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‘ICHA Is An Accreditation System That India Can Identify With’
Today, Indian healthcare organisations are waking up to international
accreditation. The Indraprastha Apollo Hospital in New Delhi and Wockhardt Hospital
in Mumbai, last year secured Joint Commission International Accreditation (JCI)
and now Asian Heart Institute in Mumbai too is gearing up for it. In the country,
associations like CII-IHCF and QCI are working towards forming National Accreditation
Board for Hospitals and Healthcare Providers (NABH). Parallel to this initiative,
is the formation of Indian Confederation for Healthcare Accreditation (ICHA),
a national accreditation body.
Dr Akhil K Sangal is the CEO of ICHA , a management
adviser and an accredited management teacher in General
Management, in addition to being a practicing medical
doctor. Over the last 30 years, he has acquired in-depth
experience in all healthcare systems and sectors, both
in India and abroad. In an interview with Falaknaaz
Syed, Dr Sangal discusses ICHA’s objectives,
its operational plans and emphasises its importance.
Please brief me about ICHA.
ICHA is an association of national associations / institutions
of all stakeholders in healthcare. The basic objective of ICHA is to create
a mechanism to establish validated excellence in healthcare through a comprehensive
healthcare accreditation system.
It was envisaged that a widely held, consensus-based organisation
be developed with synergy of all concerned with healthcare. It is a non-political
organisation driven by professionals with actual healthcare providers at the
core to take the lead. The organisation is an autonomous, not-for-profit, but
self-sustaining institution that encourages volunteering. The initial funds
have to come from various sources.
When did you start work towards creating ICHA?
Appreciating the current realities and situation, coupled
with the learn’t experience from the world over of development and establishment
of Healthcare Accreditation Systems, a participative approach was chosen. It
was decided through a series of progressive interactive meetings beginning August
2002, that an autonomous body of all stakeholders be formed.
The National Associations of Physicians (API), Surgeons (ASI),
Anaesthetists (ISA), Ophthalmologists (AIOS), Pharmacists (IPA), Hospital administrators
(AHA), Hospital Pharmacists (IHPA) were the initial members of ICHA, however,
as of now all the major associations of all stakeholders have either joined
in, or decided to join.
The ICHA register may be seen on the ICHA web page- www.indmedica.com
/ icha for updated details of associations and institutions / individuals /
organisations.
While the national associations are the voting members, individual
organisations are enrolled as affiliates. This structure not only ensures credibility
but also encourages apolitical contributions by all stakeholders.
How many members does ICHA have so far on board?
As on date we have 23 National Associations (of across the
board stakeholders) as members, 4 affiliate associations, 12 Individual organisational
affiliates and 179 individual affiliates. We have also “Friends of ICHA”
who contribute as donation.
By when will ICHA be operational?
ICHA is already operational. We are focusing on the plan of
action in three phases. Phase I will strengthen the organisation by enrolling
all stakeholders, awareness campaigns, fund raising and building databases.
Phase II will focus on content building, which includes training, guidelines
and standards development. Phase III will entail accreditation implementation.
The major work so far has been on Phase I. The work on Phase II is also underway.
Quality improvement is the primary agenda. This requires convinced
and committed participation by all. Also given the nature of healthcare and
diverse stakeholders, it takes much longer to bring people on board. Even the ‘good’
hospitals in the developed world take two and a half to three years to get ready
for accreditation. The major part of this time is invested in bringing people
on board and also recording the current situation.
How will you ensure transparency in ICHA?
The structure of ICHA has been so built that it ensures
transparency. In fact, that is what takes the longest. However, given
the current situation in India as below, the greatest need is to create awareness
and build trust.
Review of literature and experience of Indian situation
points to: -
- All pervasive felt need for improving healthcare
delivery in all its dimensions.
- General lack of awareness about the above worldview
of accreditation, with perceptions bordering on the negative.
- India with its vast reservoir of expert resources
has a unique advantage.
- There are areas of excellence, which need sharing
and evolving a consensus.
- Mistrust is rife.
The key issues that need to be addressed thus are: -
- Widespread awareness, creation to establish trust
- Finalisation of consensus based guidelines for successful
implementation. This would also ensure committed participation to the maximum
possibility.
What should be the government’s role?
The government can facilitate by providing resources, having
appropriate infrastructure, providing corrective mechanisms and so on. By virtue
of its power and authority, it can promulgate acts and regulations. However,
acts and regulations can only ensure the minimum (if at all, and only when the
acts and regulations are wisely written and implemented properly). But is the
minimum sufficient? The simple answer is – we all want more than minimum;
we all want quality care. Thus, the government’s role is both crucial and
“necessary”. But it is neither “sufficient” nor “enough”.
There are several bodies already working towards developing
a national accreditation system. Besides, several hospitals
prefer ISO and a few corporate hospitals are waking
up to international accreditation. Is ICHA really required?
In all countries there have been a multiplicity of systems.
Perhaps it is a matter of choice or an evolutionary process. There are
also different agendas. For instance ISO had its origins in the manufacturing
sector to streamline and standardise the production process. Even the automotive
sector, evolved its own system which was later adopted and incorporated by ISO.
Similarly, NABL in India was established for all laboratories - Clinical laboratories
being a small subset of the whole range. Similarly many of the initiatives are
piecemeal or local. The all-inclusive ICHA model envisages to integrate t hese
and hope as greater realisation dawns, they would join in.
Some corporate hospitals have sought and received international
accreditation for several reasons - one being absence of a credible system in
India. They have gone in for this despite high costs - out of reach and not
cost effective for Indian hospitals. Another driving force has been “Medical
Tourism” now rechristened as “Medical value travel”. However,
international accreditation does not guarantee patients coming in e.g. JCI accreditation
does not assure that HMOs will send American insurance beneficiaries to India.
Yes, ICHA is required very much so for the long-term evolution
of the Indian Healthcare delivery and ultimately the health status of Indian
society. We need to collect and collate data to build evidence of proven innovative
practices in India, which are not recognised presently due to lack of evidence.
Most of the Indian systems have suffered immensely due to the lack of evidence
based data and hence are presumed to be conjectural.
So, how different is ICHA from other accreditation bodies
being developed?
ICHA model is of a comprehensive accreditation system on lines
of worldwide accreditation systems with global acceptance. The primary agenda
is excellence in care and patient safety as is evident from ICHA logo and mission
statement. The accreditation award is an outcome or by-product of this content
based excellence. We all need to work to achieve the objective of patient centred
healthcare leading to lasting improvements in the health status of the nation
and also get integrated with the world. Everybody can participate in and contribute
to ICHA as an Individual or Organisational affiliate or “Friend of ICHA”.
Don’t you think a collaborative effort by all these
agencies is required to build one accrediting system for the country rather
than having so many accrediting systems and rating agencies?
Yes, I agree a collaborative effort would be ideal and that
is what is envisaged in ICHA. The structure of ICHA reinforces this vision.
I am sure progressively most would realise this and start contributing to ICHA
objectives. Let me reiterate that many of the efforts at present are towards
licensing and badging or certification.
When these are called accreditation it only tends to bring
bad name to accreditation and is to be a “Stick to beat with”. Let
us all understand that accreditation derives its strength from credibility,
which comes from content and that depends on competence for which capability
is necessary; available in plenty and our greatest strength. Let us capitalise
on it. True accreditation is the process of third-party validation that indicates
that healthcare delivery systems accredited conduct their activities with integrity,
deliver outcomes that justify public confidence and demonstrate accountability
for the effective use of public and private funds and achieve set standards
in the process.
falak@expresshealthcaremgmt.com
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