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Widening Horizons for NABH

To cater to its growing demand, NABH would soon roll out a slew of initiatives to strengthen its functioning, says Rita Dutta

Seeing the reams of files awaiting inspection at NABH's office in Delhi, who would believe that the quality and accreditation wave in healthcare started in India only a few years back! With 52 hospitals already NABH accredited, 132 under process and over 400 applications awaiting response, there’s no denying that NABH accreditation has become a rage.

The swelling demand for an accreditation that comes under the purview of the quasi-Government body?Quality Council of India?is quite an interesting phenomenon. And to think that most of the board members are veteran administrators from private and public sectors doing honorary work and the assessors also don’t get major monetary benefit! But the most interesting development in recent times has been change of the old guard and constitution of a new board.

At the helm of the reconstituted NABH board is Dr Narottam Puri, President-Medical Strategy and Quality, Fortis Healthcare Limited, as the Chairman, NABH Committee, who has taken on the baton from Dr PK Dave, Chairman, Rockland Hospital, New Delhi. Dr Praneet Kumar, CEO of Integrated Health & Healthcare Services India, has taken on the mantle of Chairmanship of NABH Technical Committee from Brig Pawan Kapoor, Head of Hospital Administration, AFMC. Mumbai-based Dr Ravindra Karanjekar, Group Medical Director, Global Hospital has taken on the reins of Chairmanship of Accreditation Committee from Dr Nandakumar Jairam, Chairman, Columbia Asia, Bangaluru. Additionally, an Appeals Committee has also been newly constituted with Dr Uma Nambiar from Fortis SL Raheja Hospital, Dr K Verma from Malabar Institute of Medical Sciences, Kozhikode and Dr Anita Arora from Escorts, Delhi.

New Guard, New Roadmap

Dr Praneet Kumar

Dr Narottam Puri

Dr Ravindra Karanjekar

The dynamic new board members have already convened several meetings to roll out a few initiatives that outline its agenda for the next two years. The initiatives are:

ISQUA Compliance: After making NABH standards ISQUA (the International Society for Quality in Health Care) compliant in 2008, the technical committee is working on attaining accreditation of NABH from ISQUA. “This would ensure that NABH's systems and processes are compliant with an international organisation, thus guaranteeing better documentation and process orientation,” says Dr Praneet Kumar, Chairman, Technical Committee, NABH. It is expected that an ISQUA-accredited NABH would give a boost to medical value travel, especially from the US and the UK. “It would bring in more transparency and clarity in processes involved for medical value travel,” says Dr Kumar. So far, hospital standards of only 11 countries are accredited by ISQUA.

Building robust IT: Most Government-led initiatives are plagued by slow processes and lack of transparency. NABH wants to address these challenges by more effective use of IT. Explains Dr Narottam Puri, Chairman, NABH Committee, “Though the status of NABH registration can be viewed online, hospitals can neither apply nor get queries answered online. We also have a space crunch to stack all this paper in the office. Right now, the use of IT is very rudimentary. Going forward, we need a robust IT system.”

NABH is exploring the option of having dedicated software tailor-made for its accreditation, so that the entire process is documented and updating data is faster. It has already shortlisted a few vendors for this. Later, it may go in for analytical software and an MIS.

IT would also empower the accredited hospitals. It is planning to make a daily update of data on some key parameters mandatory for the hospital. “For instance, if updating an accredited hospital's score on HAI is made mandatory, then all hospitals would be made more accountable and responsible towards quality compliance. This would help hospitals get a snapshot of where they stand and enable them to learn from each other. It would also empower patients to choose the hospitals they want to seek treatment from by noting comparative scores on key parameters,” says Dr Kumar.

International Venture: The demand for NABH accreditation has gone beyond Indian shores. It has recently launched its international arm—NABHI or NABH International, similar to JCI of JCAHO. It has already signed an agreement with the Philippines Government to launch NABHI in Philippines. NABHI has also been approached by countries like Bangladesh, Pakistan and the UAE. About the rationale of launching its international arm, Dr Puri says, “These countries respect the clinical acumen of Indian doctors. We also get a regular stream of patients from these countries. So, we are tapping a business opportunity here.” Would the standards be the same for all the countries? “Depending on the country we are working in, we would tweak our standards,” says Dr Puri.

Strengthening Manpower: Besides some key devoted Government officials, NABH is mostly managed by people doing honorary work. To cater to the increasing workload, the board has decided to strengthen its manpower. NABH is looking for a full-time Director and an executive for him/her. “In the long run, we are also looking at a CEO,” says Dr Puri. As of now, Dr Giridhar Gyani, Secretary General, QCI, is officiating as the CEO for NABH. However, with QCI being a quasi-Government body, it has been a challenge to get good manpower at a Government salary.

Training Conclave: Learning is a continuous process and it is time for a refresher course for the 450-strong team of NABH assessors. “Out of 450 assessors, not more than 70 would be regular assessors and it is time that all of them undergo a refresher course, so as to keep them abreast of the latest NABH guidelines,” says Dr Puri. NABH is organising a training conclave to impart a refresher course, which would occur over three to five days, to its existing assessors. “The idea is to utilise the experience gathered over the last three to four years to further improve the competencies and skill set of assessors for an improved survey process,” says Dr Kumar.

It is planning to have two conclaves, most probably in cities like Delhi and Bengaluru. Would the course be mandatory for the assessors? “All assessors would be expected to attend the conclave. It is purely voluntary, however, those who attend will definitely have an advantage,” says Dr Kumar. This course is different from the NABH assessor qualifying programme, which occurs over a phase where the applicant progresses from being an assessor to observer to surveyor. “As of now, we are not proposing changes in the NABH assessor test. That continues to be as rigorous as before,” says Dr Kumar. Also, there are no immediate plans to hike the fees for assessors. “NABH assessment is a non-commercial exercise and hiking charges for assessment would be a travesty,” says Dr Puri.

Quality Journal: On the anvil is a periodical journal on quality, authored by experts in quality. “We need to collect data on quality and publish it. In India, there is a severe shortage of published data,” says Dr Puri. The periodicity of the journal is not yet decided. The budget for this journal has already been allocated by QCI.

Checklist: In the pipeline is a checklist for assessors. The checklist would be for various aspects like pre-assessment, final survey, surveillance, etc. “Though NABH guidelines are very detailed, we need to rule out chances of individual interpretation by assessors. For instance, one surveyor may be OK with one lapse, while another one may not be, and this often results in one institution getting accreditation and another not getting it. We need to devise a more standardised way of assessing the hospitals, which is above individual interpretation,” says Dr Kumar.

Self-Sustainable: Efforts are also on to make NABH a self-sustaining body. As of now, despite the rising popularity and workload for NABH, it is being fully financially supported by QCI. Already a directive has been issued to make every arm of QCI self-sustainable with a separate profit and loss account. “In the next two years, hopefully, we will able to achieve that,” says Dr Puri.

Other Standards: The present board is also working on standards for dental and wellness centres. The latter would cover gymnasiums, spas, skincare centres, cosmetic care centres, fitness centres, immunisation centres, executive health check-up centres with associated advice etc. These standards are slated to be launched by this financial year. Its newly launched standard for radiology centres has been well accepted. It has received applications from seven centres and a batch of 23 people has received training for the assessor course for radiology centres.

With a well chalked out strategy and a determination to take the quality movement forward, NABH would surely set new benchmarks on how committed people from both private and public sectors can come forward to make a difference.



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