The genesis of NABH lies in medical tourism. With rising costs of medical treatment world over (US spend on healthcare is more than India’s GDP) India has come up as an attractive medical tourism destination. But the ‘spoke in the wheel’ was poor perception about our Infrastructure & hygiene standards world over. To bridge this gap NABH was formulated. NABH is in line with global standards & protocols & strives to produce global outcomes. As per Dr. Giridhar Gyani (Director AHPI) NABH standards mainly focus on 2 things- Patient safety & quality of care. All the systems, processes & practices advised by NABH, monitor & measure critical outcomes & in turn improve clinical indicators.
Medical tourism which is about $3 B today is expected to be a $ 7-8 Billion market by 2020. Just to put in perspective our government spends $ 30B on healthcare.
Why go for standards in general & NABH in particular…
After talking to quite a few Hospital managements, it was found that there are 4 main reasons why hospitals wish to opt for NABH accreditation.
- Hospitals felt that the care outcomes were not up to the professional standards. The urge to improve the level of care-giving propels the hospitals to go for NABH accreditation.
- In the competition eco-system some institutions (Hospitals) are perceived to be successful & market leaders. Since the leader is accredited to some standard, the other institutions in the eco-system mimic the leader.
- At times there are coercive impulses from other organizations like government or other organizations on which a focal organization is dependent, which forces the institution to adopt accreditation. For instance in a hospital chain if a tertiary organization is accredited & follows a set of standards, then primary & secondary care institutions of the hospital chain too follow the suit & get integrated, so that all the components of their eco-system are compatible with each other.
- NABH is aligned with IS-Qu & AS-Qu which are international standards. Thus NABH accreditation is perceived as a necessary pre-condition to enter into medical tourism ecosystem.
One of the first internationally used quality management standard to come to India was ISO: 9001. It was used to standardize & improve the services given to the customers. However ISO certification helps in consistency in production & services dispensed by an organization. It does not address clinical outcomes & safety issues; these factors directly determine the quality of services of a hospital.
Here comes NABH.
NABH standard is a third party accreditation standard in India, which provides frame-work for quality of care for patients & quality improvement for hospitals. It helps to build a quality culture at all levels & across the functions of the hospital. NABH comprises of 102 standards (set of structures & processes) & 636 objective components (a parameter which can be measured on a rating scale). In order to be NABH accredited hospitals have to demonstrate to NABH assessment team that all NABH standards as applicable are followed.
Nurses & para-medical staff is the back-bone of NABH. NABH accreditation requires them to be trained & empowered. These care-givers play a dominant role in sustenance of NABH.
Issues with NABH
Despite the obvious advantages which the hospitals will have with NABH accreditation, hospitals appear shy of acquiring them. Till 2015 only 295 hospitals & 49 SHCOs were NABH accredited. More importantly a few HCOs could not renew their accreditation (after receiving it) & their NABH accreditation stands withdrawn. Many a times this leads to disastrous consequences. A case in point is SUM hospital Bhubaneswar; a major fire took place over there in October 2016, which killed 20 people & injured 105 others.SUM hospital had lost its accreditation 2 months before the incident took place. It was found lacking in overall compliance especially in areas of Patient safety & overall intent. It is another matter that despite this the Hospital was promoting itself as NABH accredited one.
Roadblocks to NABH
There are both physical & mental constructs which act as road-blocks to NABH accreditation. We try & deconstruct a few of them.
- Most of the 30 + bed hospitals have some form of HMIS software. Ideally a HMIS should take care of administrative, financial & clinical aspects of Hospital operations. While most of the HMIS systems in the market cater to administrative & financial aspects, the clinical information is still recorded & retrieved manually. NABH on the other hand deals with a lot of Clinical trigger points (like incidence of medication errors, ADRs, incidence of Urinary tract infections & surgical site infection rate). Hence the evidence which needs to be put for NABH assessment is usually documented manually. This is cumbersome & time consuming & needs to be automated.
- Awareness of NABH has not been sufficiently drilled down to patients as yet. NABH accreditation is viewed by hospitals as something on their wish-list, but not mandatory.
- Most of the times the HMIS used by small hospitals is made by a local vendor. NABH compliance is not integrated with HMIS. More often than not fearing competition the HMIS vendor locks his system preventing any third party system to plug-in. Thus HCOs are compelled to maintain NABH documentation in a stand-alone system.
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List of abbreviations:
- NABH: National accreditation board for hospitals.
- HMIS : Hospital management & information system
- HCO : Healthcare organization
- SHCO: Small healthcare organization. Having capacity equal to or less than 50 beds.
- SOP : Standard operating procedure
- OT : operation theatre
- UI : User Interface
- WOCCOT: Work flow, collaboration & communication of things. It’s a software solution.