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‘Simplicity, Cost-effectiveness & Ease Of Implementation Will Make NIAHO Popular’
Spurred by emphasis on standards, quality and medical tourism,
health accreditation is gaining popularity in Indian hospitals. And to cater
to the surge in demand are a basket of accrediting bodies-JCI, JCAHO, NIAHO
and ISO 9001 to choose from. US-based TUVHS is an accreditation firm engaged
in accreditation of hospitals under NIAHO-ISO standards. Recently, its officials
had come down to Mumbai to do a gap-analysis for Asian Heart Institute (AHI),
which will soon apply for JCI. TUVHS's CEO Rebecca J Wise and Senior
Project Manager Ashit Dalal told Rita Dutta about the demand for
various accrediting bodies and why some are more popular
How different are JCI, JCAHO, NIAHO and ISO 9001 from each
other? Please give a brief background of each of these accreditations.
Rebecca: JCI and JCAHO are very similar, as Joint Commission
in the US has developed these standards. While JCAHO is typically applicable
in the US, JCI is an international version of JCAHO (toned down version) and
can be applied to any country.
NIAHO is again an international standard developed by TUVHS in the US and is
based on ISO 9001:2000 framework, which is the generic standard for Quality
Management System (QMS), developed by International Organisation for Standardization,
Geneva. It is by far the most popular QMS standard in the world with about 7,00,000
certifications worldwide. NIAHO is the actual standard for healthcare developed
by healthcare professionals with several decades of relevant experience. Since
it has ISO 9001:2000 as its key framework, it integrates System and Process
(Plan-Do-Check-Act) based approach of ISO with clinical and medical processes
that one sees typically in any healthcare and hospital environment. In short,
it brings together the best of both the worlds.
Which is the most popular accreditation system and why?
Is popularity country-specific?
Rebecca: It is a tricky question and depends from what
perspective you are looking. From the US perspective, JCAHO is the most popular
as the Center for Medicaid and Medicare Services (CMS) makes it mandatory for
US hospitals to get accredited by JCAHO (Joint Commission). JCI being an international
arm of the Joint Commission is getting popularity outside the US and especially
in India. However, outside the U, especially in Japan and EU, ISO 9001:2000
is still being commonly applied as Healthcare Quality Management System Standard.
NIAHO is relatively new, but due to its simplicity, cost-effectiveness, ease
of implementation and close interdependence with ISO 9001:2000, it is gaining
popularity in the US. In the years to come, it will also become popular in India
and other countries too.
Do you think that the Indian hospitals are ready for international
accreditations, which are expensive? After all, only Apollo Hospitals, Delhi
and Chennai Wockhardt Hospitals have acquired JCI and AHI is going through pre-assessment
analysis for it.
Ashit: Yes, absolutely. India for whatever reason never
had a formalised quality system framework, unlike the US, till recently. However,
with the medical tourism growing at rapid pace, international accreditations
like ISO-NIAHO and JCI have become the need of the hour. Expensive is a relative
term again. When one sees the tremendous benefits and value-add that these accreditations
bring onto the table, the cost of implementation and accreditation will be far
outweighed by the benefits (such as enhanced patient satisfaction, lower infection
control, improved patient safety, reduction in medication errors etc). In addition,
tapping the medical tourism boom in itself will demand sine-quo-nun need for
accreditation.
NIAHO is relatively new, awaiting US government's approval.
Do you think that it is going to pick up fast? If yes, why?
Rebecca: Yes. CMS is close to approving NIAHO and is
expected to accord final approval by the last week of June 2006. As such there
are already about 25 hospitals accredited in the US in the last three to four
months. Once CMS approval comes in June this year, the number of accreditations
is expected to grow to more than 500 in next 12-18 months in the US alone. Even
in India, there has been a lot of interest from large hospitals to acquire ISO-NIAHO
certification.
With so many accreditation systems, how should a hospital
shop for the best for them?
