Quality in healthcare refers to adhering to predetermined specifications and standards to meet patient needs. Over time, quality practices evolved from craftsmanship to focusing on processes through thinkers like Shewhart and Deming. Donabedian introduced structure-process-outcome measures for assessing quality. National and international organizations like JCAH, ISO, and NABH were formed to standardize healthcare quality. NABH accreditation involves an application process, onsite assessments, and meeting standards in areas like patient care, management, and information systems to certify high quality care.

2. Quality means “degree of excellence” and
depends on what the person perceives in a
particular situation.
In scientific terms, the simplest meaning of
quality is, “the degree of adherence of a
product or service to the predetermined
specification.

3. The American quality practices took place in
the 1800s as they were moulded by the
changes in the dominant production methods
like:
Craftsmanship : maintained the form of
quality by inspecting the goods before sale.
The factory system : quality was assured
through the skill of labourers, regular audits
and inspections
The Taylor system : Taylor’s aim was to
increase productivity without increasing the
number of skilled craftsmen. He attained this

4. The beginning of the 20th century marked the
addition of “processes” in quality practices. Walter
Shewhart, a statistician for Bell Laboratories, started
to focus on controlling the processes in mid-1920s.
He made quality relevant for both the finished
product and the processes that created it.
Edward Deming introduced the concept of Total
Quality Management (TQM) which was implemented
in the healthcare industry.
Dr. Avedis Donabedian introduced the three
measures called the Structure, Process and
Outcome which emphasised the value of looking at
the three measures while monitoring and assessing

5. The birth of the modern concept of quality
management in healthcare took place in 1918 when
the American College of Surgeons began the
Hospital Standardisation Program giving the criteria
and standards for accreditation of the hospitals.
The Joint Commission on Accreditation of Hospitals
(JCAH) was started in 1952 which published the first
accreditation standards and was made mandatory
for all hospitals to obtain the JCAH accreditation
standards.
In 1947, the ISO was started with the objectives of
facilitating international coordination and unification
of industrial standards.

6. UNIT OF QUALITY IS
PROCESS
PROCESS
PROCESS ……

7. According to Joint Commission on
Accreditation of Healthcare
Organisations (JCAHO), quality is defined
as “the degree to which health services
for consumers increase the likelihood of
the desired health outcomes and are
consistent with the current professional
knowledge.”

8. The International Organisation for
Standardisation (ISO) defines quality as
“the totality of features and
characteristics of a service that bear on
its ability to satisfy the stated and
implied needs of the patients.”

9. In the context of health services the stated needs
can be
availability,
accessibility,
appropriateness,
effectiveness,
efficiency
affordability
of the services to the community.
Quality is achieved when the needs and
expectations of patient are met.

10. Difference in Accreditation & Certification
 Accreditation
 It is a procedure which
an authoritative body will
give a formal recognition
to a healthcare
organisation.
 Certification
 It is the action performed
by a third party agency to
verify if the product,
process or service will
fulfil all the particular
needs of the pertinent
standards, technical
regulations or other
normative acts that are in
force.

11. Accreditation
 It is a formal
recognition of
competence which is
based on proven
technical knowledge
and so requires
certification of the
technical expert for
the scope to be
accredited.
 NABH
 JCI
Certification
 It involves making
sure that the
organisations conform
to a given set of rules.
 ISO

12. Quality initiatives in India
Quality assurance in healthcare in India was initiated at the
Academy of Hospital Administration (AHA) for the first time
which prepared a comprehensive manual for the accreditation
of hospitals in 2005.
The National Accreditation Board for Hospitals and Health
Care providers (NABH) was established in 2006. It is an
accreditation system which believes in patient-focused
approach targeted at improvement in the process of delivery
of care. It lays down certain quality standards and certifies the
quality of outcome based on the conformity to prescribed
standards. So, the accreditation by NABH is a certification of
the level of quality treatment given to patients, that is, the
patient care services and not just a certification of the
existence of quality system.

