Need for Self regulationAccreditation framework,

patient satisfaction

Dr Ketan ParikhConsultant Paed Surgeon & Paed Laparoscopist;

Jaslok, Nanavati, Hiranandani Hospitals

Tara Neo-Surg Hospital,Mumbai, INDIA.

Past President: AMC; Convenor HCAC.

Indicate a society which is marching ahead in all fields and we the ‘cream of the society’ cannot be far behind, should not be far behind.

India – a global power

India Shining

Health – a priority social need Health care is an important part of social

needs and alongwith education, possibly falls in the 2nd list of high priority issues of the society after ‘roti, kapda aur makaan’.

the society also has a right to a quality health care institutions for their health care needs.

The initiatives to address quality of health care have become a world wide phenomenon and India cannot remain far behind.

Health care is a very specialised field where quality standards need to go far beyond just granite flooring and marble windows.

Aspects of health care -The doctor - qualified/ unqualified - MBBS or specialist - which field of specialisation.

Whereas India can boast of top quality medical expertise, it is necessary that the medical institutions complement this

medical expertise.

Aspects of health care

The hospital:the other staff –qualified or else?

The infrastructure-investigative, support services like blood bank, canteen etc. (star rating of hotels )

The equipment? The capability of handling emergencies.

Safety is priceless. Levels of Perfectionism have no limits but

every level has its price. And some one has to pay this price.

Standards of care vary according to the speciality.

In a country where 60% of the population seeks health care from private sector and where almost 90% of this self-financed,

expenses on standards and safety have to be judicious and need based

In practical terms, a laminar flow disinfection is desirable in every surgical O.T. but very important in theatres for joint replacement, neurosurgery and cardiac surgery.

A bacillocid hand disinfection may be desirable on every patient cot in ICU but may become very expensive for routine general ward patients.

As a group of highly qualified and respected institution, the medical professionals are likely to be averse to standards being set by some external agencies.

This brings us to the concept of self-regulation or accreditation.

This regulation should aim to bring quality health care within the reach of all.

Accreditation

It is a process of external peer review for determining compliance with a set of standards which are higher than the minimum standards or the licensing process.

Its approach has to be based on the belief that hospitals should be safe places in which professionals should practise and patients should be cared for.

A process by which a patient has the confidence that he is in a setup which can adequately take care of his condition without paying for superficialities which he cannot afford.

In simple words, it should be value for money.

The self regulation system which we should devise has to be tailored for the needs of the country and the society rather than imitate a system prevalent in the west.

It needs to be designed and defined by the local medical professionals.

Unfortunate that the Indian govt which is for the people, by the people and of the people of India, has promoted a health accreditation system for the non-Indians since the NABH accreditation system is aimed at making our hospitals capable of handling medical tourism.

A desirable accreditation process:

Should be voluntary Should be self-governed by a peer population. In a country like India where cost matters, it

should have levels or grades.even the US accreditation system went through the 2 earlier phases of minimal and then optimal standards.

It should be dynamic It should aim to give quality health care to the

INDIAN population.

Every institution has a front panel which is easily seen by the patients and a back panel which is possibly more important for ensuring quality care.

The accreditation process should identify the essential and desirable aspects of this back panel and recognises the same when present.

Accrediation process needs to ensure the following:

– Safety mechanisms e.g. adequate emergency measures

– Adherence to essential systems e.g. autoclaving, fumgation etc.

– Adequacy and appropriateness of staff.

Miscellaneous aspects

Patient satisfaction Transparency of billing system and charges Recognition of patient rights Adherence of public health norms. Encouragement to patient and public health

education.

Advantages of accreditation

Ensures quality of health care. Permits the patient to choose his level of

care. Identifies quality adherence in an

institution. Stimulates an environment of improving

quality standards both for the society and the health care industry

Advantages…

Recognises quality Justifies costing Protects from over-expectation. Medico-legal guidelines. Stimulated improvement in quality

standards.

Win - win situation

Accreditation would thus protect the consumer and the provider.

It would provide the judiciary with a benchmark to base its judgements.

It would also facilitate the insurance sector to stratify their liabilities.

Thank You.

Only when the medical profession takes an active and purposeful initiative towards self –control and setting standards, would we be justified in rejecting the non-essential standards set by other agencies.