Improving Healthcare Quality In India


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Dr. Annabel D'Souza Sekar made this wonderful presentation at ASQ Bnagalore's event at Ramaiah Institute of Management on 8 Oct 2011.

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Improving Healthcare Quality In India

  1. 1. Quality in Healthcare – Winds of Change<br />Dr Annabel DSouza Sekar <br />MBBS, MBA, DBA (Switzerland)<br />Consultant – Healthcare, ASQ India<br />
  2. 2. Present Scenario<br />
  3. 3. Indian Healthcare Scenario<br />Unequal distribution of healthcare resources<br />Lack of strict regulation<br />Rising costs<br />Wide inequity in healthcare<br />Gender inequality<br />High cost of imported equipment<br />
  4. 4. Indian Healthcare Scenario<br />Change from government sector domination to private sector in the last 20 years<br />Large affordable middle class<br />Medical tourism on the rise<br />
  5. 5. Indian Healthcare Scenario<br />Revolution in India over the last decade<br />Increasing public awareness and private investment in healthcare<br />Complicated cases used to go to government teaching hospitals – now to tertiary care private hospitals<br />Achievement in quality in many hospitals on par with western standards<br />
  6. 6. The Government Sector<br />Commonwealth countries – British legacy<br />Used to be free – now charge nominal amount for higher end investigations like CT / MRI<br />Health insurance scheme <br />Tamilnadu, Andhra Pradesh, Kerala, Karnataka <br />Acceptance of people – ready to pay for quality healthcare<br />Public private partnership <br />Gujarat, Bihar, Assam, Madhya Pradesh – Fortis Healthcare and Government Hospitals<br />Incentives to medical and paramedical staff<br />Licences to smaller private hospitals to help the government deliver the goods<br />
  7. 7. Quality in Healthcare<br />India<br />
  8. 8. Quality in Healthcare Today<br />Domain of a select few<br />Corporate hospitals<br />Accreditation – NABH, JCI<br />Other private hospitals<br />ISO certification<br />Quality circles, TQM<br />NABH Accreditation<br />
  9. 9. ISO Certification<br />Documentation<br />No perceptible difference before & after<br />Marketing tool or strategy<br />Integrity is a “?”<br />WHO’s stand on ISO for hospitals<br />
  10. 10. Primary Health Centres (PHCs)<br />Cornerstone of rural healthcare in India<br />Targeted population around 25,000<br />Provides promotive, preventive, curative and rehabilitative healthcare<br />Also has Siddha medicine unit with a doctor and pharmacy<br />National Rural Health Mission (NRHM)<br />Indian Public Health Standards (IPHS)<br />
  11. 11. Accreditation<br />A self-assessment and external peer assessment process used by healthcare organisations to accurately assess their level of performance in relation to established standards and to implement ways to continuously improve<br />
  12. 12. Accreditation<br />NABH Accreditation<br />Joint effort between Ministry of Health and the Confederation of Indian Industry (CII)<br />105 accredited hospitals<br />447 applicant hospitals<br />Empanelled assessors, standards, inspection, certification<br />Separate standards for <br />< 50-bedded hospitals<br />> 50-bedded hospitals<br />AYUSH<br />
  13. 13. Accreditation<br />JCI Accreditation<br />International accreditation in 1999<br />Too expensive ($ 250,000)<br />Not practicable in our country<br />Standards are based on US practices, not on Indian practices<br />19 hospitals accredited as of date<br />
  14. 14. Dimensions of Quality Today<br />Infrastructure<br />Hospital acquired infections<br />Audits<br />Reactive rather than being proactive<br />
  15. 15. Where we are lagging behind <br />Quality of the processes<br />Quality of the clinical outcomes<br />
  16. 16. Quality in healthcare<br />Developed Countries – USA, UK<br />
  17. 17. Quality in the Developed Countries<br />Accreditation<br />Quality of the processes<br />Lean<br />Six Sigma<br />Malcolm Baldrige Performance Excellence Programme<br />Quality of clinical outcomes<br />Clinical audits<br />
  18. 18. Role of ASQ in India<br />
  19. 19. ASQ in India - Healthcare<br />Can help streamline processes in all sectors<br />Merely meeting standards for documentation, training, infrastructure, etc cannot ensure improvement in clinical outcomes<br />Can make use of domain expertise in quality systems such as Lean and Six Sigma that have proven improvement in clinical outcomes<br />Can be implemented in all areas – primary, secondary and tertiary care hospitals<br />
  20. 20. Lean in Healthcare<br />Value defined from patient’s perspective<br />Anything that helps treat the patient adds value – anything else is waste<br />ER – cost savings in triage and primary nursing time<br />OT – Better OT utilisation with improved turnover efficiency<br />Nursing station – better organisation leads to prevention of overstocking<br />Medical records – reduction in processing time<br />Laboratory – Improved turn-around time<br />
  21. 21. Six Sigma in Healthcare<br />Statistically based process improvement methodology<br />Used to reduce the sources of variation found in any process <br />Billing<br />Physician practices<br />Patient treatment<br />Patient triage<br />Use of technology<br />Laboratory results<br />
  22. 22. Six Sigma in Healthcare<br />Reduced blood stream infections following urinary catheterisation in ICU and SICU<br />Improvement in “take-home” baby rate for infertility patients<br />Reduced insulin errors and improved patient safety by implementing tight glycaemic control without inducing hypoglycaemia<br />Reduced incidence of patient falls<br />Reduction in hospital- acquired or nosocomial infections<br />
  23. 23. Quality of Outcomes - Patient<br />Definition of quality as given by the Institute of Medicine <br />“The degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge” <br />Desired outcome from the patient’s perspective would be a relief from the disease or better quality of life after treatment<br />
  24. 24. Quality of Outcomes - Organisation<br />Outcomes in <br />financial returns<br />patient satisfaction<br />customer retention<br />error rates <br />clearly improved after implementation of various quality systems in healthcare organisations <br />
  25. 25. Need of the Hour<br />Deficiencies in quality of care represent neither failure of professional compassion nor lack of resources<br />They result from <br />gaps in knowledge<br />inappropriate applications of available technology<br />inability of organisations to change<br />To improve quality of healthcare<br />Quality must be defined and measured<br />Appropriate steps must be taken to implement quality<br />
  26. 26. ASQ and you<br />Healthcare<br />
  27. 27. ASQ and You in Healthcare<br />Lean for Healthcare<br />Six Sigma for Healthcare<br />Yellow belt<br />Green belt<br />Malcolm Baldrige Performance Excellence Programme for Healthcare<br />
  28. 28. Thank You<br /><br />