Quality in Healthcare and Accreditation

What is quality?

Consistent delivery of a product or

according to expected service
standards.
 Health care involves three main groups of people

„customers (patients), employees (service providers) and
the managers that interact in the provision of healthcare.
The customers (clients) satisfaction was made the focus of

all operations with managers and employees working together
as a team of decision-makers and providers.
Defining Quality:
 According to ISO 9000:-
Quality is defined as „the degree to which a set
of inherent characteristics fulfills requirements‟.
•It is both objective and subjective in nature.
 According to WHO:-
Quality of care is the level of attainment of health
systems‟ intrinsic goals for health improvement
and responsiveness to legitimate expectations of
the population.
Quality of care is:
 Doing the right things (what)
 To the right people (to whom)
 At the right time (when)
 And doing things right first time
Quality Assurance:
Anything you do to measure (assess) or improve quality
can be considered as Quality Assurance
Five Approaches to Defining
Quality:-
1. The Transcendent Approach.
2. The Product-based Approach.
3. The User-based Approach.
4. The Manufacturing-based
Approach
5. The Value-based Approach.

TQM in a hospital and Healthcare
Organizations
Doing it right every time requires that every one in the

organizations is aware of the need for TQM and is equipped
with it. This involves that the personnel are qualified and
have necessary knowledge, skills and attitude.
Key concepts for TQM:-

 Defined and specific quality policies and objectives.
 Strong customer orientation.
 All the activities necessary to achieve these quality policies

and objectives.
 Organizations wide integration of the activities.
 Clear personnel assignments for quality achievement.
Specific vendor-control activities through

quality equipment identification.
Defined and effective quality information

flow, processing and control.
ISO 9000 Standards and Health Care:-
The ISO 9000 standards approach may be useful to consider in
designing quality control systems for certain health care
“production” services, such as laboratory, radiology, and food
services.
• Over 90 countries.
• Industrial standards to facilitate international

coordination and unification of standards.
• The primary ISO standards deal with manufactured

products and set basic rules for quality systems
"Hospital
Accreditation"
Process in creating collective organizational commitment of
Quality improvement,
Organizational analysis,
Self-assessment,
Strategic formulation of
the organizational
development planning,
Human resources
development,
Team work and service
systems focusing on
patient-oriented
mindedness.
What is Hospital
Accreditation?
"The Hospital Accreditation" approach is a concept
and practice that yields beneficial results to patients,
customers, hospital personnel, the hospital, the Faculty
of Medicine, the society and the country as a whole.
History
In 1917, the American College of Surgeons established

a set of minimum standards for hospitals.
In 1951, the American College of Surgeons joined with
several other professional associations to form the Joint
Commission on Accreditation of Hospitals.
Thirty years later, this voluntary accrediting body changed
its name to the Joint Commission on Accreditation of
Healthcare Organizations to more accurately reflect its scope
of health services evaluation
In addition to hospitals, the body evaluated long-term care

facilities like,
•home health agencies,
•hospices,
•clinics,
•pharmacies,
•managed care organizations and,
•health care networks.
JOINT COMMISSION INTERNATIONAL
ACCREDITATION (JCIA)
* Experience in accrediting health care organizations in

U.S, the Joint Commission on Accreditation of Healthcare
Organizations initiated the development of an international
accreditation program in 1998 and was fully implemented in
late 1999.
The JCIA standards, organized according to either
patient care functions

or
management functions.
BENEFITS TO
ACCREDITATION
1. BENEFITS OF PATIENTS:-
 Continuity of care & Safe transport
 Pain management & Focus on patient safety
 Patient satisfaction is evaluated
 Rights are respected and protected
 Access to a quality focused organization
 Credentialed and privileged medical staff
 High quality of care
 Understandable education and communication
2. BENEFITS FOR THE STAFFS:-
 Improves professional staff development.
 Provides education on consensus standards.
 Provides leadership for quality improvement within medicine

and nursing.
 Increases satisfaction with continuous learning, good working

environment, leadership and ownership.
3. BENEFITS FOR THE HOSPITAL:-
 Improves care.
 Stimulates continuous improvement.
 Demonstrates commitment to quality care.
 Raises community confidence.
 Opportunity to benchmark with the best.

