October 23, 2008

Ensuring quality care through accreditation

Government hospitals in India have often been criticised and have typically been associated with overcrowding, overworked doctors, high rates of hospital acquired infection, which are avoidable and often fatal, and improper documentation. But some government hospitals are looking to change their public image and shape up their hospitals to run more efficiently and effectively with a focus on quality health care through accreditation.

The Quality Council of India (QCI), a quasi-government body, came up with standards for Indian hospitals called the NABH (National Accreditation Board for Hospitals and Healthcare Providers), which take the best of standards from countries like the US, UK, and Australia.
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While many private hospitals in India have become accredited, the QCI is now actively trying to get government hospitals across the country to get accredited as well, since public hospitals don’t have a framework of quality established within them.

Accreditation focuses on putting standards and processes in place that can help overburdened government hospitals run more effectively and efficiently. For example, the most important area for any hospital is infection control. A 2006 study by the WHO showed that rates of hospital-acquired infections in India are at approximately 25%. This means that 25% of patients who come to hospitals acquire infections other than what they were admitted for.

“Infections can be simply averted by washing hands between seeing patients”, says Dr. Narottam Puri, president of Fortis Healthcare Limited. “In most hospitals, washing material may not be available by beds, or the sink may be 50 feet away from the bed. This is a process fault.” This could be remedied by having sanitizers available at bedsides or sinks placed in close proximity to beds, he says. Dr. Puri says, 80% of hospital infections can be avoided by washing hands.

These are the types of processes and systems accreditation forces hospitals to put in place. While the NABH has a long list of processes and systems that need to be adhered to, accreditation looks at things like proper ways to sterilize equipment, how to handle biomedical waste, administration of medication, patient education, staff training, and fire safety, to name a few. NABH accreditation will also force hospitals to put regular data collection processes in place that will enable them to analyze data on things like hospital infection diseases and take corrective measures — something that most government hospitals don’t have in place now.

In India, only 20 hospitals have accreditation, all of which are private. The QCI is working with government hospitals in a number of states including Tamil Nadu, MP, Kerala, Delhi, and UP to get them accredited. The Gujarat government will be getting all its government hospitals accredited in a phased manner — the first state government to take such an initiative. The QCI also signed a Memorandum of Understanding (MoU) with the Delhi government a year and half back, and any hospital in Delhi that’s interested in getting accredited will be backed up with funds necessary to meet accreditation standards. This includes everything from staff, to infrastructure and equipment. Accreditation, however, is purely voluntary.

Dr. K.K. Kalra, Medical Superintendent of Chacha Nehru pediatric government hospital in New Delhi, is also undergoing the process of getting the hospital ready for accreditation. He conducts regular surveys to check the satisfaction of his patients and 90% of the patients routinely say that services they receive are good to excellent. Accreditation for his institution will spread the word wider and hopefully spur a quality movement across government and private hospitals.

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