Accreditation with NABH, JCI etc and its impact on the sustainability of hospitals, India. Sustainability of hospitals is a major challenge and this presentation deals with the various challenges faced by hospitals and the impact of accreditation on the challenges.

1. ACCREDITATION AND SUSTAINABILITY OF
HOSPITALS
DR. LALLU JOSEPH
QUALITY MANAGER
CMC, VELLORE

2. GUN OWNERS VS DOCTORS
 Number of physicians in US = 700,000
 Accidental deaths by physicians/ year = 98,000
 Accidental deaths/ physician per year = 0.14
 Number of gun owners in US = 80,000,000
 Number of accidental gun deaths/ year = 1500
 Accidental deaths/gun owner =.0000188
Doctors are approximately 7500 times more dangerous than gun owners

3. ODDS OF DYING…
 In a plane crash 1:29,000,000
 In a car accident 1:5000
 In a medical error 1:300

4. WHERE DO WE STAND …
 Safety processes fail routinely
 Hand hygiene not taken seriously
 PPE usage not adhered to..
 Medication administration errors
 Patient identification errors
 Surgery on wrong side, wrong patient or body part
 Retained objects
 Fires
 Wrong gas connected

5. FALSE CEILING FALL
 A 42 year old lady undergoing Laparoscopic
hysterectomy.
 A tile from the false ceiling of the OT falls on her hands
and she sustains fracture of the lower end of radius

6. ABNORMAL VALUES
 Lab Investigations of fasting and postprandial blood
sugar show higher readings.
 Many patients were put on anti-diabetic drugs.
 Complaint by one of the affected individuals who got
the investigations done from another lab that showed
correct values.

7. BURNS SUSTAINED BY BABY
 Four month old baby for cardiac surgery at 7.30 am
given bath by night duty nurse at 5.30 am as part of
pre-op preparation.
 Nurse checked the temperature of the hot water with
her gloved hands by pouring water on her gloved
wrist.
 Baby sustains burns.

8. WRONG PROCEDURE
 Two ladies both named Nirmala were to be taken up
for surgery in OG OT.
 One for D&C and the other for a cervical ligation to
prevent mid – trimester abortion.
 Procedures got reversed.

9. THE PRACTICE OF MEDICINE WAS
SIMPLE

10. BUT TODAY……
INDIA WANTS TO KNOW……

12. Power outage at Puducherry
hospital kills 3 dialysis patients
Fire at AMRI Hospital
Kolkota, kills 92
22 Killed in SUM Hospital,
Odisha
Doctors operate on the
wrong leg of 24 year old
15 hospitalized with wrong
drug given before sterilization
2 stuck in MRI machine for four
hours

13. TODAY…..THE PRACTICE OF MEDICINE
IS HIGHLY COMPLEX
“HEALTHCARE ORGANIZATIONS ARE
THE MOST COMPLEX TO MANAGE……”
PETER DRUCKER

15. CHALLENGES- HOSPITALS
 Medical negligence, patient safety and litigations
 Increasing expectations of patients
 Healthcare expenditure
 Lack of skilled manpower and staff attrition
Sustainability- capacity of organizations to be able to
withstand the challenges and variations over time,
through a process of continuous improvement

16. ACCREDITATIONSUSTAINABILITY??

17. MEDICAL NEGLIGENCE AND LITIGATIONS
Healthcare has to move towards becoming High Reliability Organizations (HROS)
 High reliability is the consistent performance at high levels of safety over
long periods of time (Chassin, Loeb 2011)
 Nuclear power plants, aviation industry, space - failure to perform can mean
death (Engineers vs Doctors– Believe anything can go wrong vs nothing will
go wrong)

18. Safety culture
Focus is on patient and staff safety-
HH, HAI, PPE usage, safety checklists
etc…
Focus on reliability Audit safe practices
Seek to know Focus on staff training
Share learning
Incident reporting, analysis and
communication
Break down the silos and
encourage team work
Protocols and accountability,
appropriate communication between
team members
ACCREDITATION AND HRO

