‘Accreditation should recognise facilities for quality patient care’

By a Special Correspondent - Pune

There exists many challenges in the development of accreditation system in India, in the form of different ownership of healthcare organisation, wide variance in health infrastructure, plural medicine practices, wide differences in economic status of states and their health budgets, unregulated growth of hospitals and nursing homes. Accreditation process should therefore be dynamic, creatively structured and should be adopted,” said Major General N K Parmar, commandant, Command hospital, Kolkata while delivering the keynote address on the occasion of a two-day national conference on Grading, Rating, Accreditation, Certification and Evaluation of Healthcare Facilities (GRACE) held between 24 to 25 September, 2005 at Armed Forces Medical College (AFMC), Pune.

The conference aimed at discussing the various attempts to standardise the hospitals across the country at the level of primary, secondary and tertiary care so that healthcare services can be planned to meet the consumer’s needs and demands. Over 500 delegates attended the conference.

According to Col M Dayananda, professor and head, dept of hospital administration (DHA), AFMC, Pune, “The conference was instrumental in converging opinions of various stakeholders- the clientele, hospital owners, hospital administrators, clinicians, health economists, government representatives, NGOs, insurance agencies and Third Party Administrators (TPAs), which is essential in evolving a system and process of grading, rating accreditation, certification and evaluation.”

Said Lt Gen R Rai, director general, medical services (Army), “With mushrooming of hospitals across India and with many of them adopting a business like posture, it has become necessary to develop objective standards for evaluation of hospitals to ensure quality in healthcare.”

Echoing the same view, Lt Gen M P Jaiprakash, director and commandant, AFMC, Pune, said, “Rapid growth of knowledge and technology with their associated skill requirements, popularity of evidence-based practices, changing customer preferences, increase in number of profit healthcare facilities, growth of insurance sector are some of the changing paradigms that have impacted the healthcare delivery system of Indian hospitals. It has therefore become mandatory to develop suitable mechanisms for their credible evaluation through an accreditation system.”

Lt Gen M P Jaiprakash is seen lighting the lamp, while Col M Dayananda and Lt Col S Basu clap

Speaking on the subject of structural standards for accreditation of hospitals, Lt Col S K M Rao, joint director, Medical Services (Hospital Projects), Dte General Medical Services (Army) pointed out, “JCAHO in its recent policy document had identified physical environment and patient safety as the priority areas. Similar recommendations have been made by the Centre for Enquiry into Health and Allied Themes (CEHAT).” Said Lt Col S Basu, organising secretary of the conference, “The term accreditation is a vehicle for systematic external review of the physical facilities, policies and procedures, managerial system and results, which are indicators of quality patient care.”

Different methodologies for total quality management of products and services have been accepted throughout the world. “Standardising agencies like ISO, ISI, FPO and rating agencies like ICRA and CRISIL certify other services. Future hospitals in India are bound to take the shape of industry and therefore cannot rely on providing mere arbitrary services and products. Some western countries have developed their own certifying agencies. These agencies have developed their own standards, process of evaluation of standards, accountability systems, review mechanisms etc,” added Dr Basu.

Speaking on the subject of Medical Audit: Historical Perspective, Major General M Srivastava, additional director general, office of DGAFMS, Ministry of Defence, New Delhi, said, “There is a need to introduce topics on medical audit at graduate/ post graduate level in medical curriculum for sensitisation, if one wants to bring grading, rating, accreditation, certification and evaluation in healthcare facilities across the country.”

Speaking on The Impact of Judicial Activism and Legislative Efforts in Providing Quality Healthcare, Dr S K Jawahar, administrative medical officer, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, said, “There are no prescribed standards which are enforceable for Indian hospitals. In this context, it is worthwhile to explore the impact of judicial activism and legislative efforts in providing quality healthcare. It includes the debate on whether hospital is an industry, decisions about the negligence of doctors in treating patients, The Consumer Protection Act, 1986, Biomedical Waste Management Rules, 1998, The Transplantation of Human Organs Act, 1994, The Indian Medical Council Act, 1956, Bombay Nursing Home Registration Act, 1949 and the similar decisions and legislations in the health sector.”

Speaking on the subject of “Standard Operating Procedures in Hospitals- A Reality Check”, Dr Sona Bedi, chief medical officer, ESIC, NOIDA informed that adoption of quality care is mandatory in healthcare delivery. ‘There is a need to demonstrate those quality measures undertaken by healthcare organisations which are validated by experts in the field of quality evaluation. While the developed nations are far ahead, India is still in infancy for quality healthcare.”

Speaking on the “Role of Healthcare Grading in Quality Evaluation”, Dr Shyama S Nagarajan from ICRA said, “ICRA and the Hospital Services Consultancy Corporation India Limited (HSCC) have jointly developed a unique methodology for grading healthcare institutions.”