Quality Matters

Quality management today occupies a significant position in hospitals

Dr Aninda Chatterjee

With healthcare coming under the purview of the Consumer Protection Act, 1986, the doctor-patient relationship built on mutual trust has assumed the status of service provider-customer relationship. One objective which every customer does have in mind when he hires a service provider is to get 'value-for-money'. Value-for-money is a product of quality and unit cost. Cost is something which cannot be fully controlled as it is guided by a lot of external forces, like cost of capital, raw material cost, competitors pricing policy etc. Hence, it is quality alone which can be controlled to a great extent in our endeavor to deliver value-for-money.

The Boon of NABH

The key question is—how could a customer be assured of credibility and trust that the services being offered are as per the stated standards while conforming to minimum basic professional standards required to deliver the stated and implied quality? The customer has the right to ask questions and only one answer that can satisfy all questions is accreditation. What is accreditation? It is 'a public recognition of the achievement of accreditation standards by a healthcare organisation, demonstrated through an independent external peer assessment of that organisation's level of performance in relation to the standards'. While some Indian hospitals have already achieved accreditation from different bodies, both international and from the domestic terrain, lot more are in the process of getting accredited under the National Accreditation Board for Hospitals & Healthcare Providers (NABH).

Benefits of NABH

• Prominent display of services together with proper staff orientation has resulted in better customer awareness and handling by the front office and public relation staff.
• An appropriate mechanism for transfer or referral of patients who do not match organisation resources have helped not only in preventing unnecessary admissions but also ensured that serious patients are not neglected due to bed shortage and get safely referred to facilities which match their clinical requirement.
• Certain aspects of safe medical care like use of safe blood and blood products, safe storage and dispensing of medications have been enhanced leading to decrease in post transfusion reactions and drug errors.
• The greatest beneficiary has been probably hospital infection control, like sharp decline in the infection rate, post operative wound infection and ventilator-associated pneumonia.
• The continuous thrust on quality improvement across the organisation has resulted in pushing up the quality benchmarks even in the non-core and neglected areas. This has further augmented the performances of core departments like clinical and diagnostic services.
• Abundant improvement has been created in maintenance of medical records in terms of their completeness, accuracy, timeliness and preservation techniques.

Adoption of Balanced Score Card

The Balanced Score Card (BSC) emphasises that the financial and non-financial aspects must be a part of the information system for employees at all levels of organisation. The BSC translates a business unit's mission and strategies into tangible objectives and measures. Though many organisations had clear cut business missions and visions, yet they could not be translated into fruitful results, owing to lack of proper policies and guidelines. The BSC thus brings about the following benefits:

• It helps hospitals to make an in-depth study of all their processes, include new processes and delete those processes which were contributing to non performance.
• The processes are not only aligned to the business needs, but also have certain measurable indices attached to them so that the performance of each process could be monitored.
• It has improved the employee engagement index, training, development of existing employees as well as induction of fresh talents in the organisation every year.
• This has led to continuous improvement in internal processes like medical process excellence, nursing process excellence, leading to reduction of mortality, morbidity and infection rate.
• It has also led to cost optimisation of each individual procedure, thus helping to offer competitive package to customers.

Implementation of Six Sigma

Six Sigma is one of the most popular quality methods used lately. It is the rating that signifies best-in-class with only 3.4 defects per million units of operations (DPMO). The concept works and results in remarkable and tangible quality improvements when implemented wisely.

Six Sigma recognises that there is a direct correlation between the member of product defects, wasted operating costs and the level of customer satisfaction. In short, Six Sigma is a method to eliminate defects. It utilises a statistical unit of measurement to measure the capability of the process, then achieve defect-free performance, and ultimately increase the bottom line and customer satisfaction. The working of Six Sigma is based on five activities of define, measure, analyse, improve and control (DMAIC).

Few hospitals in India had the courage of going ahead and trying to implement Six Sigma in certain departments. Departments where customer satisfaction and profitability are directly related to cycle time and material use have benefited the most from Six Sigma. Six Sigma as a process has helped to reduce OPD waiting time, door-to-needle time for indoor admissions, optimal utilisation of under used facilities like cath lab, CT scan and MRI machines. It has also helped in optimising inventories, thereby reducing incidences of blocked finances or crisis purchase.

The implementation of Six Sigma happens in four phases:

Phase 1: Key problems areas are identified and quantified.
Phase 2: Potential product or process improvement solutions found and quantified.
Phase 3: Multi-functional teams improve key process.
Phase 4: Improvements are implemented and monitored.

With Six Sigma, many hospitals which are following various types of accreditation, process improvement techniques and adopting a minimum defect approach have immensely benefited in terms of brand enhancement, better market positioning, employee engagement, optimum resource utilisation and profitability.

The writer is Medical Superintendent BM Birla Heart Research Centre Kolkata
E-mail: anindachatterjee@hotmail.com