19. IMPACT OF ACCREDITATION- PATIENT SAFETY
 Mousa Al Shammari et al., “Impact of Hospital‘Accreditation on Patient Safety in Hail
City, Saudi Arabia: Nurses‘Perspective” Journal of Nursing and Health Science 2015,
51-55
 JCI accredited hospital, 200 respondents, found positive impact of accreditation
on patient safety, HAI; nursing documentation; and medication management
 Hinchcliff et al., “Narrative synthesis of health service accreditation literature” BMJ
Qual Saf 2012,0. 1-13.
 Reviewed 122 empirical studies, highlights relationships among
accreditation, high quality organizational processes and safe clinical care.

20. INCREASING EXPECTATIONS OF PATIENTS
Accreditation stresses on
 Communication with patients
 Attending to the needs
 Rights of patients
 Clean environment, ambience
 Patient feedback, complaint handling

21. IMPACT OF ACCREDITATION- PATIENT EXPECTATIONS
 Haute Autorite de Sante , “Literature review on the impact of hospital accreditation” Matrix
Knowledge Group, 2011
 56 articles included in analysis. “positive relationship between accreditation and improvement in
the management, professional practice within hospitals”
 Mona et al., “The impact of the status of hospital accreditation on patient satisfaction with the
Obstetrics and Gynecology Clinics in the Eastern Province, Saudi Arabia” Journal of Medicine and
Medical Sciences, 2012, 665-673
 420 patients responded. Patients at the accredited hospital were more content with the quality of
health care, professionalism, indicated higher overall satisfaction

22. HEALTHCARE EXPENDITURE
Accreditation focusses on
 Appropriate use of resources
 Reducing wastage, energy efficiency, expired items by
systems and accountability
 Management of equipment
 System efficiency and improving productivity-
discharge process, waiting time etc.

23. IMPACT OF PM AND CALIBRATION 0N BM
• Study by Dr. Lallu Joseph & Mr. Arul Prakash
• Based on 8 years data taken from BMEsoft
• Data split into two parts; before calibration (2007-2010)
and after (2011-2014)
• Electrosurgical units, Ventilators, Defibrillators, Infusion
Pumps and ECG Machines were taken

24. BREAKDOWN IN PERCENTAGE
0
50
100
150
200
250
300
350
400
450
500
2007 2008 2009 2010 2011 2012 2013 2014
Percentageofbreakdown
Year
Infusion
Ventilators
Defibrillator
ESU
ECG
Breakdown of
• Electro Surgical Units (ESU)
reduced from 453% in 2007 to
54% in 2014
• Ventilators decreased from
455% to 140%
• Defibrillators reduced from
116% to 29%
• ECG from 183% to 77%
• Infusion devices reduced
from 379% to 196%

25. JCI STDY- JORDAN
 Results demonstrate statistically-significant improvements in the JCI-
accredited hospitals on 3 indicators
 Return to ICU within 24 hours of discharge
 Staff turnover per year
 Completeness of medical records
Total annual savings per accredited hospital = $87,600

26. STAFF ATTRITION
 Enhances staff development
 Enhances staff education and
learning
 Develops leadership qualities
 Motivated team players
 Responsibilities defined and more
responsible
 Satisfaction with the work
environment
 Forum to address their grievances
 Communication is effective
 Feeling of belongingness and
ownership

27. ACCREDITATION- KEY TO SUSTAINABILITY
 Continuous improvement
 Culture change
 Better outcomes
 Measure and manage
 Accountability
 Discipline

28. Systems awareness and systems design are important
for health professionals, but are not enough. They are
enabling mechanisms only.
It is the ethical dimension of individuals that is
essential to a system’s success.
Ultimately, the secret of quality is love.
You have to love your patient…., you have to love
your profession, you have to love your God.
If you have love, you can then work backward to
monitor and improve the system.
Avedis Donabedian