Ashit: Hospital has become an industry, which has very
complex clinical and other support processes (like EHS, Facility Management,
IT etc.) Patient safety and infection control are two key areas that one can
improve with properly implemented Quality System Standard, be it JCI or ISO-NIAHO.
Selection of the appropriate accreditation is contingent on the overall value
and objectives, cost and internal requirements of the healthcare organisation.
Should a hospital go for a basket of accreditations, rather
than only one? How will that help?
Ashit : It is dependent on what a hospital is overall
looking for and what its business and internal requirements are. I feel starting
with one set of accreditation (based on overall cost-benefit) system is the
most cost-effective approach. For instance, a hospital can surely go for ISO-NIAHO
based system to begin with. And once they get accredited, they can go for more
expensive JCI type accreditation since with ISO-NIAHO in place, it is very easy
and cost-effective to implement JCI, if required. In addition, hospitals that
already have either ISO 9001: 2000 (like AHI) or JCI (like Wockhardt Hospital),
it is very easy to implement NIAHO at marginal cost.
It is a known fact that most hospitals prepare themselves
for getting accreditation, but once they achieve it, they are negligent towards
maintaining the quality standards. How do we address such issues?
Ashit: It is the question of commitment of the hospital
senior management and staff towards providing quality healthcare to their patients.
That commitment and philosophy will drive the entire initiative and not just
having a certificate on the wall. AHI is one such brilliant example of this
kind of unparallel commitment, which we can see right from CEO to the lower
most level. Being an Indian, I am very proud to say that hospital like AHI has
one of the best patient safety and infection control standards in the world.
This cannot just come from accreditation to ISO or JCI or NIAHO, but also requires
an exemplary commitment of the senior management and the entire staff to achieve
this kind of success.
A lot of people believe that ISO 9001 is the stepping stone
to JCI. Please comment.
Ashit: As I have mentioned, ISO 9001:2000 is the generic
standard that can be applied to any organisation including healthcare. Using
that as the foundation, one can build any other system like JCI or NIAHO. However,
I want to further add that it is easier to get accredited to NIAHO than JCI
if the hospital already has ISO 9001:2000 accreditation. As a matter of fact,
to get NIAHO accreditation, ISO 9001:2000 accreditation is mandatory, while
there are no such requirements if you are just seeking JCI accreditation.
In India, JCI is picking up because of emphasis on medical
tourism. Do you see other international accreditation systems also gaining equal
popularity in India?
Ashit: Your observation is partly true. Till recently,
JCI (based on JCAHO) has been the only known healthcare-specific standard internationally
apart from generic ISO 9001:2000. However, with the advent of NIAHO, which is
getting a lot of attention and popularity in the US, scenario shall change soon
and you will see (especially those already accredited to ISO or are in the process
of acquiring ISO) may soon start adopting NIAHO.
In the face of international accreditation systems coming
to India, do you think that indigenous accreditation formed by QCI and CII-IHCF
will stand a chance?
Ashit: QCI is the governing body for accrediting registrars
that provide ISO accreditation services; JCI and NIAHO are healthcare industry-specific
international standards from different organisations and are not governed by
QCI accreditation.
A lot of auditors in healthcare accreditation don't have
experience in healthcare. So, what is the ideal qualification for an auditor
of accreditation in healthcare?
Rebecca: We are going to accept only those people as
the auditors who are doctors or with MHA degrees and relevant healthcare background.
Non-medical professionals without proper healthcare background will not be able
to qualify to audit or certify hospitals. In addition, to become a NIAHO auditor,
the healthcare professional must have completed recognised (IRCA or RABQSA)
Lead Auditor Course in ISO 9001:2000 and also completed requisite training in
NIAHO, which we shall start offering soon in India.
Please tell me about TUVHS and your plans for Indian operations.
Ashit: TUVHS is the part of Global TUV Group. TUV is
a reputed accreditation body and registrar with excellent operations and large
number of clientele in India. We shall work closely with their Indian operations
in providing these services to Indian healthcare industry. However, overall
programmes of ISO-NIAHO accreditation will be managed by TUVHS, US.
rita@expresshealthcaremgmt.com
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