13. Quality Council of India (QCI)
QCI was set up in 1997 jointly by
Government of India and
3 Premier Indian Industry Associations
1. Associated Chambers of Commerce
and Industry of India (ASSOCHAM)
2. Confederation of Indian Industry (CII)
3. Federation of Indian Chambers of
Commerce and Industry (FICCI)

16. National accreditation board for hospitals &
healthcare providers (NABH) is a constituent
board of Quality Council Of India, set up to
establish and operate accreditation programme
for healthcare organisations. The board is
structured to cater to much desired needs of the
consumers and to set benchmarks for progress
of health industry.
.

18. PROCESS OF ACCREDITATION
Initial Application including
Self Assessment as per the laid
down standards
Screening of the Application
Pre assessment survey
Assessment survey

19. PROCESS OF ACCREDITATION
Accreditation committee
Recommendations
If required Verification
Visit
Approval of Accreditation
by the NABH
Re-assessment Surveys

21. Benefits for Patients
 Patients are the biggest beneficiary
 Results in high quality of care and patient
safety.
 The patients are serviced by credential
medical staff.
 Rights of patients are respected and
protected.
 Patients satisfaction is regularly evaluated.

22. Benefits for Hospital Staff
 The staff in an accredited hospital is
satisfied lot as
 it provides for continuous learning,
 good working environment, leadership
and
 above all ownership of clinical processes.
 Improves overall professional development
of Clinicians and Para Medical Staff &
provides leadership for quality
improvement with medicine and nursing.

23. Benefits for Hospital
 Improve quality of health care
Patient safety and risk management
Evidence-based practice
Continuous learning and improvement
Continuous Quality improvement
 Stimulate and improve integration & management
of health services
 Reduce variation in care and health care costs
 Strengthen the public’s confidence in the quality of
health care
 Helps demonstrating commitment to quality care
 It also provides opportunity to healthcare unit to
benchmark with the best.

24. A quality philosophy accompanies the definition of
quality and a set of guidelines for quality
management of a healthcare organisation.
Healthcare services must have a patient- centric
philosophy which has a definite vision, mission,
and values in the task of delivering services to
patients.
Healthcare services must function according to its
philosophies and must aim to provide service in a
manner that respects patient rights.
It is also important for healthcare services to
maintain high standards of service through a

25. A standard must be a level of performance
that is agreed in advance and it must be
measurable.
A healthcare must have realistic and
achievable standards in relation to the
available resources.
When a standard is not measurable, it is
divided into parts that are measurable. These
measurable parts are called criteria and give
the actual measurements of quality.

26. The standards and objective elements for valuation by
NABH have been set in the following 10 areas particularly
the clear intent of standards:
Patient Centred Standard
o Access, Assessment and Continuity of Care (ACC)
o Care of Patient (COP)
o Management of Medication (MOM)
o Patient Rights and Education (PRE)
o Hospital Infection Control (HIC)
Organisation Centred Standards
o Continuous Quality of Improvement (CQI)
o Responsibilities of Management (ROM)
o Facility Management and Safety (FMS)
o Human Resource Management (HRM)
o Information Management System (IMS

27. CONTENTS
Chapter
Standards
Objective Elements

28. NABH SCORING
Scoring on a scale of 0, 5 and 10
Compliance to the requirement : 10
Partial compliance to the requirement : 5
Non-compliance to the requirement : 0
Not Applicable : NA
Evaluation criteria:
 Regulatory / Legal Requirements : No - 0
Average Score
 Individual Standard : not < 5
 Total Score for all standards : > 7
 Individual Chapter : not < 7

30. NABH Requirements
 Data documentation of 64 Quality Indicators for
at least 6 months. (Basic Data then Analysis of
data)
 Quality manual &Department wise policy
manuals.
 Hospital Committees – Minutes of meetings
 Inter-Departmental meetings documentation
 Compliance of structure, process, outcome &
statutory requirements
 Mock Drills – Fire , CPR , complete Evacuation
 Medical Audits
 Continuous Quality Improvement
 Display of Citizen Charter

31. CONTINUOUS QUALITY IMPROVEMENT
 Part of the management of all system and process
 Achieving the highest of performance
 The process of continues improvement must
contain regular cycles of planning, execution and
evolution

32. QUALITY IMPROVEMENT CYCLE
Plan Do
CheckAct
Quality
hospital
Hospital
CQI
Accredit
Accredit
QA/
Standard
RM