Improving Healthcare Quality In India

Quality in Healthcare – Winds of Change
Dr Annabel DSouza Sekar
MBBS, MBA, DBA (Switzerland)
Consultant – Healthcare, ASQ India

Present Scenario

Indian Healthcare Scenario
Unequal distribution of healthcare resources
Lack of strict regulation
Rising costs
Wide inequity in healthcare
Gender inequality
High cost of imported equipment

Change from government sector domination to private sector in the last 20 years
Large affordable middle class
Medical tourism on the rise

Revolution in India over the last decade
Increasing public awareness and private investment in healthcare
Complicated cases used to go to government teaching hospitals – now to tertiary care private hospitals
Achievement in quality in many hospitals on par with western standards

The Government Sector
Commonwealth countries – British legacy
Used to be free – now charge nominal amount for higher end investigations like CT / MRI
Health insurance scheme
Tamilnadu, Andhra Pradesh, Kerala, Karnataka
Acceptance of people – ready to pay for quality healthcare
Public private partnership
Gujarat, Bihar, Assam, Madhya Pradesh – Fortis Healthcare and Government Hospitals
Incentives to medical and paramedical staff
Licences to smaller private hospitals to help the government deliver the goods

Quality in Healthcare
India

Quality in Healthcare Today
Domain of a select few
Corporate hospitals
Accreditation – NABH, JCI
Other private hospitals
ISO certification
Quality circles, TQM
NABH Accreditation

ISO Certification
Documentation
No perceptible difference before & after
Marketing tool or strategy
Integrity is a “?”
WHO’s stand on ISO for hospitals

Primary Health Centres (PHCs)
Cornerstone of rural healthcare in India
Targeted population around 25,000
Provides promotive, preventive, curative and rehabilitative healthcare
Also has Siddha medicine unit with a doctor and pharmacy
National Rural Health Mission (NRHM)
Indian Public Health Standards (IPHS)

Accreditation
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

Accreditation
NABH Accreditation
Joint effort between Ministry of Health and the Confederation of Indian Industry (CII)
105 accredited hospitals
447 applicant hospitals
Empanelled assessors, standards, inspection, certification
Separate standards for
< 50-bedded hospitals
> 50-bedded hospitals
AYUSH

Accreditation
JCI Accreditation
International accreditation in 1999
Too expensive ($ 250,000)
Not practicable in our country
Standards are based on US practices, not on Indian practices
19 hospitals accredited as of date

Dimensions of Quality Today
Infrastructure
Hospital acquired infections
Audits
Reactive rather than being proactive

Where we are lagging behind
Quality of the processes
Quality of the clinical outcomes

Quality in healthcare
Developed Countries – USA, UK

Quality in the Developed Countries
Accreditation
Quality of the processes
Lean
Six Sigma
Malcolm Baldrige Performance Excellence Programme
Quality of clinical outcomes
Clinical audits

Role of ASQ in India

ASQ in India - Healthcare
Can help streamline processes in all sectors
Merely meeting standards for documentation, training, infrastructure, etc cannot ensure improvement in clinical outcomes
Can make use of domain expertise in quality systems such as Lean and Six Sigma that have proven improvement in clinical outcomes
Can be implemented in all areas – primary, secondary and tertiary care hospitals

Lean in Healthcare
Value defined from patient’s perspective
Anything that helps treat the patient adds value – anything else is waste
ER – cost savings in triage and primary nursing time
OT – Better OT utilisation with improved turnover efficiency
Nursing station – better organisation leads to prevention of overstocking
Medical records – reduction in processing time
Laboratory – Improved turn-around time

Six Sigma in Healthcare
Statistically based process improvement methodology
Used to reduce the sources of variation found in any process
Billing
Physician practices
Patient treatment
Patient triage
Use of technology
Laboratory results

Six Sigma in Healthcare
Reduced blood stream infections following urinary catheterisation in ICU and SICU
Improvement in “take-home” baby rate for infertility patients
Reduced insulin errors and improved patient safety by implementing tight glycaemic control without inducing hypoglycaemia
Reduced incidence of patient falls
Reduction in hospital- acquired or nosocomial infections

Quality of Outcomes - Patient
Definition of quality as given by the Institute of Medicine
“The degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge”
Desired outcome from the patient’s perspective would be a relief from the disease or better quality of life after treatment

Quality of Outcomes - Organisation
Outcomes in
financial returns
patient satisfaction
customer retention
error rates
clearly improved after implementation of various quality systems in healthcare organisations

Need of the Hour
Deficiencies in quality of care represent neither failure of professional compassion nor lack of resources
They result from
gaps in knowledge
inappropriate applications of available technology
inability of organisations to change
To improve quality of healthcare
Quality must be defined and measured
Appropriate steps must be taken to implement quality

ASQ and you
Healthcare

ASQ and You in Healthcare
Lean for Healthcare
Six Sigma for Healthcare
Yellow belt
Green belt
Malcolm Baldrige Performance Excellence Programme for Healthcare

Thank You
http://asq.org.in

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Improving Healthcare Quality In India

by ASQ India on Oct 16, 2011

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Improving Healthcare Quality In India — Presentation Transcript