionals should be the hallmark of a Quality professional. Right outcomes are the by-product of the right approach.

Why Quality professionals do not become CEOs?

Very interesting question posted by Mr. Hoskote, Senior Director, Quality and Performance Excellence at Max India Group. I had the opportunity to explore the ASQ's online resources today and I'm amazed at the work the organization is doing in this field and that such a large network exists today.

I watched Mr. Hoskote's talk on ASQ's Facebook page: https://www.facebook.com/ASQ and those who do not access facebook, can watch this video on another interesting website from ASQ - Quality for Life... http://www4.asq.org/qualityforlife

Now the question is very pertinent to the discipline. Frankly speaking, he's very right that quality professionals miss the woods for the trees. The entire focus on process and its related aspects take them away from the requirements of business. For sure, all functions of the enterprise should align themselves to the basis premise of the enterprise, i.e. to make money for the share/stake holders. Nobody says that quality doesn't result into more money for the enterprise, rather, it generates more value. But the quality guys should be able to themselves see this impact and should be able to convey the same to the decision-makers in the organization.

In one of our client hospitals where we are assisting the management to implement NABH standards, there is a very clear understanding the management has that their hospital has to prepare itself for the needs of the patients of tomorrow and for that, it has to benchmark itself against a quality system like NABH and continuously strive to build their brand based on solid performance. The stronger brand would result into better business and higher margins for the hospital, apart from the goodwill it will create in the community.

I think quality professionals should take this message from Mr. Hoskote seriously and attempt to align their roles with the needs of the business of their respective healthcare organizations.

Quality in Healthcare - ASQ India

Recently came across this presentation by ASQ India (American Society for Quality) on Quality in Healthcare - Indian Scenario.

The presentation gives a peek into the Indian healthcare context and various quality paradigms like ISO, NABH, JCI, Lean, Six Sigma, Malcolm Balridge etc. which can be applied to healthcare.

Improving Healthcare Quality In India

View more PowerPoint from ASQ India

PeopleHosp Bangalore: Voices from the Conference

The conference on Human Resource Management in Healthcare, named PeopleHosp, was organized by AMEN on July 4^th at Ashraya International Hotel in Bangalore. The conference attracted HR professionals from hospitals from Bangalore and outside.

The conference opened with an interesting talk by Mr. Siddharth N, General Manager & Head HR for Cloudnine Hospitals, Bangalore. His topic covered a futuristic view on HR competencies required in healthcare. The presentation, made enjoyable with a healthy dose of cartoons, discussed some key challenges facing the industry, like training, retention, sourcing, lack of discipline among the new breed of employees, lack of English speaking skills among the prospective employees, professionalism, skill-levels, employability and ramping-up of operations.

He put forth questions on how to deal with a large employee-base who is required to deliver personalized care to the patients, how to design systems that ensure customer centricity at each employee level and how to ensure sensitivity among the staff on medico-legal aspects of their profession. In the end, he emphasized the role of HR in driving critical circuits in the organization, in being the advisor to the business head while managing the core responsibilities of the function, managing risk, creating change and making a difference to the enterprise. He signed off by proposing the ‘competency way of thinking’ for managing HR in healthcare.

Ms. Nagarathna A, Asst. Prof. of Law at National Law School – Bangalore, shared her insights on ‘Statutory and Legal issues related to HRM in hospitals. Dr. Navin Chugh, who heads Quality at Global Group of Hospitals – Bangalore, discussed the requirements of NABH quality standards applicable to HRM. He took up the discussion based on the latest 3^rd edition of NABH standards for hospital and provided suggestions to audience on implementing the standards and facing the audit. When asked whether doctors practicing alternative medicine (AYUSH) can work in an allopathic hospital through privileging, he cited MCI regulations and said that this practice is illegal and therefore will attractive non-conformance in an NABH Audit. He also shared the practice of daily quality rounds as a means to monitor process compliance in his hospital.

Ms. Reshma Lobo, Principal – Padmashree College of Hospital Administration Bangalore, gave a talk on ‘Manpower Requirement & Planning for hospitals’. The topic on training of hospital staff was taken up by Mr. Schreyas Nair, GM – Training and Development, at Fortis Hospital Bangalore. She explained the approach followed at Fortis hospital in ensuring that the staff is appropriately trained to work in the hospital. Her talk began with a discussion on finding out how the training fits into the agenda of the organization. This, she said, is achieved through an identity statement for the training department, which in their case covers aspects like anticipates requirements of the business, be a catalyst of change, contribute to performance excellence, have people focus and connect, raise the bar of excellence and enable the organization to fulfill its vision.

She explained that the training department plans its activities through a 4 step process, which involves training needs investigation, needs analysis, creation of training modules and creation of training calendar. One interesting insight she shared about training at Fortis hospital was the Nurses Leadership program. The program is undertaken for nurses who show commitment at their work and consistently excel among their team members. The nurses who undergo this program are selected to lead floor teams or even head smaller hospitals’ nursing teams. For their performance management, the balanced scorecard is used which even includes financial metrics. The metrics focuses on cost reduction through a reduced Average Length of Stay (ALOS). She highlighted the importance of nurses in implementing strict infection control processes, thereby reducing the overall risk to the patients and ensuring a lower ALOS.

Mr. Kiran Gautham, Dy. Director at Alliance University Bangalore spoke about strategies for effective selection, recruitment and employee retention. This was followed by a talk by Mr. Marian Jayson on ‘Performance Appraisals – Tools and Techniques’. His talk focused on managing performance in the organization and linking the same through a robust appraisal system where the superior performance is rewarded and a below-expectation performance attracts strong feedback and strict action. He also shared insights on ways and means for deciding KRAs (Key Result Areas) and KPIs (Key Performance Indicators) of various staff levels.

The conference ended with Mr. Ganesh Selvaraj, VP – HR at Manipal Health Enterprises, sharing his views on ‘Motivating today’s hospital staff’. His presentation was centered on techniques used at Manipal for motivating its employees. The methods which were employed by the company included staff-management interaction, employee engagement exercise, appreciating contribution by senior-most employees of the company at important events etc.

The conference successfully touched upon the various aspects of Healthcare HRM with the views of various industry leaders. The audiences were thoroughly engaged by the speakers and the question-answer sessions saw good participation from them.

The success of PeopleHosp in Bangalore has raised the expectations from the conferences which are going to be part of this series at other cities of India. The next edition is going to happen in Mumbai on August 29th.