4. BENEFITS TO THE COMMUNITY:-
 Quality revolution
Disaster preparedness
 Epidemics
Access to comparative database

Indian Scenario:-
NABH is a constituent board of Quality Council of India

(QCI), set up to establish and operate accreditation
programme for healthcare organizations.
NABH is an Institutional Member as well as a member of the

Accreditation Council of the International Society for Quality
in HealthCare (ISQua).
NABH is the founder member of proposed Asian Society for

Quality in Healthcare (ASQua) being registered in Malaysia.
NABH is a member of International Steering Committee of

WHO Collaborating Centre for Patient Safety as a nominee of
ISQua Accreditation Council
Objectives of NABH:-
 Enhancing health system & promoting continuous

quality improvement and patient safety.
 It provides accreditation to hospitals in a non-

discriminatory manner regardless of their ownership,
legal status, size and degree of independence.
Emerging healthcare quality scenario in India:
PERIOD QUALLITY ACCREDITATION
MANAGEMENT
SYSTEM
1980’S Healthcare does not need what it is and why?

it, more of an industrial
requirement
1990’s A fad of few, let us try, no Yes, but not so relevant to

harm Indian healthcare system
2004’S A useful tool, must for a Required urgently

well run organization, RED ALERT SOUNDED
good for marketing too.
Important questions considering accreditation:-
 What sectors of the health system should be accredited—

hospitals, ambulatory and primary care facilities, or both?
 Should both public and private sectors be included?
To what extent should community representatives participate on

accreditation boards or survey teams?
Should the accrediting bodies be governmental or nongovernmental
organizations?
Should accreditation surveys be scheduled or “surprise visits” or

both?
Assessment of the Need for Quality
Evaluation:
 Maintain quality
Improve quality
 Ensure public safety
Establish entry level requirements and legal recognition
Verify that design or maintenance specifications are met
Document special capability as an organization

or health care professional
 Risk management
 Implementation of new delivery settings
 Address national public health issues
 Allocation of limited resources
 Create centers of excellence
 Formation of new systems or networks of services

Approaches Used in Conducting an Accreditation Survey :
 Leadership interviews
 Clinical and support staff interviews
 Patient and family interviews
Observation of patient care and services provided

Building tour and observation of patient care areas,
building facilities, equipment management, and diagnostic
testing services
Review of written documents such as policies and
procedures, orientation and training plans and
documents, budgets, and quality assurance plans
Evaluation of the organization‟s achievement of specific

outcome measures (e.g., immunization rates, hospital-acquired
infection rates, patient satisfaction) through a review and
discussion of monitoring and improvement activities.
 Review of patients‟ medical records.

Conclusion:
 Systems of health care service delivery, political processes of health

care reform and methods of quality assurance vary through out the
world.
 Proposals for quality improvement should be comprehensive,

to include accreditation, licensure, and certification.
 Voluntary accreditation was considered the most reasonable approach

such that client participation is stimulated and that standards are
promoted and established.
The accreditation process would be most effective if it were
designed by and adapted to the needs and resources of
individual countries
Accreditation would be a valuable quality assurance approach not

only in hospitals, but also all health care institutions within the
system of services.
Licensing should remain the responsibility of the state, which is

legally authorized
The focus of certification would be better placed in assuring

quality of care, rather than creating competition between
professionals.

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What is quality?

Consistent delivery of a product or

 Health care involves three main groups of people

The customers (clients) satisfaction was made the focus of

•It is both objective and subjective in nature.

 To the right people (to whom)

 At the right time (when)

 And doing things right first time

2. The Product-based Approach.

3. The User-based Approach.

5. The Value-based Approach.

Doing it right every time requires that every one in the

Key concepts for TQM:-

 All the activities necessary to achieve these quality policies

 Clear personnel assignments for quality achievement.

Specific vendor-control activities through

Defined and effective quality information

• Industrial standards to facilitate international

• The primary ISO standards deal with manufactured

In 1917, the American College of Surgeons established

In addition to hospitals, the body evaluated long-term care

* Experience in accrediting health care organizations in

patient care functions

 Improves professional staff development.

 Provides education on consensus standards.

 Provides leadership for quality improvement within medicine

 Increases satisfaction with continuous learning, good working

 Stimulates continuous improvement.

 Demonstrates commitment to quality care.

 Raises community confidence.

 Opportunity to benchmark with the best.

Access to comparative database

NABH is a constituent board of Quality Council of India

NABH is an Institutional Member as well as a member of the

NABH is the founder member of proposed Asian Society for

NABH is a member of International Steering Committee of

 Enhancing health system & promoting continuous

 It provides accreditation to hospitals in a non-

1980’S Healthcare does not need what it is and why?

1990’s A fad of few, let us try, no Yes, but not so relevant to

2004’S A useful tool, must for a Required urgently

 What sectors of the health system should be accredited—

 Should both public and private sectors be included?

To what extent should community representatives participate on

Should accreditation surveys be scheduled or “surprise visits” or

Establish entry level requirements and legal recognition

Verify that design or maintenance specifications are met

Document special capability as an organization

 Implementation of new delivery settings

 Address national public health issues

 Allocation of limited resources

 Create centers of excellence

 Formation of new systems or networks of services

 Clinical and support staff interviews

 Patient and family interviews

Observation of patient care and services provided

Evaluation of the organization‟s achievement of specific

 Review of patients‟ medical records.

 Systems of health care service delivery, political processes of health